Balettie, K Amy DPM

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AKA: K Amy Balettie Dpm
Categories: Physicians & Surgeons, Podiatrists, Medical Clinics, Physicians & Surgeons, Physicians & Surgeons, Dermatology, Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Sports Medicine, Physicians & Surgeons, Surgery-General, Sports Medicine & Injuries Treatment

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Phone: (734) 241-0200

Address: 1060 N Monroe St, Monroe, MI 48162

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Balettie, K Amy DPM

General Practitioners

Warts
Arthritis
Primary Care
We spend quality time with each patient in order to better understand your foot care needs, and to recommend the best course of treatment. We work closely with primary care physicians and other specialists to ensure the most effective treatment plan.

Endocrinologist

Diabetes Care

Ultrasound
Magnetic Resonance Imaging (MRI) can show tendon injury and inflammation but cannot be relied on with 100% accuracy and confidence. The technique and skill of the radiologist in properly positioning the foot with the MRI beam are critical in demonstrating the sometimes obscure findings of tendon injury around the ankle. Magnetic Resonance Imaging (MRI) is expensive and is not necessary in most cases to diagnose posterior tibial tendon injury. Ultrasound has also been used in some cases to diagnose tendon injury, but this test again is usually not required to make the initial diagnosis.
MRI
The diagnosis of Neuromas is made by a physical exam and a thorough history of the patient's complaint. Conditions that mimic the pain associated with Neuromas are stress fracture of the metatarsals, inflammation of the tendons in the bottom of the toes, arthritis of the joint between the metatarsal bone and the toe, or nerve compression or nerve damage further up in the foot, ankle, knee, hip, or back. X-rays are generally taken to rule out a possible stress fracture or arthritis. Because nerve tissue is not seen on an x-ray, the x-ray will not show the neuroma. A skilled foot specialist will be able to actually feel the neuroma on his exam of the foot. Special studies such as MRI, CT Scan, and nerve conduction studies have little value in the diagnosis of a neuroma. Additionally, these studies can be very expensive and generally the results do not alter the doctor's treatment plan. If the doctor on his exam cannot feel the neuroma, and if the patient's symptoms are not what is commonly seen, then nerve compression at another level should be suspected. In this instance, one area to be examined is the ankle.
X-Rays
Computed Tomography

Joint Replacement
If the condition progresses to the point of spurring around the joint, surgery may be indicated. Depending upon the degree of degeneration of the joint, surgery may consist of simply removing the bone spurs around the joint, a decompresion osteotomy or may require a total joint replacement or joint fusion ( See surgery of Hallux limitus ). Following surgery, the use of a functional orthotic is useful to improve the joint function.
Metatarsal Surgery
There are numerous over the counter treatments for corns and calluses. Some of these remedies have an acid in them that burn the callous off. Care should be taken when using these medications. If used incorrectly they can cause a chemical burn to the skin. Additionally these remedies are only temporary because the source of the pressure has not been alleviated. Professional treatment consists of using a special shoe insert called a functional orthotic that corrects foot function. In certain instances surgery may be recommended. Surgery is directed at correcting the alignment of the offending bone. Cutting out the callous will only make the condition worse if the underling boney problem is not corrected. Metatarsal surgery is discussed in another section.
Bunions
The classic bunion, medically known as hallux abductovalgus or HAV, is a bump on the side of the great toe joint. This bump represents an actual deviation of the 1st metatarsal and often an overgrowth of bone on the metatarsal head. In addition, there is also deviation of the great toe toward the second toe. In severe cases, the great toe can either lie above or below the second toe. Shoes are often blamed for creating these problems. This, however, is inaccurate. It has been noted that primitive tribes where going barefoot is the norm will also develop bunions. Bunions develop from abnormal foot structure and mechanics (e.g. excessive pronation ), which place an undue load on the 1st metatarsal. This leads to stretching of supporting soft tissue structures such as joint capsules and ligaments with the end result being gradual deviation of the 1st metatarsal. As the deformity increases, there is an abnormal pull of certain tendons, which leads to the drifting of the great toe toward the 2nd toe. At this stage, there is also adaptation of the joint itself that occurs.
Gangrene
Ingrown toenails are due to the penetration of the edges of the nail plate into the soft tissue of the toe. It begins with a painful irritation that often becomes infected. With bacterial invasion, the nail margin becomes red and swollen often demonstrating drainage or pus. In people who have diabetes or poor circulation, this relatively minor problem can be become quite severe. In this instance, a simple ingrown toenail can result in gangrene of the toe. Patients with joint replacements or pace makers are at risk of bacterial spread through the blood stream resulting in the spread of infection to these sites. These patients should seek medical attention at the earliest sign of an ingrown toenail. There are several causes of ingrown toenails: a hereditary tendency to form ingrown toenails, improperly cutting the toenails either too short or cutting into the side of the nail, and ill-fitting shoes can cause them. Children will often develop ingrown toenails as a result of pealing or tearing their toenails off instead of trimming them with a nail clipper. Once an ingrown toenail starts, they will often reoccur. Many people perform "bathroom" surgery to cut the nail margin out only to have it reoccur months later as the nail grows out.
Ingrown Toenails
Treatment for ingrown toenails is relatively painless. The injection to numb the toe may hurt some, but a skilled doctor has techniques to minimize this discomfort. Once the toe is numb, the nail margin is removed and the nail root in this area is destroyed. Most commonly, the doctor will use an acid to kill the root of the nail, but other techniques are also available. It may take a few weeks for the nail margin to completely heal, but there are generally no restrictions in activity, bathing, or wearing shoes. Once the numbness wears off, there may be some very mild discomfort but rarely does this require pain medicine. A resumption of sports activities and exercise is generally permitted the following day.

