Lower Keys Foot and Ankle Surgery, 1111 12th Street Suite 211, Key West, FL (2025)

05/23/2024

The vast majority of wounds of all etiologies (diabetic, venous, arterial, trauma) can be successfully treated with good wound care. In some cases, the tissue destruction is so extensive that more advanced care is required. We here, at Lower Keys Foot and Ankle, are skilled limb salvage surgeons. Trained to perform skin grafting, muscle flaps, off loafing with external fixators, reconstructive foot and ankle surgery to give every patient the best chance at healing the most difficult wounds.
Above picture: treatment for gas gangrene consisted of initial incision and drainage with excision of all devitalized tissue, followed by repeat I&D at 48 and 96 hours after the index procedure. Wound vac application. Followed by final debridement and washout and MTF Somagen meshed allograft dermal matrix grafting. Patient is severely immunocompromised so I elected to not take skin from his thigh which creates a new wound.

01/11/2024

Lapiplasty of right 1st metatarsal cuneiform joint, adductoplasty, lis franc fusion, autogenous bone graft from right calcaneus. First of this type of procedure performed here. Providing quality patient care from a Tri-State area Top Surgeon/Physician. The OR is my second home. My patients will always be my 1st priority.

10/18/2023

Approximately 15,000 lower extremity amputations are performed in the USA each year.
Most often, as a result of diabetes mellitus, peripheral vascular disease, neuropathy and trauma.

These photos depict the sequela of a trans metatarsal amputation.

Removing the forefoot takes out the ankle dorsiflexors ( the tendons that move the ankle upward towards the leg). This leads to an adducto-varus (down and in) rotation of the foot with resultant plantar lateral ulceration.

In cases where conservative management, wound care, bracing, off loading are unsuccessful, Surgical intervention becomes necessary for limb salvage

These photos depict a TTC fusion with tibial wedge osteotomy to produce a more re**us plantigrade foot.

During the initial amputation an Achilles tendon lengthening should be performed to mitigate the risk of adducto varus deformity.

These wounds are extremely complicated and require a highly skilled experienced surgeon and wound care team to manage them.

Failure at this stage of the game leads to a more proximal below the knee amputation and all the deleterious effects on quality of life that a leg amputation presents.

08/29/2023

Dr. Robert W. Hutchison, FACFAS
For the past 23 years, Dr. Robert Hutchison, a Double Board Certified Surgeon, has been voted a perennial Top Doctor in the NY Tristate area, specializing in limb salvage, reconstructive, trauma and elective surgery of the Foot and Ankle.

Prior to private practice, Dr. Hutchison attended the New York College of Podiatric Medicine, graduating Magna Cum Laude in 1997.
Following medical school, Dr. Hutchison started his training in Podiatric medicine with the New York Health and Hospital Corporation, followed by an extensive surgical training program at St Barnabas Medical Center in New Jersey, where he performed over 2,500 surgical procedures under the supervision and training from well-renowned surgeons, who happen to be some of the best Foot and Ankle surgeons in the world.

Dr. Hutchison has led a very successful surgical practice for the past 23 years. He was elected Chief of Foot and Ankle Surgery at Union Hospital only 5 years after completing his residency training.

It is well known that Dr. Hutchison feels that his greatest professional accomplishment has been playing a very integral part of training over 200 surgical residents at 2 of the largest and most respected surgical training programs in the nation.

Dr. Hutchison is Double Board Certified by the American College of Foot and Ankle Surgery, Certified in wound care by the American Professional Wound Care Association, as well as being Certified to supervise Hyperbaric Medicine for wound care.

Dr. Hutchison is a a Diplomat of the of the American Board of Foot and Ankle Surgery, Fellow of the American College of Foot and Ankle Surgeons, member of the American Diabetes Association, Florida Podiatric Medical Association, and the American Podiatric Medical Association.

08/24/2023

Dr. Robert W. Hutchison, FACFAS
For the past 23 years, Dr. Robert Hutchison, a Double Board Certified Surgeon, has been voted a perennial Top Doctor in the NY Tristate area, specializing in limb salvage, reconstructive, trauma and elective surgery of the Foot and Ankle.

Prior to private practice, Dr. Hutchison attended the New York College of Podiatric Medicine, graduating Magna Cum Laude in 1997.
Following medical school, Dr. Hutchison started his training in Podiatric medicine with the New York Health and Hospital Corporation, followed by an extensive surgical training program at St Barnabas Medical Center in New Jersey, where he performed over 2,500 surgical procedures under the supervision and training from well-renowned surgeons, who happen to be some of the best Foot and Ankle surgeons in the world.

