Welcome to another insightful episode of the Head to Total Podcast! Have you had an injury from skating, running, or some other sport? Afraid you might need surgery? Join us to set your mind at ease as we discuss how surgeries don't always have to be a big deal with Dr. Deepali Darji.
#Fear #afraid #healthcast #podcast #podcasting #Synergy #detroit #Michigan #Foot #Ankle #Injury #sports #skating #bunion #Bone
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Welcome to another insightful episode of the Head to Total Podcast! Have you had an injury from skating, running, or some other sport? Afraid you might need surgery? Join us to set your mind at ease as we discuss how surgeries don't always have to be a big deal with Dr. Deepali Darji.
#Fear #afraid #healthcast #podcast #podcasting #Synergy #detroit #Michigan #Foot #Ankle #Injury #sports #skating #bunion #Bone
Refresh by Roa Music | https://soundcloud.com/roa_music1031
Music promoted by https://www.free-stock-music.com
Creative Commons Attribution 3.0 Unported License
https://creativecommons.org/licenses/by/3.0/deed.en_US
Colleen Young: Hi everyone. Welcome to Head to Total, your favorite podcast that pulls back the curtain on all things medical. Today, our special guest is Dr. Deepali Darji. Welcome, Dr. Deepali Darji.
Dr. Deepali Darji: Thank you so much for having me, Colleen.
Colleen Young: Deepali, there's so many things we want to cover today. First, I want to cover that you are a fellowship-trained podiatrist. Can you let the audience know why people should be looking for a fellowship-trained physician, and in your case, a podiatrist?
Dr. Deepali Darji: That's a very good question, Colleen. In our world of podiatry, we are very similar to medical school. We do four years of schooling and then after that we do a three-year foot and rear foot surgical residency. After that, there is an opportunity to continue extra training called fellowship programs, in which you do additional reconstructive specializations in sports medicine, or even things like minimally invasive surgery. The fellowship is an additional year of surgical training for podiatrists in order to gain more tools in their belt to help patients out.
Colleen Young: It's amazing because when I first met you and I learned a little bit about your training, I was amazed. And then knowing that you had your fellowship, that is just something now that I, as a patient, look for consistently. So, thank you for educating us on that. Most of the time, as a patient, you don't understand what to look for in a physician. And podiatry is such a science that I have come to appreciate over the years, because, as we all know, if you listen to this podcast, my feet are just a mess. An absolute mess.
Dr. Deepali Darji: We got help for you, Colleen.
Colleen Young: Yeah. I could fund your retirement, my friend. But one other thing I wanted to talk to you about is, I've never been a dancer, which is the only reason my feet are so bad is because I try to stuff them into shoes that don't fit well. But I was fascinated that you also teach dance in addition to being a podiatrist. Can you talk to us a little bit about that?
Dr. Deepali Darji: Yeah. Growing up in the Indian community, my mom was obsessed with the Indian dance culture. So my sister and I did an extensive training in an Indian classical dance form, very similar to American ballet, but the Indian version called Apart Natia. So our feet had these constricted bells on them at all times, like a tight tourniquet and then dancing to it, making the rhythm of the music as well. Growing up in that dance form, a lot of ankle sprains, a lot of pains and aches. I myself have bunions, which is painful. That's where my love for the foot and ankle came in. Then I went to school and now I'm podiatrically trained to help other people with their foot and ankle ailments.
Colleen Young: I know that we were talking the other day to our friends over at the Detroit Skating Club, and they have such an interest in you coming up there to talk to them because they've heard and seen on the website some great pictures of you in your dance outfit. They know all about that history, and ice skaters go through a lot of the same things, correct?
Dr. Deepali Darji: A hundred percent. And then the shoe gear that they wear is so important for them to be able to function their spins and their routines. That's even more heightened for some, with kind of foot and ankle pains. My best friend was an ice skater and she did it competitively as well. So she's always messaging me about some foot and ankle stuff, but I'd be honored to go talk to them, meet the team, and just help out and have a conversation.
Colleen Young: I was always under the understanding that skaters also have a lot of ankle problems and ankle stability. What is the difference? Because a lot of people will say, "Oh, I broke my ankle, or I fractured my ankle." What is the difference between a fracture and a break within the ankle?
