Dr. Scott T. Vantre of the Virginia Foot & Ankle Center has been providing comprehensive foot and ankle surgical care to adults and children in the Richmond region for more than 15 years, and he continues to be named one of Richmond's Top Doctors (2008, 2011, 2012, 2013, 2014, 2015, 2016, 2017, 2019, 2020) as selected by his medical peers.
Upon completion of his three-year foot and ankle surgical residency program at The Graduate Hospital (Drexel University School of Medicine), Vantre moved to Richmond to join, and eventually purchase, the foot surgery practice of Dr. Jonas Katz. Vantre, a fellow of the American College of Foot & Ankle Surgeons and a diplomate of the American Board of Foot and Ankle Surgery, is on the medical staff at Bon Secours St. Mary's Hospital and a member of the hospital’s medical executive committee.
Certified in both foot surgery and in reconstructive rearfoot/ankle surgery by the American Board of Foot and Ankle Surgery, Vantre special interest areas include bunion surgery, treatment of the diabetic foot, foot and ankle reconstruction, joint replacement, ankle arthroscopy, revision foot and ankle surgery, and sports medicine.
Interviewed last week, Vantre shared his thoughts on introducing telehealth within his practice and other practical advice for those seeking foot and ankle care.
With the COVID-19 containment restrictions, is your office also seeing patients virtually?
Dr. Scott T. Vantre: We had looked into telemedicine over the years, but with the pandemic there has been with some easing of the regulations, which has led us to use Zoom, and we have been seeing two to five patients per day that way. It’s been great — it’s been a good opportunity to keep in touch with our patients. And we’ve had a few new patients along with established patients.
What are three preventive measures you can share?
Vantre: The best prevention for foot pain, tendonitis, arch pain and heal pain is wearing supportive shoes. Patients coming in with arch, ankle or heel pain are often not wearing a supportive enough shoe — they prefer to wear something that is flimsier. A lot of ailments we treat could be minimized or prevented with better footwear. And similarly, another large population of patients are diabetic, and they would benefit from wearing better fitting shoes, and just wearing shoes around the house [to protect their feet], period. Diabetics often have neuropathy. They can’t feel pain because they don’t have normal sensation, and sometimes because of poor vision, they can’t detect infection. They don’t know they have an infection sometimes until something something smells bad or is feeling really bad. Diabetics cannot mess around with potential infections in the feet because they can result in amputations. They need to do a daily foot inspection or have someone do it for them.
In addition to heel, arch and ankle pain patients, many patients develop bunions, oftentimes from abnormal foot mechanics. We tend see people in the their 40s, 50s and 60s who have done nothing for their bunions because they are fearful of surgery or they weren’t bad enough to justify surgery. Coming in early is key here. I see a lot of those patients who wish they would have sought treatment at a younger age. A lot of them could have prevented surgery or minimized their progression if they would have worn better shoes or custom orthotics.
Orthotics aren’t recommended enough. Custom orthotics can improve foot mechanics and alleviate stress to joints with a lot of different conditions. And we do have one over-the-counter orthotic designed by a podiatric physician that we recommend if they have mild foot pain or the start of a bunion.
What do you most often treat children for?
Vantre: The true pediatric patient is under 14 or 15, and the most significant condition that we see them for is Sever’s disease — inflammation of the growth plate in the back of the heel, and it’s often overlooked. There are things that we can do to help. You can treat it with over-the-counter or custom orthotics, physical therapy and stretching all the way up to a removable cast or a cast. There are things we can do to allow them to continue participating in their activities.
Arthritis of the foot and ankle seems prevalent. What can be done to alleviate pain?
Vantre: A lot of people have arthritis in their feet, sometimes because of abnormal foot alignment or abnormal foot mechanisms that cause arthritis. If you have arthritis in your feet, you often hear from your primary care doctor that there is nothing you can do. That is not the case. In some cases, a good orthotic can help people with arthritis.
And, for example, if they have the start of arthritis in their big-toe joint, they may be a candidate for a very mild outpatient procedure with with a two- or three-week recovery with no time off their feet versus if they let it go and it developed into a stage three or four arthritis that may ultimately require a fusion surgery.
We’ve also been using [outside-sourced] stem-cell injections for six or seven years. We use them for pain with tendonitis, plantar fasciitis and for arthritis because they reduce inflammation. The challenge is that insurances don’t cover them.
What is another therapy or test that you are especially excited about?
Vantre: I’m pretty passionate about treating peripheral neuropathy, whether that’s diabetes-induced or nondiabetic. I do quite a number of epidermal nerve fiber density tests. It gives you, on a tissue level, evidence whether the patient has neuropathy or not. Oftentimes, neuropathy is diagnosed on history alone, but there’s an entire subset of patients who present a normal, or false negative, standard nerve conduction velocity test result. What this result on the epidermal nerve fiber density test does for me in our practice, it triggers me to offer the patient supplements to improve not only improve a patient’s symptoms, but to regenerate some nerve fibers.
This interview has been edited for length and clarity.
