Archive for the ‘Foot Surgery’ Category

The posterior tibial tendon is located on the inside of your ankle and plays a major role in supporting and maintaining the arch on the bottom of the foot. Due to the high demands of the tendon with every day life, it can result in overuse of the tendon. This overuse is referred to as posterior tibial tendon dysfunction. When this occurs, patients will eventually develop a flat foot deformity and loss of arch height due to the weakened tendon no longer being able to support the arch. This condition is commonly seen in middle-aged women. Those with diabetes also have an increased risk.

The major problem with posterior tibial dysfunction is that it is a progressive disorder. This means that it will get worse overtime. The initial symptoms of the condition are pain and tendonitis; however there is normally no decrease in strength of the tendon or loss of arch at this stage. As it worsens, the tendon will develop tears and the patient will eventually end up with a decrease in the arch height and a flat foot. With early diagnosis, the progression can normally be slowed, or halted, through the use of orthotics, bracing, immobilization and physical therapy. If the dysfunction is left untreated, or progresses, then it may eventually have to be treated with surgical intervention.


–Dr. Colleen Law

We are humbled and honored to be on the ‪#‎ballot‬ this year for ‪#‎Best‬ ‪#‎Podiatrist‬ ‪#‎Charlottesville‬.  Voting is open till 22 June.

Thanks to all our patients who continue to support and appreciate our office.  You all make us all enjoy what we do everyday.…/…/HealthampBeauty


Elaine Allen, DPM joins Blue Ridge Foot and Ankle Clinic
Elaine Allen, DPM joins Blue Ridge Foot and Ankle Clinic

Blue Ridge Foot and Ankle Clinic is pleased to announce Dr. Elaine Allen will be joining our practice. Dr. Allen is Board Certified in Foot Surgery by the American Board of Foot and Ankle Surgery. Dr.  Allen has been actively practicing podiatry and foot & ankle surgery in Virginia and Georgia for 8 years.  She will be seeing patients in our newly built Fishersville office beginning September 14, 2015.

Call our Fishersville office at (540) 949-5150 or schedule and appointment online at Schedule Appointment to consult with Dr Allen on your foot and ankle injury or concern.


Construction Pictures

July 16th, 2014 by Dr.Chang

Work has started on our NEW Fishersville podiatry clinic. Stay tuned for more exciting news and progress pictures.











Construction 10.22.14

Construction 10.22.14

Fishersville Office 10.22.14

Fishersville Office 10.22.14

The internal walls are framed.

The internal walls are framed.

OFFICE 10.13.14.small.2


Walls are going up! 10.8.14

Walls are going up! 10.8.14


August 2014

BRFAA Fishersville Map2

66 Parkway Lane Fishersville, VA


July 2014


July 2014


July 2014




February 11th, 2014 by Dr.Chang

Ingrown nails

One of the more common and less glamorous conditions we see is ingrown toenails.   Sometimes there is an associated infection but many times it is pain along the nail border that brings patients to our office.  Many people suffer with ingrown nails for years not knowing anything can be done.  There is a simple, pain relieving procedure for this problem!   The procedure has been around for many years and most of the time offers a permanent solution.  The offending nail edge is removed.  A chemical is then applied to destroy the root.  This simple procedure is done in the office and requires no down time.  Daily cleansing of the area along with a band aid for 3 – 4 weeks is all that is needed.

