Best Ways to Treat the Feet

Our feet and ankles are among the most commonly injured parts of our body. There’s a wide range of problems, and thankfully, with the right experts, a wide range of treatment options. Dr. Lauren Geaney, UConn Health foot and ankle surgeon and director of UConn’s orthopedic surgery residency program, describes some of the advances in addressing both common and complex problems. She also discusses her role in educating tomorrow’s orthopedic surgeons, including a narrowing gender gap in the specialty, and shares news of a recent development in UConn’s orthopedic surgery training.

(Dr. Lauren Geaney, Carolyn Pennington, Chris DeFrancesco, January 2022)


Chris: We ask a lot of our feet. There’s a lot going on down there, and a lot can go wrong. Today on the Pulse, we talked to a specially trained orthopedic surgeon about the best ways to address problems with our feet and ankles.

This is the UConn Health Pulse, a podcast to help you get to know UConn Health and its people a little better, and hopefully leave you with some health information you’ll find useful. With Carolyn Pennington, I’m Chris DeFrancesco. Our feet and ankles are among the most frequently injured areas of the body.

Carolyn: And from that frequency comes the need for experts in foot and ankle injuries and disorders. UConn Health has several such experts in its orthopedics and sports medicine practice, and one of them is here with us today. Dr. Lauren Geaney is a foot and ankle surgeon who is also director of UConn’s orthopedic surgery residency program. Thank you for joining us.

Dr. Geaney: Thanks for having me.

Carolyn: So to start things off, give us a sense of just the wide range of foot and ankle problems that are out there that people can suffer from.

Dr. Geaney: It’s interesting because this is what really brought me to foot and ankle surgery as well: the idea that there’s so many different things that we can treat in it, and there’s so much variety and it’s so complicated, which is really challenging for me on a daily basis, and I’m always learning more. But things can range. We talk about with the foot, we have bunion deformities; we have hammertoes; we have tendonitis, including Achilles tendonitis; flat feet; we have high arched feet that can sometimes cause problems; we also have sports injuries, ankle sprains; we have tendon tears that we’ll treat, and then we’ll treat arthritis from the ankle to the foot, to the toes. And those all have different treatments for them.

Carolyn: How about any new advances in any of those treatments?

Dr. Geaney: This is something that’s really exciting in the world of foot and ankle surgery. In the past few years, we’ve really started to look at doing things more minimally invasive. And the idea is not that the surgery is any different, in the sense that to correct a bunion you still have to shift bones over, but doing it through smaller incisions with smaller tools, with the hopes that may be things like wound complications or pain after surgery or swelling after surgery, maybe minimized.

Chris: Minimally invasive surgery as a concept is not all that new to the world of surgery, but it’s becoming newer do certain elements of foot and ankle specifically, right? So bunions is one example you gave. What are the advantages to the patient of having it done this way?

Dr. Geaney: Yeah, so that’s a great question. Depending on different areas of the body and different areas of the foot can range. So specifically to the bunion, cosmetically it looks better. You have a lot smaller incisions. It’s interesting, if you’ve ever talked to somebody that’s had a bunion correction, they will inevitably tell you about the horrible pain, the two or three days afterwards. And it’s funny because I do a lot of complex foot and ankle surgeries and for whatever reason, the bunion surgery is the most painful. And so that’s one area that we’re seeing that the pain isn’t quite so bad. Other areas, so for example, when I do a flat foot reconstruction, there’s a lot of incisions, a lot of potential for wound complications, and when you get incisions too close together, you worry about issues with wound healing. And this way, by making those incisions smaller, we believe we’re going to have fewer wound complications, and injury to nerves are probably little less likely as well.

Carolyn: Are their ideal candidates for the minimally invasive approach?

Dr. Geaney: Really, most people would be candidates for it, but certain situations where you may be at higher risk for an open procedure. So people like diabetics that we know are poorly controlled, and we worry about wound healing and infection, you do it through a smaller incision, and now you have less of those risks. People that have rheumatoid arthritis or are on steroids or certain medications that, again, have those risks for wound complications. People that smoke, we worry about their risk of wound healing. So all those patients may be better served by these minimally invasive surgeries.

Carolyn: Are there people that would not benefit from minimally invasive, should go the other way, the open way?

Dr. Geaney: Sure. Some of the bigger deformities or more three-dimensional deformities, trying to correct things in multiple different planes in directions, can be a little bit more challenging. So there are still patients that have, a certain type of foot or shape a foot that probably will still benefit from the traditional open procedures.

Carolyn: Because a lot of people, when they come in, they have multiple problems, right? Bunions, hammer toes, and then you’re trying to fix them sometimes all at the same time?