Dr. Deepali Darji: That's a great question. When you break your ankle, sometimes it can feel like a sprain. You don't really know. It's really the X-ray that tells us that the bone has broken versus a ligament where an MRI is needed to see which ligament is causing this instability. So a lot of the times when patients think they have a minor fall or a tweak or poor shoe gear that caused a twist and turn that just didn't feel right, it's really getting an assessment about the patient's muscle strength. Is there any weakness in a certain area of the ankle? Is there any pain to the bone? Does the X-ray show that the bone is intact? If not, we do some further investigation with an MRI to see if the ligaments are intact. If they're not, and the muscle strength shows weakness in any direction, it gives us a telltale sign that there's some instability and the ligaments need strengthening, almost like a rotator cuff or a knee where you're knitting it back together so it doesn't keep going in the wrong plane. So when you take a walk, you don't feel like you are going to fall again.
Colleen Young: And can you tell us, Deepali, what happens in the case of a total ankle replacement? Is that something you also do? And how does it get to that level?
Dr. Deepali Darji: Yeah. A lot of fellowship-trained podiatrists can be privileged in doing total ankles as well, and it's all patient-dependent. Depending on the ankle pain, a lot of times my patients come in and say, "Hey, I have ankle pain," but really they don't have ankle pain; they have pain under the joint called the subtalar joint. So it really just depends on when the patient comes in. If they're truly painful at their ankle or joint under that ankle—which we don't talk about that joint much, so nobody knows the name subtalar joint—but usually, sometimes that is the pathology. So when they come in, we evaluate them, we evaluate them walking, we evaluate their muscle strength, and then we check, is it really the ankle joint? If it's the ankle joint, the X-ray will tell us if it's end-stage arthritis, like a knee, and when there's an end-staged knee arthritis, the knee gets replaced just like that. An end-staged ankle arthritis gets replaced. The options in the knee world, we don't really fuse knees, but in the options in the ankle world, it's a three-dimensional motion of that ankle joint. There is an option to fuse that joint sometimes as well, depending on the pathology of the patient, which is another tool that we offer our patients for pain relief, depending on how bad the arthritis is and the deformity. A lot of times people have a really severe flat foot or a really severe high arch, and that impacts what their ankle joint looks like. If their ankle joint is not in the correct placement, then the replacement would be hard. They'd have to fix the other deformity for the replacement to even hold. So sometimes there's just a little bit more investigation on knowing exactly where their ankle arthritis comes from..
Colleen Young: Often you hear of people getting a hip replacement or a knee replacement and needing to have it redone. Is there a lifetime warranty on an ankle, or do you have to get that replaced?
Dr. Deepali Darji: There is a shelf life of total ankles, so it all depends on the patient. But the ideal candidate from the original guidelines is an elderly patient with low-impact activity that isn't going to continue, affecting the surrounding bone around the total ankle replacement, because it does have a shelf life. It may need to be replaced, and sometimes needs to be converted into a fusion, which is stiffening of the joint. A fusion can get a bad rep compared to a replacement because people like hearing the word “motion”. But sometimes we have to remember that if the motion is already lost, it can't be magically regained. We can try to save as much motion that's left, if possible. So sometimes it just depends.
Colleen Young: I think one of the questions I'd have if I were preparing for this surgery is, are you doing these in the hospital or at an ambulatory surgery center? We've talked on Head to Toe a lot of times about ambulatory surgery centers, and I love the idea of more personalized attention and going home the same day of my surgery. What's that like when someone comes to you? Do you operate out of an ambulatory surgery center?
Dr. Deepali Darji: Yes, I operate out of both ambulatory surgery centers and the hospital. It can be insurance-dependent. You're allowed to do some of these implants now as an outpatient. It all depends on the patient's comorbidity. Outpatient care is very nice and patients definitely love that. Sometimes, if the patient requires rehab or the insurance requires an extra day of observation, they'd be done at the hospital.
Colleen Young: What's the recovery time from a total ankle replacement?
Dr. Deepali Darji: The recommendation is to start passive range of motion right away, but high-impact weight-bearing should not be started as quickly. Sometimes we wait six to eight weeks, so the patient is either in a cast or a boot that they can take off and continue to move their ankle passively.
Colleen Young: But before that, they start high-impact physical therapy at six to twelve weeks, and there's always physical therapy.