Ingrown toenail


April 10th, 2013 by Dr.Chang

          Bunions are enlargements of the joints at the big toe (hallux valgus) or little toe (Tailor’s Bunionette). However, bunionsbunion before are more than just bony protrusions: they are structural abnormalities in the foot, misalignments caused by hereditary factors or lifestyle habits such as wearing narrow shoes, high heels, and tight sporting or dance shoes. The structural change causes the “V” shape, or “valgus” of the big toe, that is marked by an enlarged joint.
          Especially because your feet support the weight and movement of your entire body each day, it makes sense that any sort of disturbance to the structure of your bunionfeet can cause considerable pain. However, the “V”ing of your first toe joint places considerably more stress on the joint than when the bones in the joint connect in a straight line. Bunions can therefore be excruciatingly painful. Luckily, treatment 
and surgery for bunions are highly effective means to limiting your pain and allowing you to return to your daily activities!
          Initial, non-invasive treatments for bunions include side lining your tight-fitting shoes in favor of comfortable, well-fitted footwear (shoes that do not bunch your toes together or cause pressure on your toe joints). Splints and orthotics can also do wonders for repositioning your toes. Bunions caused by arthritis in the joint are treated well by medications that can reduce pain and swelling. If these methods do not improve your foot pain, your podiatrist may suggest surgery, which is a highly effective form of addressing the structural misalignment in your foot.
          The main goal of bunion surgery is to improve your ability to walk and do other activities on your feet. Bunion surgery straightens the structural misalignment of the bones in your foot, decreasing the pressure on the joints. As a result of your surgery, your pain will be drastically improved, if not eliminated.
          Bunion surgery involves work on the soft tissue and/or bone of the big toe joint in order to relieve the pain in the joint, and to restore normal alignment to the joint. Not all bunions are created equally, and, as follows, not all patients with bunions will receive the same sugery. In fact, there are over one hundred kinds of bunion surgery!
Common types of bunion surgery include:
*Removal of the metatarsal head (the part of the foot that is bulging out toward the center of your body). This is called an “exostectomy” or “bunionectomy.”
*Realignment of the soft tissues (ligaments) around the big toe joint.
*Removal of a small wedge of bone from the foot (metatarsal osteotomy), or from the toe (phalangeal osteotomy).
*Removal of bone from the end of the first metatarsal bone, which joins with the base of the big toe (metatarsophalangeal joint). At this joint, both the big toe and the metatarsal bones are reshaped (resection arthroplasty).
*Fusion (arthrodesis) of the big toe joint
*Fusion of the joint where the metatarsal bone joins the mid-foot (Lapidus procedure)
*Implant insertion of all or part of an artificial joint
Bunion after 
          The more involved the bunion is, the more complex the surgery. In the case that the joint is severely deformed, a surgeon may stabilize the re-alignment with wires, stitches, screws, or plates. Depending on your foot misalignment, your surgeon will suggest the optimal procedure for you.
          Bunion surgeries are most frequently conducted as an outpatient operation, and take about one hour. Most often, patients receive local anesthetics with IV sedation (twilight anesthisa). You will be required to have a follow up visit to take your stitches out in two weeks.  In most cases the healing process takes about 6 weeks.
          Unfortunately, there are many distressing myths about bunion surgery that you may find while browsing the internet. Let us help to quell your fears by assuring you that an overwhelming number of bunion surgeries (over 90%!) are successful in relieving pain and properly realigning the joint.
          While surgery can be painful, bunion surgery is no more painful than any other invasive procedure. The greatest cause of pain, in fact, is the swelling after surgery.  Remember that, because your foot is below your heart, it is more difficult for your veins to fight gravity in order to return blood from your foot to your heart. Therefore, the swelling can often throb, and you will have to consistently elevate your foot. Furthermore, your feet have an incredible amount of nerves without much soft-tissue padding around them. The swelling can aggravate the nerves and cause pain. However, in the long run, bunion surgery vastly reduces pain that bunions cause with walking and standing for long periods of time.
          Another myth is that bunions can reemerge after surgery. While reoccurrence is possible, it is not likely. Furthermore, a bunion would come back over time and due to a lack of change in lifestyle and habits that caused your bunion in the first place. Go into the surgery aware of the fact that you will have to stay committed to the health of your feet! Side-lining your high heels and prioritizing comfortable shoes and time for foot exercises will be necessary for the longevity of the surgery.
          Finally, depending on your specific surgery, you won’t necessarily have to take a lot of time off of work. Most patients can return to a desk job after two weeks, and to an active job after two months. Additionally, over 90% of our patients report an amazing decrease in pain and increase in function after their surgeries!
          Depending on the surgery, you may be placed in a surgical boot and able to walk within two weeks of the surgery. With more complex surgical procedures, you may be required to wear a cast or splint, and walk on crutches.
          In order to best maintain the results of your surgery, it will be important for you to continue to be dedicated to the health and wellbeing of your feet. Committing to lifestyle changes, such as not wearing tight shoes and doing prescribed exercises and stretches for your toes and feet, will drastically increase the benefits of surgery, and reduce the likelihood of any future pain.
            Dr. Chang and Dr. Murray to have decades of experience successfully treating and operating on bunions. Remember that treatment and surgeries are most successful when you address and treat your bunion early. So contact us at Blue Ridge Foot and Ankle – we can help you solve your foot pain!
Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!
Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980       (540) 949-5150
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.