Dr. Geaney: Yeah, exactly. Certain procedures, there’s really no way around it, because if you need a plate, we can’t put a plate in percutaneously. So it depends at how we’re going to have to fix these things. Things like fractures, we really have to open them up and realign things. So there are certain things in certain issues that I don’t think we’ll ever really completely switch over to the minimally invasive world.

Chris: Now, Dr. Geaney, one of your colleagues in UConn Health Orthopedics, and Sports Medicine, Dr. Vinayak Sathe, wasn’t able to join us for this conversation. He also does foot and ankle surgery. He mentioned he’s not doing the minimally invasive surgery for the bunions yet, but he is doing it with small joint arthroscopy with nanoscopes, and a couple other things that he’s doing that I want you to help us understand what these mean: major foot reconstruction, sports injuries, and percutaneous Achilles repair. Tell us a little bit about what’s involved with those procedures.

Dr. Geaney: Sure. Going into specifically, we can talk about the percutaneous Achilles repair. And again, this goes back to, can we do the same surgery through smaller incisions? And so this idea, we do this a lot on athletes, and so again, it’s using smaller incisions to do the same job, passing sutures through smaller incisions. And particularly with the Achilles tendon, we worry because the blood flow in the area is just not as good. And so an infection in that area really is devastating, so whatever we can do to decrease the likelihood of that complication. The nanoscope is kind of a new technology that’s come along as well. And essentially, a lot of people have heard or have had friends or themselves have had surgeries that we use the arthroscope, so essentially what that is, is we’re putting cameras into joints to see what’s going on in them. This new technology is just a much smaller one that allows us to do the same kind of surgery, except on the toe joints, other areas, small areas that we weren’t really able to get in safely previously because our equipment was just too big for it. And this allows a little bit more flexibility to get into those smaller areas.

Carolyn: Can we back up just a second and talk about why, like the people that may be having all these terrible foot symptoms, but they don’t really want to come in, how bad does it have to get before they should come see you?

Dr. Geaney: People will often very similarly ask me, “Am I ready for surgery?” And that’s not a question I can answer because in the end, it’s about quality of life. That’s what we do in orthopedics. Sometimes you don’t have a choice; it’s a broken bone or a ruptured tendon, and we have to fix it. But for a lot of these things, it’s about quality of life. And I can’t tell you how big your bunion has to be. It’s, how much is it affecting your lifestyle? And, “I can’t go for a walk anymore because my shoes hurt.” That’s important. And it may not be the biggest bunion I’ve seen, but it’s affecting you. If it’s affecting your lifestyle, if you can’t be as active as you want to, if you can’t go for a walk with your dog, which is something that’s really valuable to you, then it’s time.

Other people will say, “You know what? I never really wanted to run. I don’t really care if I can’t run a mile without hurting. Cause I don’t want to do that. And I’d rather just never run again, then have a surgery or even go to physical therapy.” So really, it’s a matter of quality of life, how much it’s affecting you, and what you’re unable to do because of it.

Chris: You mentioned the physical therapy, which is something I should have asked you about as part of this. Whether it’s minimally invasive or not, there’s some element of that to most of what you treat, right? And does the minimally invasivem maybe make you require less physical therapy as a part of the recovery, depending on what it is?

Dr. Geaney: Physical therapy for a lot of what we do is important both before and after surgery. A lot of times, we can even avoid surgery by doing physical therapy. Achilles tendonitis is a good example of that. Surgery is not easy, no matter what, and then if there’s a 70% chance we can make you better without surgery, obviously that’s the benefit. And what I always say is, even if it doesn’t make your pain go away, No. 1, if it makes it better, maybe it’s more tolerable or it will at least get you stronger so that you’ll have less recovery to do after surgery. Because being non-weight-bearing, which a lot of our surgeries require, you lose a lot of muscle mass. So the better you are beforehand, the easier that recovery would hypothetically be now with postoperative physical therapy. Some of that depends on what we’re doing. I can’t say that we’ve necessarily seen that. Although we’re noticing, and the biggest — I keep going back to the bunions because that’s really where we have the most data on it — and probably a year after surgery, it’s no different, right? Just like I said, your body still has to heal the fact that you broke a bone, it’s still the same surgery we’re doing, we’re just doing it through smaller incisions. So where we’re seeing it is in the soft tissue part of this. You have less of an incision, so probably less swelling, less pain for sure we’re noticing. And if you have less swelling, you can move things quicker, and that stiffness early on is less of a problem. So while we haven’t necessarily seen less need for physical therapy, I am — and of course, this is anecdotal — at least in my practice, people are moving sooner and their early recovery is easier.

