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Carpentry and bunion surgery

by Dr. Richard Perez

Posted on November 8, 2015 at 7:13 PM

There are dozens of different types of bunion surgery. Many named after the doctor who first published the particular technique. Scarf bunionectomy, however, is named after a wood working technique referring to a joint made by notching, grooving, or otherwise cutting the ends of two pieces and fastening them together so that they overlap and join firmly into one continuous piece. It is this concept that drew me towards this performing this type of bunionectomy.

I have performed many different types and bunion surgery over the years and found pluses and minuses in all of them. One common theme was stability and returning the patient to...

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Alamo Family Foot and Ankle Care is Coming to Boerne!

by Dr. Bryce Karulak

Posted on April 1, 2015 at 7:09 PM

Alamo Family Foot and Ankle Care is branching out to Boerne to provide all aspects of foot and ankle care to the Hill Country. Bryce Karulak, DPM, a native of Boerne, is returning to start the new branch located at 604 N. Main Suite 200. Alamo Family Foot and Ankle Care has been serving the San Antonio community since the early 1990’s. After many years of continued success with a growing practice in the San Antonio and surrounding areas, Alamo Family Foot and Ankle Care is undergoing expansion and placing a full time clinic in Boerne.

Dr. Karulak, grew up in Boerne during his formative years and is very excited to return with his wife, Jessica, and two kids, Beckett and Weston, to provide Foot and Ankle Care to the community of Boerne. Dr. Karulak completed his Doctor of Podiatric Medicine degree from Des Moines University in Iowa and is currently finishing a 3 year forefoot, rearfoot and ankle reconstructive residency in Houston and is trained in all aspects of foot and ankle medicine and surgery. Dr. Karulak’s professional interests include elective, reconstructive, and minimally invasive surgery, as well as revision surgery. Dr. Karulak’s training is extensive in Diabetic Charcot Reconstruction and wound care. In his free time, he enjoys cycling in the hill country and spending time with his family.

New treatment for chronic Achilles tendonitis and plantar fasciitis

by Dr. Richard Perez

Posted on March 17, 2015 at 12:09 PM

Over 10 million people in this the United States suffer from chronic Achilles tendon or plantar fascial pain, in addition to pain, these conditions also limit range of motion and prevent people from living active lives. Common treatment options include rest, stretching and ice. Next, pain medication addresses the pain but not the source of the pain. Physical therapy modalities are ordered to help improve range of motion, flexibility and strength. Finally, an open surgical procedure can be performed to remove the damaged tissue. These procedures have good success, however, there are always risks associated with any invasive surgery. Additionally, considerations must be given to the time missed from work while recovering from traditional treatments for tendon and fascial pain.

TenexTx minimally invasive heel surgery

The podiatrist of Alamo Family Foot & Ankle Care are among the first specially trained doctors in this area to offer an advanced treatment option for tendon and fascial injuries—called the Tenex Health TX System. We are extremely pleased with the results we are seeing in our patients who have been treated with Tenex Health TX. They have reported experiencing tremendous pain relief and a quick recovery. This new option will become the curative treatment that removes the source of tendon pain and allows the tendon to truly heal.

What causes tendon pain?

Tendon pain is caused by damage to the tendon by trauma from a hit, twist, or pull on the joint or by repetitive motion from overuse in work, exercise, or activity. In these situations, the tendon tissue breaks down. The damaged tissue causes intense pain, which dramatically affects people’s ability to function. Tenex Health TX is an optimal solution for Achilles tendonosis and plantar fasciitis. Many patients lead very active lifestyles and therefore suffer tendon injuries. Prior to Tenex Health TX, they either had to live and work around the pain or take time off to recover. Tenex Health TX allows them to return to what they enjoy doing quickly. Patients can generally return to their normal daily activities, without the restrictions caused by pain from damaged tendon tissue, physical therapy, and lengthy recovery times.

What can I expect during the Tenex Health TX procedure?

Tenex Health TX—medically known as Percutaneous Tenotomy and Fasciotomy—is a minimally invasive procedure that allows the surgeon to remove the source of tendon pain quickly and safely. Tenex Health TX is performed at an outpatient surgery center, using a local anesthetic to numb the area. During a Tenex Health TX procedure, musculoskeletal ultrasound imaging is used to identify the location of the damaged tendon or fascia tissue. Once located, a small incision it made and a 1/16” probe delivers ultrasonic energy specifically designed to break up and remove damaged, scared tissue safely and quickly, allowing the tendon to heal and eliminating the pain. The treatment itself takes less than 20 minutes, and most patients are able to return to their normal activities within two to six weeks. We are excited about being able to provide the most technologically advanced treatment option for tendon and fascial injuries here in San Antonio that truly benefits our patients. It is profoundly rewarding to see them really enjoying their lives—without pain. Tenex Health TX has made a world of difference for our patients.

Eight tips for new runners

by Dr. Richard Perez

Posted on February 1, 2015 at 4:42 PM

I have the good fortune of seeing many runners in my practice. Typically, around marathon season, there will be a steady stream of runners coming to see me with various injuries ranging from tendonitis to stress fractures.

Until recently, I could not directly relate to runners; I was not one of them.