Dr. Deepali Darji: Correct. After a total ankle, mostly after all surgeries, having physical therapy is key because it gets patients over a little speed bump. They have gotten all the tools, they understand where they want to go back to before they were undergoing surgery. Then sometimes there's just some extra scar tissue, edema control, tricks, and tools that our physical therapists have to be able to get the patient back to that person's activity of daily living.
Colleen Young: Here's a question I get emailed a lot: managing expectations. A lot of people think when they talk to us about a total joint replacement, total ankle replacement, everything, they'll wake up and everything will magically be better. They won't have any ankle pain, they'll be able to walk the mall, and do it in stilettos. What can you tell us about the reality of it? Will some people have pain?
Dr. Deepali Darji: Yeah, surgery can be difficult to paint the picture for. Surgeries come with risks and complications. I always ask my patients if they've gotten to the point where they can't perform their activities of daily living and they're in so much pain that they can't do the things they like to do.
Colleen Young: So we talked a lot about a total ankle replacement, but I heard that you also do minimally invasive procedures on the foot and ankle. I'm glad you mentioned having bunions, because as we all know, that's a problem for some of us. What's this minimally invasive bunion procedure?
Dr. Deepali Darji: Great question! Minimally invasive bunion surgery has been around for a while, but technology has improved so much that we can get the best correction possible. It all depends on the type of bunion a patient has, but depending on the type, we have tools to fix the bunion architecture through tiny keyhole incisions or minimally invasive incisions. We don't need to use a large saw blade or plate, and we go in there and recreate the same surgical steps with smaller instruments and cameras. We can correct the bunion from a leaning tower of pizza to being straight again. Patients end up having four poke holes that are stitched up with one or two stitches, if that. In the last five to 10 years, minimally invasive surgery has gotten even better with some of the implants and reproducible JGs. So each time we use it, the correction is consistent. Patients have smaller incisions and better swelling, and can sometimes bear weight on it day one. When you have a big incision that takes two weeks to knit, it takes a while for it to heal, but when it's tiny, it knits up quickly. That's been really nice as a surgeon, being able to see a patient move their toe day one without all that fluid retention or scar tissue even building up.
Colleen Young: I think that's huge for patients to know because most of us have been putting off a bunion surgery because we think it's going to always be, "Oh, I've got to wear a boot and I'm not going to be able to drive and I'm not going to..." And the reputation of bunion surgery is that it's very painful. So, it's safe to assume that when it's minimally invasive surgery, not as much pain and obviously the recovery time is much faster, which is great news for those of us. Can you do that on a Tailor's bunion as well, or is it something completely different?
Dr. Deepali Darji: I love that question. Yes. A Tailor's bunion on the pinky toe is exactly like the big toe where you have the opportunity to also do minimally invasive corrections. And a caveat these days: patients sometimes, depending on their comorbidities, may be able to tolerate hardware versus no hardware. And sometimes on the Tailor's bunion, we even have an option to correct it without hardware, which is really cool because it gives some of our elderly patients that bony prominence they're dealing with. We make a minimally invasive correction and let them walk on it, and the bone actually goes to the spot it wants to go to without recurring that pain cycle or that bump again. So, we do definitely have some different types of procedures for minimally invasive Taylor bunions as well.
Colleen Young: I know you have a long line of patients, so I won't keep you too much longer. Okay.
Dr. Deepali Darji: This is great stuff, I like this.
Colleen Young: It's a lot more fun than what you think it's going to be, isn't it?
Dr. Deepali Darji: Yeah, you're good, you're definitely keeping me on top of it to answer those questions.
Colleen Young: Hey, this is what people are asking about, and I know you do it every day and you do a marvelous job. I've seen the reviews for you on Google. Oh, thank you. People can come see you in Livonia and Warren, and I believe you're going to be in West Bloomfield soon. Yeah, in southeast Michigan, this is the place to be. But I wanted to ask you, when it comes to shoes, right? And I know that you can't make recommendations, but I'm sure you know what I'm going to tell you. If I could wear Ferragamos all day, every day, I would. But is there a brand of shoe that is a little bit easier on those of us that have some foot issues that you talk about with patients? Does that change with the seasons? Or is there really everybody who needs a different brand because everybody's foot is different?