Youth and Adolescent Ingrown Toenails

March 13th, 2013 by Dr.Chang

     A large number of young patients visit us for help with their ingrownpainful ingrown toenails. Typically, these children and adolescents are in a considerable amount of pain and discomfort, and have already sought treatment from their pediatrician multiple times. Pediatricians can prescribe oral antibiotics and other temporary fixes, but, ultimately, the most effective and long-lasting treatment comes from an experienced podiatric specialist. Podiatrists are trained in minimally-invasive procedures to treat the vast majority of ingrown toenails, and are able to do so with the best results and the least amount of pain involved.
     An ingrown toenail is a curved nail that grows into skin around toenail borders. Basically, the nail doesn’t fit its border, and the sharp edges of the nail gradually grow into the skin around the nail, irritating the skin. Ingrown toenails start out as tenderness when pressure is applied to the outside of the nails. They lead to redness, swelling, warmth and pain in the skin around the nail. If an ingrown nail breaks the skin, bacteria can easily enter and cause an even more painful infection in the area.
     Ingrown toenails have various causes. Contrary to popular belief, they are more often hereditary than caused by incorrect nail maintenance or clipping, especially among younger populations. Second to heredity, pediatric ingrown toenails commonly result from improperly sized footwear, such as wearing socks or shoes that are too tight, or from repetitive activities, such as kicking and running, that involve repeated pressure on the toes. Causes also include trauma, such as stubbing the toe, having an object falling on it. In more rare cases, ingrowns result from improper trimming such as cutting the nails too short, encouraging the skin next to the nail to fold over the nail. Other nail conditions such as fungal infections or losing a nail due to trauma, certain medications, and a deepening of the nail groove due to obesity, can also cause ingrown toenails.
     A number of highly effective treatment options are available to patients with ingrown toenails. While copious material is available on the Web for home-treatment, such as soaking feet in Epsom® salt, using antibiotic ointment, using ingrown nail medications such as Outgrow®, or cutting the nail in certain ways, these treatments almost always provide only temporary relief from pain: these products do not prevent or heal ingrown toenails. Ultimately, the nail continues to cause problems until a specialist can remove the part of the nail that is causing the problem.
     At Blue Ridge Foot and Ankle, we perform a minimally invasive procedure, removing 15% of the offending nail border. Cosmetically, nails end up looking normal, and healthier, and, more often than not, patients never again have ingrown toenail problems. The key to successful treatment is early intervention and this kind of specialized treatment from your podiatrist.
     Be sure to communicate with your children what Cleaning of a foot.they should expect in the podiatrist’s office, and from ingrown toenail treatment. Ingrown toenail surgeries take place in the podiatrist’s office. Local anesthetics are used to anesthetize the entire toe, which will last for approximately eight hours. Once the toe is anesthetized, there is no pain involved with performing the actual procedure, and the procedure takes only minutes. The nail border, and sometimes the root of the nail, is removed with the treatment best suited for each person’s individual case. The foot is then lightly bandaged.
     Most patients experience minimal pain after ingrown toenail procedures, and are able to resume normal activities after one day, and most do not even need a follow-up appointment. If an infection is present, an antibiotic may be prescribed. In fact, most patients are so surprised by how easy the procedure is that they wish they had come in much earlier to get their ingrown nail problem fixed!
     After the surgery, and in everyday life, proper nail maintenance routines are important to prevent further incidence of ingrown toenails. Be sure not to cut notches into the nail, since they are proven ineffective: notches do not to reduce the tendency for the nail to curve downward. Do not repeatedly trim nail borders, because this will not change the way the nail grows. Do not place cotton under the nail, because it will not relieve pain and can increase the incidence of infection by providing a place for harmful bacteria to grow. Also, remember that foot maintenance is paramount for patients with diabetes or other secondary nerve or circulatory problems. If you or your children have such problems, be sure to consistently seek help from a trained medical specialist for routine podiatric care.
     Ingrown toenail procedures are easy and highly effective; so don’t postpone making an appointment with Dr. Murray and Dr. Chang at Blue Ridge Foot and Ankle. As in the case with most medical conditions, remember that the earlier the symptoms are treated, the more successful the outcome. So visit us at Blue Ridge Foot and Ankle to help you solve your ingrown toenail problems.
     Comment on this post to share your story or contact Blue Ridge Foot and Ankle. We’d love to hear from you!
Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.