Cycling has been my passion for the last ten years. In 2005 I weighed 50 lbs more than I do now - I needed to take action. After watching the Tour de France that year, I went to a local sporting goods store and bought an indoor bike. About three weeks of boredom led me to abandon the machine and soon it became a fixture for hanging clothes and various odds and ends. I graduated to a true road bike and discovered my passion. Biking. Fast forward to the winter of 2014-15. It has been cold and wet here in San Antonio. I have an indoor trainer for my bike, but I decided that unlike years past, I would forgo the tedium of that activity.


Dr. Richard Perez

Running was going to be my go to aerobic sport for this winter. Mind you, I have never run before, but I was determined to not regain the 50 lbs that I had fought so hard to lose.

Six weeks into the hobby, I must say I have a new appreciation for the various ailments I have treated for runners throughout the years. My shins hurt, hips ache, forefoot burns, peroneal tendons pull and my Achilles tendons pulsate. But slowly, my body is becoming accustomed to the new movements. The pains subside and the benefits realized. From my brief time running here are 8 things I’ve learned.

Therapeutic diabetic footwear decreases ulceraton, study

by Dr. Walter Strash

Posted on August 1, 2014 at 6:42 AM

Dr. Comfort, a leading manufacturer of therapeutic footwear, has released the results of its recent study, which examined the clinical impact of therapeutic footwear on diabetic complications, including foot ulcers and amputations, in patients with Type 2 Diabetes mellitus (T2DM). The retrospective claims database study reviewed patients during a three-year period and showed that the likelihood of foot ulcers and amputation in T2DM patients not wearing therapeutic footwear was higher than in patients who did wear therapeutic footwear. The study revealed that foot ulceration decreased by 2 percent and 12 percent in years one and two respectively, while lower limb amputation decreased by 29 percent and 18 percent in years one and two respectively.

My toenails are gross!

by Dr. Richard Perez

Posted on May 30, 2014 at 10:47 AM

I often hear words similar to this from many of my patients who seek podiatric care for their toe nail problems. More often then not, the problem can be blamed on fungus. Toenail fungus is a very common problem seen by podiatrist. It is often ignored, starting out as a small discoloration on the tip of the nail. But with time, that small area grows and grows. And before you know it....

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My bunion embarrasses me!

by Dr. Richard Perez

Posted on April 29, 2014 at 3:50 PM

Severe bunion deformities often cause quite a bit of physical pain. Shoe gear, especially, dress shoes can be quite bothersome. Physical activities can also make the bunion hurt. But beyond the physical pain, there can also be an emotional toll.

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You See What You know.

by Dr. Richard Perez

Posted on April 6, 2014 at 7:52 PM

I can recall as a fourth year medical student examining a patient who came in complaining of a rash to her foot. Looking down at her foot, I saw a raised red round rash.

"You have an athlete’s foot infection" I said.

Upon presenting the case to my attending, I was confident in my diagnosis. It was a clear-cut, easy dermatology problem. Well not so fast.

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In Office MRI - We are the first San Antonio Podiatrist to offer this advanced technology.

by Dr. Richard Perez

Posted on March 30, 2014 at 4:16 PM

Since 2012, we are proud to be the first and only(as of this writing) podiatrist in the San Antonio area to offer this advanced imaging modality for our patients. MRI is a critical part of establishing

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5 causes of top of foot pain

by Dr. Richard Perez

Posted on January 25, 2014 at 10:40 AM


Before talking about causes of pain to the top of the foot, lets review the anatomy. The top of the foot consists of bones (talus, navicular, cuneiforms, cuboid, metatarsals), several small arteries, small nerves, and tendons. So any pain generally is a problem with one or a combination of those anatomic structures.

1. Stress Fracture

Stress fractures the the most common cause of top of foot pain. Usually, these injuries start of as a mild discomfort which gradually progress and become worse. Swelling will usually occur towards the end of the day or after prolonged activities, only to feel better in the morning. Stress fracture are caused from repetitive stress to the bones which results in microscopic injuries. The body is unable to heal the injuries fast enough and an accumulation of micro fractures leads to increasing pain and swelling.

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Rickets- Victorian era malady with modern day persistence

by Dr. Richard Perez

Posted on January 4, 2014 at 6:05 PM

It is not often that I see a Victorian era disease come through the office. But that's exactly what occurred recently. Rickets , also known as Osteomalacia is a bone disease caused primarily by a lack of Vitamin D.

If you are a baby boomer, think back to sitting at the kitchen table with a box of cereal and milk...

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Monckeberg's arteriosclerosis

by Dr. Richard Perez

Posted on January 4, 2014 at 6:05 PM

Monckeberg's arteriosclerosis, also called medial calcific sclerosis, is a form of arteriosclerosis or vessel hardening, where calcium deposits form in the middle layer of the walls of medium sized vessels (the tunica media). It is often not clinical unless it is severe. This human medial calcification, Mönckeberg’s sclerosis, is common and occurs independently of atherosclerosis.

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The Bunion Blues

by Dr. R. Jordan Mechell

Posted on December 15, 2013 at 7:13 PM

Got the bunion blues. Don’t worry; you’re not alone. Let me help shed some light on this matter.

What exactly is a bunion?

A bunion is a bump on the side of the foot. A bunion is NOT an extra piece of bone; is NOT an enlargement of bone; is NOT a bone spur and more importantly it is NOT a tumor but it represents progressive disorder caused by a splaying of 2 bones that are normally parallel.  It has been reported that there is a genetic component that plays a role in the development of a bunion along with shoe gear.

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