Dr. Hutchison has led a very successful surgical practice for the past 23 years. He was elected Chief of Foot and Ankle Surgery at Union Hospital only 5 years after completing his residency training.

It is well known that Dr. Hutchison feels that his greatest professional accomplishment has been playing a very integral part of training over 200 surgical residents at 2 of the largest and most respected surgical training programs in the nation.

Dr. Hutchison is Double Board Certified by the American College of Foot and Ankle Surgery, Certified in wound care by the American Professional Wound Care Association, as well as being Certified to supervise Hyperbaric Medicine for wound care.

Dr. Hutchison is a a Diplomat of the of the American Board of Foot and Ankle Surgery, Fellow of the American College of Foot and Ankle Surgeons, member of the American Diabetes Association, Florida Podiatric Medical Association, and the American Podiatric Medical Association.

$Fifth metatarsal fractures are among the most common fractures of the foot.They are inherently predisposed to poor heali...$

07/28/2023

Fifth metatarsal fractures are among the most common fractures of the foot.
They are inherently predisposed to poor healing due poor blood supply to specific areas of the bone.
Diagnosis is made through plain film xray.
Treatment options include protected weight bearing, immobilization and off weight bearing and surgery. Depending on the area of the bone fractured, the amount of displacement and the activity level of the patient.

07/14/2023

This patient lost his second toe to an infection 1 year prior to this photo.
He continued to be non-compliant following his second toe amputation. At the time of this photo, his HgA1c was 13.7, which correlates to a blood sugar of 360mg/dl average over the past 3 months.

It may seem like a minor thing to lose a single toe, but statistically when a diabetic has an amputation of any part of the body, they will have a second amputation within a year and lose their life within 5 years.
This is the reason, as Foot and Ankle surgeons, we spend the majority of our time preventing even a tip of the toe amputation.

Diabetes does not affect the feet in a vacuum. When we see the obvious external signs of diabetes in the feet we know the same changes are taking place in the heart, kidneys, eyes and larger blood vessels as well..

It is essential that you follow up routinely with your endocrinologist, dietitian, nephrologist, ophthalmologist and podiatrist.

07/13/2023

Ankle Arthroscopy.
Top photo before
Bottom after arthroscopy..
Patients with ankle pain that had not responded to conservative care such as physical therapy, N-SAIDS and steroid injections, are often candidates for arthroscopic surgery.

Ankle arthoscopy is through small less than 1/2 inch incisions in each side of the ankle joint.

Recovery is much faster than open surgery. Typically patients are up and walking in 2-3 weeks after surgery.

Conditions such as arthritis, impingements, bone spurs, loose bone fragments, cartilage damage and torn ligaments can be addressed with arthroscopic surgery.

Advantages of arthroscopic surgery include:
Minimal blood loss, faster recover, significantly less risk of complications, and less pain.

07/12/2023

This patient was seen in his endocrinologists office on Monday. The foot was examined and noted to be infection and ulcer free.
This photo was taken on Wednesday afternoon, 2 days later.
Patient stated that he cut his own nails on Monday evening.
The severity of the infection, combined with severe peripheral vascular disease and peripheral neuropathy, made salvage impossible, requiring trans-metatarsal amputation.
This post is to bring awareness to how quickly these infections progress and how a seemingly innocuous event can lead to amputation.
It is recommended that patients with diabetes visit their podiatrist regularly, at least every 2-3 months, to prevent these occurrences. Although we are highly trained surgeons, it is our goal at Lower Keys Foot and Ankle Surgery Associates to prevent the need for surgery by providing our patients with regularly scheduled routine foot care appointments.

07/11/2023

Hallux Rigidus… latin meaning stiff big toe.
Hallux rigidus is a painful degenerative arthritic condition that affects the joint where the big toe meets the foot.
Characterized on X-ray by joint space narrowing and osteophyte (bone spur) formation around the joint
Conservative treatment options include: shoe modifications, Physical therapy, orthotics, NSAIDS and steroid injections.
In many cases, surgery becomes necessary.
Surgical options include:
1. cheilectomy ( removal of bone spurs)
2. 1st MTPJ (metatarsal phalanges joint) fusion. A procedure that eliminates motion of the joint, limits mobility but results in a pain free joint.
3. Joint replacement surgery, where the diseased parts of the joint are removed and replaced with metal or plastic. Similar to knee and hip joint replacement.

Age, bone quality, weight, comorbidities, lifestyle and surgeon experience all factor in to what procedure is best for each patient.

Lower Keys Foot and Ankle Surgery

05/23/2024

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10/18/2023

08/29/2023

08/24/2023

07/28/2023

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07/12/2023

07/11/2023

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