Summer Blog Series: Acute Inflammation

July 31st, 2012 by Dr.Chang

Inflammation is your body’s response to injuries, trauma, illness or infections, in which your body tries to increase the blood flow to the affected area. The accumulation of fluids, however, can be painful and result in swelling, increased warmth and redness of the skin, and even bruising. Acute inflammation is the immediate response to trauma, injury, irritation or surgery, and will usually occur within two hours of the event of injury. Note that acute inflammation is different from chronic inflammation, which is more regular, does not always follow a traumatic injury, is caused by a virus or bacteria and therefore treated differently.

Acute inflammation treatment should be responded to with “RICE to the D” therapy: the age old Rest, Ice, Compression and Elevation, mixed with a Diagnosis from your podiatrist, since your podiatrist can best determine the cause of your foot and ankle pain and swelling. Remember to R: stay off your foot or ankle since pressure on it may cause further injury. I: Apply an ice pack or bag of ice to intervals of 15 minutes to the injured area, placing a thin towel between the ice and your skin. Wait for 40 minutes before icing again. Repeat as desired – the more the better! C: you can control swelling with an elastic wrap around the inflamed area, and E: raise your foot or ankle slightly above the level of your heart to reduce the swelling. Your podiatrist may also suggest that you take NSAIDs. With RICE, your symptoms will most likely improve within a few days. If your symptoms persist or worsen, be sure to see your podiatrist to receive a proper diagnosis and care.

With summer now in full swing, many of our patients are excited to get in shape and restart their outdoor exercise routine. Exercise can create a great amount of strain on the body’s bones, joints, ligaments and tendons. During a 10-mile run, the feet make 15,000 strikes. Each strike is at a force of three to four times the body’s weight.

Are you feeling pain when you run?  It is important that you are aware of the difference between typical running injuries and possible symptoms of more serious ailments, such as Peripheral Artery Disease (P.A.D.). Many common symptoms of running injuries are the same as those of P.A.D., so we caution you to treat any discomfort seriously. Common symptoms of P.A.D. include:

  • Painful cramping of leg muscles
  • Numbness, weakness or heaviness in the muscles
  • Toe and foot sores that do not heal

Fortunately, there are easy-to-use, non-invasive diagnostic systems that can be utilized in our office to help identify P.A.D. and determine whether medical or surgical treatment is necessary. These tests can be completed in just 15-20 minutes during a regular office visit.

