Foot Doctor of Rappahannock, Ltd.
12010 Kilarney Drive
Fredericksburg, VA 22405
Welcome to the Foot Doctor of Rappahannock, Ltd. Our priority is to deliver quality care to informed patients in a comfortable and convenient setting. We have been working with patients since 1986 to provide the best podiatric care for patients in the
When you have problems with your feet, you need to turn to a podiatrist who listens and responds... an experienced doctor who knows the field and can effectively diagnose and treat your needs ...a friendly physician who counsels you on the best ways to maintain and improve your health. Our physicians meet all these criteria. Our website provides you with background about our physicians and staff. You benefit from a dedicated team of trained professionals who give you the individual attention you deserve.
At the Foot Doctor of Rappahannock, Ltd., we believe that informed patients are better prepared to make decisions regarding their health and well being. Because we want all our patients to be informed decision makers and understand any health issues you may face, we've included an extensive section on our website covering the full array of topics associated with podiatry and podiatric diagnoses and treatments. We encourage you to use this information whenever you have an interest or concern about your feet.
Comfortable, Convenient Setting
The best care in the world doesn't mean anything if you can't access it. At the Foot Doctor of Rappahannock, Ltd, we strive to make our
office as efficient and convenient as possible. Included in our web pages is information about the Foot Doctor of Rappahannock, Ltd's office including our
office location, maps, directions, hours, insurance policies and appointment scheduling procedure.
About the Practice
Dr. Ilene S. H. Terrell is board certified in foot surgery by the American Board of Podiatric Surgery. She provides conservative as well as surgical management of foot and ankle ailments for children, teens, adults and seniors, including diabetic patients.
Dr. Ilene S. H. Terrell has been practicing in the
area since 1986. She has maintained Board certification in foot surgery since 1995. Dr. Terrell maintains privileges at Mary Washington hospital and the
. She has served as chairman of the Podiatry department at
Dr. Ilene S. H. Terrell attended the Pennsylvania College of Podiatric medicine and the Surgical Residency programs. She is committed to providing the highest level of care, taking the time to explain your ailment and address your concerns. She believes that ongoing training and product knowledge assists her in her efforts to remain current with new trends in podiatric medicine and surgery.
The ankle bone (talus) and the ends of the two lower leg bones (tibia and fibula) form the ankle joint, which is stabilized and supported by three groups of ligaments. Muscles and tendons move the foot and ankle.
More than half the women in
have bunions, a common deformity often blamed on wearing tight, narrow shoes. Bunions cause the base of your big toe (Metatarsophalangeal Joint) to enlarge and protrude. The skin over it may be red and tender. This can be acquired through time or it can be congenital (you got it from your family)
Wearing any type of shoe may be painful. This joint flexes with every step you take. The bigger your bunion gets, the more it hurts to walk. Bursitis may set in. Your big toe may angle towards your second toe, or even move all the way under or over it. The skin on the bottom of your foot may become thicker and painful.
Pressure from your big toe may force your second toe out of alignment, sometimes causing it to overlap your third toe. If your bunion gets too severe, it may cause be difficulty in walking. Your pain may become chronic and you may develop arthritis.
Most bunions can be treated conservatively with wider & softer shoes, pads to relieve the pressure and/or medications. If this does not help then surgical treatment is indicated.
Bunion surgery, or bunionectomy, realigns the bone, ligaments, tendons and nerves so your big toe can be brought back to its correct position and the bump on the inside of the joint removed. Many bunion surgeries are performed on a same-day basis (no hospital stays) using a local anesthesia. During your recovery it is common to have pain and swelling. This swelling and stiffness may be persistent for several months.
The average person, engaging in non-strenuous activity, walks approximately 4 miles every day or about 115,000 miles in a lifetime.
What is Neuropathy?peripheral nerves. Peripheral nerves are the nerves that branch out from the spinal cord and connect the brain to all parts of the body. Peripheral nerves are fragile and can be easily damaged by many factors such as systemic illness, infections, alcoholism, autoimmune diseases, exposure to toxins and injuries or fractures. Neuropathy affects more than 2 million Americans at any given time. Diabetes is one of the most common causes of neuropathy.
No matter what caused the neuropathy, the symptoms are the same. Neuropathy initially manifests itself as a tingling in the toes which gradually spreads up the feet or hands and worsens into a burning pain. The sensations, whether tingling or pain, can be either constant or periodic. A person with neuropathy can also experience muscle weakness or numbness.
Diabetic Neuropathy Neuropathy is among the one of the most common complications of diabetes. Over time, diabetic neuropathy may occur in up to 50% of diabetics, despite controlling blood sugar. Once it occurs and without treatment, it almost always gets worse.
