It took a Long Island woman more than 20 years to find a surgeon who could fix a problem that caused shame and embarrassment from the time she was a child. Her search ended at Hospital for Special Surgery, where a highly skilled orthopedic surgeon was able to correct the toe deformities that had plagued her for so many years.
Her embarrassment started when Susan was 10 years old, when another child made fun of her toes, calling her "crooked toes". The middle toe on Susan's left foot was much shorter than her other toes and curled up. On her other foot, the fourth toe near her pinkie was also malformed. "After that, I wouldn't let anybody see my feet," Susan says. "I felt they looked horrible, and I was extremely self-conscious of them. As a child, I was always afraid people would make fun of me."
For more than 20 years, the only people who saw Susan's feet and knew her emotionally painful secret were doctors, as she searched in vain for a surgeon who could fix the problem. She hid it from almost everyone else, even her immediate family.
Keeping it a secret took some work, especially since she loved the beach. She lives near the water on Long Island's south shore and also has a summer home in Westhampton Beach. But she always buried her feet in the sand or wore rubber water shoes to hide her toes. Sandals were out of the question. Until she met Dr. Robert Rozbruch at Hospital for Special Surgery.
After seeing 10 doctors who could do nothing for her, she finally found someone who could correct the deformity and restore her confidence. Dr. Rozbruch, chief of the Limb Lengthening and Deformity Service at HSS, is one of a handful of orthopedic surgeons worldwide performing the kind of highly specialized surgery Susan was seeking. HSS is one of only two hospitals nationwide with a center dedicated to correcting deformities affecting the upper and lower extremities and limb lengthening. Patients come to Dr. Rozbruch from around the country and around the world.
Over the years, Susan says many doctors dismissed her concerns as trivial. One orthopedic surgeon suggested amputating the deformed toes. "He said that way, if someone looked fast at my feet, they would not notice something was different."
In the summer of 2004, Susan started looking for a doctor on the Internet. She found a specialist in southern California and called his office. He said he could fix her toes with a bone graft from the hip, but the surgery would mean she would be in a wheelchair for three months and away from her daughters.
"I would have gone to the ends of the earth… I was desperate to find someone to help me," Susan explains. "Then I said to myself, 'I live just outside of Manhattan, there has to be a doctor there who can help me. We have the top doctors here in New York City.'" She remembered her grandmother had a knee replacement at HSS many years ago. She called the hospital's Physician Referral Line, and they gave her Dr. Rozbruch's phone number.
"I'll never forget, he walked in the room and said, 'I can fix that, no problem," Susan recalls. "I felt such a sense of relief, I wanted to cry with happiness. It was my dream to be able to walk on the beach and leave a normal footprint in the sand. And to finally wear open-toe shoes and get a pedicure for the first time."
Susan's malformed toes resulted from a short metatarsal bone in each foot, which she was born with, according to Dr. Rozbruch. He also found a misalignment of her tibias (the leg bone between the knee and the ankle), which led to bowlegs.
Dr. Rozbruch says problems such as bowlegs and knock knees put more pressure on one side of the knee joint. This can cause discomfort and limit certain activities, and it often leads to early arthritis. He found that both her toes and legs were causing problems for Susan. In addition to the way it looked, she could not be as active as she would have liked, she had trouble buying shoes, and she was developing pain on one side of her knee.
Unlike many of the other doctors she had come across, Dr. Rozbruch was "genuine" and inspired confidence, Susan says. "He's very personable and caring. He makes you feel as if you're his only patient."
Dr. Rozbruch treated both problems using a similar technique. One goal was to correct the misalignment of her tibia bones to make her legs straight. The other was to reconstruct her short toes to give them a normal appearance.
Performing a procedure called an osteotomy, Dr. Rozbruch used a minimally invasive technique to cut the bone in each affected area. The incision was only half an inch long. An external frame called a fixator was applied to her legs and feet after surgery.
"We use an external apparatus that works almost like braces," Dr. Rozbruch explains. "By teaching patients how to make very small daily adjustments to the frame, this gradually changes the position of the bone, like braces that gradually move crooked teeth. It can either lengthen or straighten the bone, depending on the goal." Patients usually spend one or two nights in the hospital.
"In the case of the bowleg, we make an angular correction, and in the case of the short toe, we lengthen the bone by creating a space. Bone has the ability to regenerate itself, so new bone will grow in the gap. This is how we can lengthen the bone or correct a deformity," he explains. The process usually takes a few weeks, and most patients have little if any pain, Dr. Rozbruch says. Susan says she had no pain to speak of, and her two teenage daughters offered much support after the surgery. Her toes now look perfect and she no longer has bowlegs.
"It was the best thing I've ever done for myself," says Susan, who now goes for a pedicure every week and delights in wearing open-toe shoes. "It was life-altering. It definitely changed my quality of life."
She only wishes she had found out about it sooner. "The sad part is, they've been doing this procedure at HSS for years, but nobody I went to ever told me," she says. "I might have ended up with a knee replacement if the misalignment of my tibias had not been corrected."
"When we fix these problems, we really transform peoples' lives, and it's the combination of improving both function and body image," Dr. Rozbruch says. "People not only look better. They have less pain, a decreased chance of developing arthritis in the joint, they can engage in more athletic activities, and it leads to much happier patients."
Susan is clearly one of them. She is an athlete who enjoys running, cycling and skiing. Several months ago, at age 43, she completed her first New York City marathon. She is also learning how to surf along with her two daughters.