Please contact us if you would like to schedule an evaluation!


Our feet are susceptible to a variety of injuries and conditions: fractures, flat feet, bunions, ingrown toenails, and the list goes on…and on… Anticipating surgical treatment for your feet can certainly be frustrating, but thinking about the positives of recovering from your injury and being pain free is an important element for a successful surgery and expedient recovery.  First off, if you are reading this blog, chances are you are in the experienced and attentive hands of Dr. Kevin Murray and Dr. Stewart Chang. With years of podiatric care and foot surgery under their belts, you can be confident that they will take great care of you and your feet. On a more personal note, think of the surgical recovery process as providing you with time to regroup and care for your feet, your body and your self. Preparation for surgery can allow for long-term planning of your podiatric health and the recovery process can enable you to enlist the support and care from your friends and family.

That being said, knowing more about your surgery and what to expect after surgery will help you prepare for the process, ensuring a successful and efficient recovery from general foot surgery.  The pointers below will provide guidelines and suggestions for the different steps along the way.


Each individual’s feet, injuries and conditions are unique, and it’s important that you know the basics of your injury and why surgery is the best option for you. Whether you are suffering from an injury or underlying condition, what surgical procedure you will have and the expectations from the procedure are all important questions for you and your podiatrist to answer together. You should also know whether you will have general or local anesthesia during the surgery and about the post-operative recovery room conditions, especially if you have other preexisting conditions (if you are diabetic, for example, note that glucose monitoring is available during surgery).

There is an enormous variety of surgical procedures and healing times for them. Cryosurgery, for example, has a recovery period of two days to a week. Other invasive surgeries can take up to six months or more to heal. This time frame could put a considerable wrench in your schedule and regular daily activities. Be sure to discuss a realistic recovery time frame with your Charlottesville or Waynesboro podiatrist so that you can plan ahead and give your body the proper time to rest.


Preparing for the post-operative phase begins well before your surgery even starts. Consider what care and support you’ll need, such as a drive home from the hospital and help cooking meals or taking showers. Enlist the support of your family, friends or a nurse. You will want to stock up on basic groceries for when you return home and medications you might need for after surgery. Chances are that your movement will be restricted, so you may want to have a bed on the ground floor or in a main room of your house. Having pillows to elevate your foot, a backrest for sitting up, water bottles, writing materials, and a way to keep track of your medications are all helpful post-surgery. You may need to supply yourself with a range of entertainment – a computer and plug within reach, DVDs, magazines, books, and music.

Showering can be challenging after getting surgery, and falls in the shower after surgery commonly lead to damage of the surgical area or additional injuries. Preparing the bathroom and shower area with grab bars and a shower stool may be helpful. You may also want to stock up on plastic garbage bags or purchase a cast protector in order to keep your leg and foot dry while showering. Obtaining a Temporary Handicap Placard from the DMV is possible for post-surgery patients. In most states this requires your physician to complete Temporary Disabled Parking Permit form. You can also download a form from the Virginia DMV.

POST SURGERY: Managing the Pain

After surgery, be prepared for your foot to swell at the incision site. This swelling is due to the increased blood flow in the foot because of the surgery and compounded by the lack of movement in your leg, decreasing your capacity to return blood to the heart. Swelling often causes pain. Since the greatest swelling occurs in the first few days after surgery, it is no surprise that this is also when you will need to pay the most attention to pain and swelling management.