Diabetic neuropathy usually affects the feet first and then the hands. It starts with sensory changes such as numbness or tingling in the toes. At first these symptoms come and go, but then they become constant. Over a long period of time, the person may experience such a loss of sensation that he might not feel how tight his shoes are, know whether the bath water is hot or cold, or whether or not he has injured himself.
Changes in muscle strength also occur, possibly causing the diabetic to fall or the arches of his feet to collapse. Diabetic neuropathy is the leading cause of ulcerations and infections in the feet, and in advanced cases, amputation.
New testing and treatment has revolutionized care for diabetic neuropathy. The main methods of treatment, until now, have been rigorous control of blood sugar levels, meticulous care of the feet and the use of pain medication. The new testing procedures and specially-developed treatment procedures can slow and even reverse the progress of this.
Testing Procedure Sensory Testing (QST): Neurosensory and Motor Testing (NMT). It will tell the doctor the stage of a person's neuropathy so that appropriate treatment can be done. It also accurately diagnoses other conditions that have similar symptoms to neuropathy so the correct treatment can be performed.
The American Diabetic Association recommends yearly testing for diabetics.
New Treatment for Neuropathy Conservative methods of treatment, such as special shoe inserts, nerve blocks or anodyne treatments (infrared light) can be used when neuropathy is in its early stages. If the neuropathy has progressed to the point where there is numbness and tingling throughout the day and weakness interferes with daily activities, then the person might be a candidate for Oral Medication like Lyrica or a surgical procedure like peripheral nerve decompression surgery. This is particularly suited to the treatment of tarsal tunnel (like carpal tunnel in the wrist but it is in the foot) neuropathy, with about an 80-90% improvement rate. Ideally, surgery is done before there is no feeling left in the nerve and before the condition has worsened to the point of ulcerations.
Peripheral Nerve Decompression Surgery Diabetic & Non-Diabetic Neuropathy: The Theory
Dr. Lee Dellon, Professor of Neurosurgery and Plastic Surgery, John Hopkins University, made the discovery in 1988 that nerves were subject to compression and swelling in areas that were anatomically tight-such as the inside of the ankle thus causing symptoms of neuropathy.
With Diabetic?s there are two reasons why a diabetic's nerves are subject to compression. The first reason is the propensity of a diabetic's nerves to swelling. Sugar from the blood enters into the nerve to give the nerve energy; this sugar, glucose, is converted into another sugar, called sorbitol. Sorbitol's chemical formula makes it attract water molecules and water is drawn into the nerve causing the nerves in a diabetic to be swollen. If a nerve swells in a place that is already tight, then the nerve becomes pinched, or compressed.
The second reason is related to the transport systems within the diabetic nerve. It is believed that proteins are transported to the nerve to keep it functioning normally. This mechanism does not work well in diabetics because of compression on the nerve in the nerve tunnels. The flow of proteins to repair the nerve is impeded. Opening the nerve tunnel allows the flow of proteins to resume.
In the case of non-diabetic neuropathy, the neuropathy may or may not be caused by swelling nerves, but is thought to be caused by tight nerve tunnels. Surgery may be effective in many cases where the neuropathy is unrelated to diabetes. Success rates in non-diabetic neuropathy are equal to those in diabetic neuropathy patients.
Peripheral Nerve Decompression Surgery: What to Expect The surgery that is done for neuropathy is similar to the surgery commonly done for nerve compression in the wrist (carpal tunnel syndrome) and the ankle (tarsal tunnel syndrome). The surgery opens the tight area through which the affected nerve passes by, dividing a ligament that crosses the nerve. This opening gives the nerve more room, allows blood to flow better in the nerve and permits the nerve to glide with movements of nearby joints.
The surgery can be done in a
and takes about one hour, with one hour of recovery. (Times vary for individual patients}
A long-acting local anesthetic will be put into the incisions so that once awake you will feel very little pair, along with numbness in your foot that wears off in 12-24 hours. Many surgical patients have noted restoration of sensation and reduction of pain immediately after anesthesia wears off.
When the nerves that have been "asleep" awaken, you may temporarily experience hot or cold or shooting pain in your toes. This is a good indication of recovery, but there still may be some discomfort to the patient. There is medication available that can help with this discomfort.
How does this type of surgery help diabetic neuropathy? Most recent studies show that 80-90% of those diabetic patients who have had a nerve decompressed have had decreased pain and improved sensory and motor function with improved balance.
The surgery to decompress the nerve does not change the basic, underlying metabolic (diabetic) neuropathy that made the nerve susceptible to compression in the first place. When the surgical decompression is done early in the course of nerve compression and nerve fibers have begun to die, decompression of the nerve will actually permit the diabetic nerve to regenerate or re-grow.
These patients with advanced neuropathy (ulcerations or lost toes} may recover less sensation because damage to the nerve has become irreversible. In this case, a consultation can determine how much help you can get from the surgery .
Hours of work