Plastic Surgeons

Hammertoe Surgery
Home treatment should be directed at reducing the pressure between the toes with cotton or a foam cushion and using an antibiotic ointment to reduce the risk of infection. Over the counter corn removers should never be used in this area because of the risk of increased damage to the skin resulting in infection. Professional treatment consists of removing the irregular shaped bone that causes the development of the corn. Some patients prefer that the doctor simply trim down and pad the calloused areas. This is a common form of treatment in patients with diabetes. See correcting soft corns, removing bone spurs, and hammertoe surgery.

Corns
Soft corns are areas of white moist skin between the toes. They most commonly occur between the fourth and fifth toes. They can be very painful and if not treated can form small ulcerations or sinus tracts that can become infected. Acute athlete's foot can mimic the soft corn. The soft corn is due to an irregularity in the shape of the bone in the fourth or fifth toes.
Cyst
Calluses
The most common area for the formation of calluses on the bottom of the foot is in the area of the ball of the foot. This is a weight bearing area where the long bones behind the toes called metatarsals, bear the greatest amount of weight and pressure. If one or more of these long bones (metatarsals) is out of alignment then excessive pressure is generated in the area producing a callous. The callused area can be very discreet and have a "core" or they can be more dispersed covering a larger area. These areas can become quite painful as the skin thickens. People who have diabetes are at risk of these areas breaking down producing sores or ulcerations that can become infected. People with diabetes should not try home remedies and should see a doctor for the treatment.
Fungus
The most common cause of yellowed, thick and /or deformed toenails is a fungal infection of the toenail. The fungus that infects the nail, most commonly, is the same fungus that causes athletes foot. It tends to be slowly progressive, damaging the nail to a greater and greater degree over time. The infection usually starts at the tip of the nail and works its way back. It usually is not painful and often not noticed until it has gotten well established. A single toenail or any number of nails can be affected. It can also occur on just one foot. Over time, the nail becomes thickened, crumbly, and distorted in appearance. Sweaty feet contribute to the initial infection process and contribute to its spread. The fungus prefers an environment that is moist, dark' and warm, which is why it affects the toenails much more often than fingernails. It does not spread through the blood stream. The infection limits itself to the nails and skin. It is often found in association with areas of dry scaly skin on the bottom of the foot or between the toes. The dry scaling skin is frequently found to be chronic athletes' foot. It is not highly contagious, and family members are almost as likely to contract it from some other source as they are from the family member who has the infection. Keeping common showering areas clean is recommended, and sharing shoes should be avoided.
Lesions
Laser removal of the wart works by burning the wart with a laser beam. The area must be numbed with an anesthetic prior to the procedure. There is little advantage to removing warts with a laser unless the warts are very large (mosaic warts) or there are a large number to be removed. The risks associated with the use of the laser are the same as for cutting the warts out. These risks include infection and the development of a scar after healing. A new type of laser has been developed to treat several different types of skin lesions called the Pulsed Dye Laser. This new laser has promise in the effective treatment of warts.
Psoriasis
Not all thicken or yellowed toenails are caused by a fungal infection. Injury to a toenail can cause the toenail to grow in a thickened or malformed fashion. This can be due to an established fungal infection or may be due to the damage caused to the nail root when it was injured. In these instances, treatment with anti-fungal medications will not correct the malformed nail. Other causes of thickened toenails are small bone spurs that can form under the toenail and psoriasis. Taking a scraping of the toenail and culturing it makes the diagnosis.