Dr. Deepali Darji: Here's a secret and it's probably going to save a lot of patients some office visits. But the biggest thing is if you take a shoe and if you can bend it in half, it's going to be most likely that the shoe is not doing much of the work and your foot is doing all of the work. And if you take that shoe and you have a really hard time bending in a half, most likely that shoe is doing a lot of the work for you when you're walking in it and your foot is doing a little less of the work, it's taking less of the heat. What I've found is there's many brands that can offer this, but consistently I have found HOKA’s offers this more than others. It's consistently gotten in different types of shoes that have a stiff, supportive sole and allows for the natural gate cycle from equally putting load on the heel to the toe and it's got a little bit of a rocker, so sometimes people have heel pain or big toe pain. It offloads it while they're walking all day long. And I've actually noticed some of the PAs that we work with, they've been using it in surgeries for long cases and they're like, my feet feel great. So it is showing to improve people who've been on their feet for longer too. A lot of the times, custom orthotics in a shoe can make that shoe a little bit better, so sometimes I recommend finding out if custom orthotics are fit for that patient. And sometimes they can be quite pricey. Insurances have a hard time covering them when you're trying to protect your feet from getting worse. But at that time, I think over the counter options, there are a couple of brands like SuperFeet and PowerStep do a good job mimicking something that a custom orthotic would do, something that's supportive and stiff. I think the idea today is memory foam feels good, soft feels good, but sometimes it does the opposite effect and causes more plantar fascitis and more bone pain and more arthritis rubbing. So sometimes we can control that motion of that foot and you can control some of the pain.
Colleen Young: Let me ask you this: I've heard a lot of people talking about this new trend of adding fillers to the bottom of their feet and toes so they can cram them into stilettos. Is there a little bit of padding? Have you heard about people adding fillers, the same fillers you add to your lips, into the bottoms of their feet?
Dr. Deepali Darji: I have heard about it, but in a slightly different manner. So, what ends up happening as we get older, the fat pad on the ball of our feet withers away and becomes atrophied. I have seen many pediatric surgeons successfully inject some fat fillers into that area and sometimes patients avoid surgery because they no longer feel their bony prominence or bunion or toe pain, because now they have that cushion. There is a little bit of a shelf life where it needs to be done quite often, as it gets absorbed quickly. But, cosmetically for the heels, I have not heard about that one yet. However, definitely for the fat pad fillers, I have heard about that. I actually have some colleagues doing it in Chicago and they've had great results; they love it.
Colleen Young: Dr. Darji, here's the thing: Our audience is across the nation, and you being in southeast Michigan, is there a way people can interact with you? Do you have an Instagram? Do you do telehealth? How can somebody who's not local find you and have a good discussion about their feet?
Dr. Deepali Darji: That's a very good question. I do have an Instagram. It's DarjiDPM (D A R J I D P M). I love following patients and a lot of my patients are there too, so definitely go ahead and follow me. Sometimes I post cool cases, with patient permission of course. As for telehealth appointments, the great thing at MendelsonKornblum Orthopedics is we offer same-day appointments. So, if there's anything going on and you want to walk in the same day, as long as our clinic is open at that time, we offer walk-ins, telehealth, as well as an urgent care orthopedic service. So, I urge patients to make an appointment and talk to a specialist about it if they're confused with something happening with their foot.
Colleen Young: I've heard a lot of people stub a toe and think it's just a normal toe stub. They go to the orthopedic urgent care. You review some of the cases and you can see it's not a stubbed toe; the toe is dislocated and that's a bigger problem.
Dr. Deepali Darji: Yeah, we're definitely on call 24/7 with some of the physician assistants, where they directly contact physicians with x-rays or physical exams. A patient comes in with a fracture, tendonitis, or gout, and we review it remotely and give them the best treatment plan until they can come see us as specialists in our clinic, sometimes the very next day or in the days to follow.
Colleen Young: You have just been absolutely amazing and I can't thank you enough for spending time with us. Thank you, Dr. Darji. Everybody can look you up and see some great things that you have done. There's a great video if you haven't seen it. Audience, check out Deepali Darji. She is an outstanding pediatric physician and it has been a privilege to talk to you today. I can't thank you enough.
Dr. Deepali Darji: Thank you so much, Colleen. This was great. It was a lot of fun. I hope to be back soon and talk about some other updated foot and ankle stuff.
Colleen Young: Oh, we're holding you to that. Thank you so much.
Dr. Deepali Darji: Awesome. Thank you.