Throughout your recovery process, and especially right after surgery, try hard to stay on top of your pain using a number of strategies. Your foot surgeon may use nerve blocks around the operative site that numb your foot and reduce pain for the hours immediately after the procedure. Your podiatric surgeon will also provide you with a prescription for narcotic pain medications. Be sure to discuss pain medication options with your podiatrist, and know whether your medication is long acting (requiring only 2-3 doses per day) or fast acting (requiring a higher dosage). Because pain medication side effects can include confusion, felling strange, and nausea and vomiting, keep track of your medication intake. Additionally, be aware that these drugs may also cause problems including constipation (which you can counteract with products like Metamucil) and the potential for addiction. Your podiatrist may also recommend that you take non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, Advil, Motrin, or Aleve, after the initial recovery period. Consult your podiatrist before self-prescribing these, as they may have negative effects on bone, tendon and ligament healing. These drugs can also cause stomach irritation, ulcers and kidney problems when taken in high dosages. Drink lots of water with NSAIDs and consult your podiatrist or physician if you are having any such side effects.

Other methods of pain-reduction include foot elevation (prop your foot up 6-18 inches above your heart as you lie down), avoiding activities that require you to keep your foot dangling downwards for long periods of time and using crutches and/or a walker to keep your weight off your foot. If your foot is not in a cast, then place ice in a plastic bag or use a cold pack, applying it to the swelling for 15 minutes at a time. Ice will restrict the blood vessels in your foot, reducing blood flow to the area just enough to help minimize the swelling. Note that you should never ice your foot when it is numb from post-operative drugs like nerve blocks, since your foot will be prone to frostbite.

On top of managing swelling, try to keep your bandages clean and dry in order to keep the incision site infection-free. Consult your local Charlottesville or Waynesboro podiatrist if your foot, ankle or leg turns blue, cold or numb or if you are running a fever or have thigh or calf pain.


Resting up is a full time job and will help your recovery enormously. In the first week to month after your surgery, you will need to be a dedicated couch potato, lying down with your foot elevated. Don’t plan on being productive during post-operative rest! Chances are that you will be woozy from your medications, in pain, and need more rest than anticipated. Just focus on your recovery, allowing yourself and your body the time it needs to be on the mend. In addition to plenty of rest, healing requires your attention to eating well and drinking plenty of water. Additionally, be sure to avoid caffeine, alcohol and cigarettes as these will have negative effects on your healing process.

During the initial bed-ridden period, you can expect generalized soreness and aches, often because of being more sedentary than usual. Movement stimulates blood flow, cycling of oxygen and the removal of toxins from our bodies. Inactivity can therefore cause us to be sore. To counteract this achiness and to stimulate the release of toxins generally prompted by everyday exercise and movement, you can gently stretch, move and massage the non-effected areas of your body with neck, shoulder and arm rolls or by gently twisting your torso to loosen up your abdominal muscles. Do not stretch or massage your legs or feet until your podiatrist tells you it is okay to do so. And again, drink plenty of water and eat oxygen rich foods like vegetables (especially leafy greens) and fruits, in order to help flush your system and to provide metabolic support for your joints.


Once you’ve made it through the post-operative period of being a (healthy and medically sanctioned) couch potato and managed to finagle as many massages out of your family and friends as possible, it’s time for you to start activity again. In this phase, expect to visit the Physical Therapist often as well as your podiatrist for follow up appointments. Since your body has been sedentary while recovering, expect that you will feel slower and a bit weaker than you did before surgery. Work with your Physical Therapist and your podiatrist, pacing yourself with activity and being honest about your level of pain. Be sure that you don’t over-do the rehab process; slow and steady is the name of the game. If you feel like you’re doing too much too soon, speak with your physical therapist and podiatrist to modify your rehabilitation plan. And finally, recognize that your body should set the pace for recovery. Be patient with your feet and continue to be responsible and caring for them.

All the best with your surgery and recovery: stay positive, communicate you’re your health providers, accept help from your family and friends, and remember that you can control the conditions of your recovery, whether by healthy eating and fluid intake, managing swelling and pain or dedicated rehab. Your local Charlottesville and Waynesboro podiatrists, Dr. Chang and Dr. Murray, are around when you need them or have questions.

Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

Blue Ridge Foot and Ankle Clinic

              Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116

Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150

Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.




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