Physical Therapists

Sports Medicine
Physical Therapy
We have three doctors and two offices dedicated to the treatment of the foot & ankle. You can count on us to provide the highest standard of care in the treatment of any foot or ankle problem. Our state-of-the-art offices in Monroe and Lambertville, MI provide onsite digital x-ray, digital scanning for custom molded orthotics, diagnostic ultrasound, diabetic shoes, and physical therapy. Both our offices utilize an electronic medical records system.
Flatfoot Correction
Heel Pain
Orthotics and Prosthetic Therapy

General Podiatry
A Podiatrist is a physician and surgeon dedicated to the treatment of the foot and ankle. There are 3 categories of physicians and surgeons in the state of Michigan; Medical Doctor (MD), Doctor of Osteopathy (DO) and Doctor of Podiatric Medicine (DPM). We are the only health care professional whose training focuses specifically on the foot, ankle and related body systems. After obtaining an undergraduate degree, the podiatric physician spends four years in a college of podiatric medicine to obtain a doctorate degree. Following their doctorate degree podiatrists now further their education by participating in at least a 3 year post-graduate residency program at an approved hospital or university and then pass both national and state examinations in order to be licensed.
Bunions Problems
One of the more common conditions treated by podiatric surgeons is the painful bunion. Patients with this condition will usually complain of pain when wearing certain shoes, especially snug fitting dress shoes, or with physical activity, such as walking or running. Bunions are most commonly treated by conservative means. This may involve shoe gear modification, padding and orthoses. When this fails to provide adequate relief, surgery is often recommended. There are several surgical procedures to correct bunions. Selection of the most appropriate procedure for each patient requires knowledge of the level of deformity, review of the x-rays and an open discussion of the goals of the surgical procedure. Almost all surgical procedures require cutting and repositioning the first metatarsal. In the case of mild to moderate bunion deformities the bone cut is most often performed at the neck of the metatarsal (near the joint).
Calluses
Diabetic Foot Care
Flat Feet
Hammertoes
Corns are areas of thick skin that most commonly occur on the top of the toes. Generally there is an associated hammertoe deformity, which causes the toes to rub on the top of the shoes. Professional treatment is directed at correcting the hammertoe deformity. Small corns can also occur on the side of the little toe next to the toenail. A small bone spur causes this problem. Professional treatment consists of removing the bone spur. Bone spurs also cause corns between the toes.
Heel Spurs
To understand the cause of the pain one must understand the anatomy of the foot and some basic mechanics in the function of the foot. A thick ligament, called the plantar fascia, is attached into the bottom of the heel and fans out into the ball of the foot, attaching into the base of the toes. The plantar fascia is made of dense, fibrous connective tissue that will stretch very little. It acts something like a shock absorber. As the foot impacts the ground with each step, it flattens out lengthening the foot. This action pulls on the plantar fascia, which stretches slightly. When the heel comes off the ground the tension on the ligament is released. Anything that causes the foot to flatten excessively will cause the plantar fascia to stretch greater than it is accustom to doing. One consequence of this is the development of small tears where the ligament attaches into the heel bone. When these small tears occur, a very small amount of bleeding occurs and the tension of the plantar fascia on the heel bone produces a spur on the bottom of the heel to form. Pain experienced in the bottom of the heel is not produced by the presence of the spur. The pain is due to excessive tension of the plantar fascia as it tears from its attachment into the heel bone. Heel spur formation is secondary to the excessive pull of the plantar fascia where it attaches to the heel bone. Many people have heel spurs at the attachment of the plantar fascia with out having any symptoms or pain. There are some less common causes of heel pain but they are relatively uncommon.