Like I said, a year out, probably, and I have patients who’ve had both sides and now they’re at year, they say, “I like ’em both.” But that early first few weeks, it was certainly a lot easier with the minimally invasive.

Chris: I would love to talk with you, before we let you go, Dr. Geaney, about your role as the orthopedic surgery residency director, a program, you went through yourself after graduating from this medical school, and now you’re in charge of it. So how do you see yourself kind of fitting into the continuum? Especially as we try to get more women in orthopedic surgery?

Dr. Geaney: I’ll tell you the hardest thing about that was calling people by their first name that I’ve been calling doctor for 12 years. So it’s been a really interesting journey and it really something that I really value, and it’s been exciting for me to see it. And I think one of the biggest changes we’re seeing is just, as you said, getting more women into orthopedic surgery. It’s great that there’s been certainly a bigger focus on this, really at the national level. Our national orthopedic association has really put a big emphasis on, “Where are the problems? Why is this a problem?” and try and identify how to make it better. But I think that we’ve had a really great push here at UConn. A lot of thanks to Dr. Kathy Coyner, who’s one of my partners and she’s really spearheaded this effort, but we have seen a difference. In fact, last year of our UConn students, we had five women applying it to orthopedic surgery, and normally we only have four to five students total going into orthopedic surgery and every single one of them was a female this past year. They did so well, and I’d be happy to have any of them as one of our residents. So I think that that’s a testament to what Dr. Coyner is doing, and the fact that we’re all recognizing this and we’re trying to make it a more inclusive environment, where you don’t need to be able to bench press whatever to do the job. I mean, I always say it’s more about leverage than about strength.

Carolyn: Oh, that was the big excuse, right? “Oh, you have to be…”

Dr. Geaney: Right, to bang a hammer. But yeah, and it really, it’s been exciting to see how the mindset has changed.

Chris: So compared to that to when you were looking into residency programs, like how rare of a bird were you?

Dr. Geaney: I was, there were two of us here at UConn at the time. I can’t give you, I mean, even now the percentage, only 14% of residents are women. It’s going to take a long time for us to really tap into that because you know, only about 9% of faculty are full-time orthopedic surgeons are women.

There are so many more of them. It’s going to take a lot more cycles of women coming through residency to really tackle that number there. But I remember the advice I got when I was doing my away rotations was, “Don’t cry and don’t get pregnant,” because that’s what they think women do. And so you go in having the burden of trying to work your tail off anyway, to prove yourself, but now you also have to prove that women can also do the job. So it was kind of a double burden at the time. And I was very lucky to have very supportive mentors here, because I have friends that didn’t get that at other places.

Carolyn: Since you are the director, anything else that you can tout about your orthopedic residency?

Dr. Geaney: I think that it’s fun. We get some amazing, amazing students and that’s always the joke: I would have screened myself out when I was looking at the applicants this year, because they’re just so strong and they all are so unique, with such interesting backgrounds that they’ve gone through. It’s not, we don’t see people anymore go from medical school to residency, to fellowship. I mean, people have lives, and it’s, they brings so much more to the table than just, board score. So it’s really exciting. And new excitement for me is that we actually just got approved for a new foot and ankle fellowship. It’s going to be a really great collaboration, not only here, but with Hartford Hospital and some other foot and ankle surgeons in the area. We’re all going to come together, and help develop a curriculum to train foot and ankle surgeons, so that’s really exciting for us.

Carolyn: Congratulations.

Dr. Geaney: Thank you.

Chris: How long has it taken to try to make that happen?

Dr. Geaney: We kinda got together, it was before COVID that we had the idea that this is something that we wanted to do together. And these other surgeons, they’re my mentors, even though they’re at a different hospital, since I trained here, they’re the ones that I’ve used as my mentors through the process. And so the ability to work with them again, it was really an exciting idea. And they really, now that they’re further in, they they miss working with the academic side and doing the research. And so it’s something that they wanted, it was a really good opportunity for me, and so we started thinking about it before COVID, and then things slowed down a bit. But I mean, it’s been, when I look back to my emails, because I had to recently, it’s been over two years to get this approved. And now since when we match, we match fourth-year residents, so it’s gonna be two more years before we get our first fellow. So it’s really a four-year process to get it going.

Chris: Just the latest example of UConn Health as the state’s academic medical center, another level of training for tomorrow’s physicians and surgeons. So that’s outstanding. Dr. Lauren Geaney. Thank you so much for giving us the time today.

Dr. Geaney: Thank you.

Chris: That is our time for today for UConn Health foot and ankle surgeon, Dr. Lauren Geaney, and for Carolyn Pennington I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Be sure to subscribe so you can catch us next time, and please share with a friend.