Heel Pain
Ingrown Toenails
There are very few complications associated with this procedure. Reoccurrence of the ingrown toenail can occur a small percentage of the time. Continuation of the infection is possible which can be controlled easily with oral antibiotics. On occasion, the remaining nail may become loose from the nail bed and fall off. A new nail will grow out to replace it over several months. With removal of the nail margin, the nail will be narrower and this should be expected.
Foot Neuroma
A neuroma is the swelling of nerve that is a result of a compression or trauma. They are often described as nerve tumors. However, they are not in the purest sense a tumor. They are a swelling within the nerve that may result in permanent nerve damage. The most common site for a neuroma is on the ball of the foot. The most common cause of neuroma in ball of the foot is the abnormal movement of the long bones behind the toes called metatarsal bones. A small nerve passes between the spaces of the metatarsals. At the base of the toes, the nerves split forming a "Y" and enter the toes. It is in this area the nerve gets pinched and swells, forming the neuroma. Burning pain, tingling, and numbness in one or two of the toes is a common symptom. Sometimes this pain can become so severe, it can bring tears to a patient's eyes. Removing the shoe and rubbing the ball of the foot helps to ease the pain. As the nerve swells, it can be felt as a popping sensation when walking. Pain is intermittent and is aggravated by anything that results in further pinching of the nerve. When the neuroma is present in the space between the third and fourth toes, it is called a Morton's Neuroma. This is the most common area for a neuroma to form. Another common area is between the second and third toes. Neuromas can occur in one or both of these areas and in one or both feet at the same time. Neuromas are very rare in the spaces between the big toe and second toe, and between the fourth and fifth toes. Neuromas have been identified in the heel area, resulting in heel pain.
Foot Orthotics
Treatment of heel pain generally occurs in stages. At the earliest sign of heel pain, aggressive calf muscle stretching should be started. Additionally, taking an oral anti-inflammatory medication and over-the- counter arch supports or heel cushions may be beneficial. The next phase of treatment might consist of continued calf muscle stretching exercises,a night splint, cortisone injections and orthopedic taping of the foot to support the arch. If this treatment fails, or if there is reoccurrence of the heel pain, then functional foot orthotics might be considered. A functional orthotic is a device that is prescribed and fitted by your foot doctor, which fits in normal shoes like an arch support. Unlike an arch support, however the orthotic corrects abnormal pronation of the subtalar joint. Thus orthotics address the cause of the heel pain and abnormal pronation of the foot. Surgery to correct heel pain is generally only recommended if orthotic treatment has failed. There are some exceptions to this course of treatment and it is up to you and your doctor to determine the most appropriate course of treatment. Following surgical treatment to correct heel pain the patient will generally have to continue the use of orthotics. The surgery does not correct the cause of the heel pain. The surgery will eliminate the pain but the process that caused the pain will continue without the use of orthotics. If orthotics have been prescribed prior to surgery they generally do not have to be remade.
Podiatric Surgery
We care for people of all ages. Common disorders of feet include bunions, heel pain/spurs, hammertoes, neuromas, ingrown toenails, warts, corns, calluses, sprains, fractures, infections, and injuries. Dr. Vogt and Dr. Hughes are certified by the American Board of Podiatric Surgery. They have successfully completed a laborious credentialing and examination process and have demonstrated knowledge and expertise in podiatric surgery. This includes the diagnosis of general medical problems and surgical management of foot diseases, deformities, and trauma of the foot, ankle and related structures.

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