+ How long do I have to wait between my new patient consultation and my surgery?

Although there is no specific time you need to wait before you schedule a surgery, the best way to move forward is have a chance to consult with the doctor first, then take time to digest the plan and think over the recovery process. This way, when you regroup with the doctor for your pre-op visit, you have questions you can ask and dive into the details with more information.

Remember, surgery if done right, is part technique, and part art form. And planning is a big part of getting it right. We talk pride in our low volume model, and practice this way so we’re not rushing our patients through like the factory model of healthcare.

So taking the time to consult, then regroup for further questions is what we believe is the best, most consistent way to coordinate the surgical effort.

+ How far in advance do I have to schedule a surgery?

We’re humbled by the popularity of our practice, and because of this our schedule is usually booked a few months in advance. This does not mean that we would no be able to accommodate your scheduling needs or limitations.

Part of our philosophy of the low volume practice model is to make sure that every patient is treated with the highest level of service. As a result of the slow flow, low volume model, we have some flexibility in our scheduling.

What we recommend to our patients is if they know they want to proceed with the corrective surgery, to schedule it and get it on the books, this way they have held the spot and are able to work to that goal date.

If the desired dates are booked, then our concierge will do their best to accommodate the scheduling challenges and make it happen for you.

+ Does the doctor have any other offices?

Someday, we might! At this time we love being able to offer the best to our patients. Part of offering the highest level of excellence in foot surgery, is to keep it tight and small. Small is exclusive, and exclusive is excellent.

+ I have another surgery scheduled, can I do my feet at the same time?

In most cases, the answer is yes. It’s important however that you make sure to communicate this with your doctor so they can make the final decision. Some procedures are better “staged” so that the recovery challenge imposed on the body is separated by a few weeks for optimum healing of each procedure.

+ How long will my surgery take?

Depending on the procedures you are having performed, surgeries can go from 30 minutes to 2 hours, per foot.

+ How long do I have to wait between feet?

The preferred window of time between surgeries is 6 to 8 weeks. This allows for most of the healing and bone strength to be completed before proceeding to the next foot.

The actually number however is based on when you feel ready to proceed. We always tell our patients “the time to get the next foot done, is when you feel the first foot is ready to be your main one.”

+ Can I choose to have both feet done at the same time?

Ideally, it’s best to perform the procedures one foot at a time. This sets you up for a faster and easier recovery. Think of it this way, with one surgery your body is able to allocate its resources more effectively to that one region. It’s when we do multiple surgeries that your body has to allocate it’s resources to the different areas, and hence more stress on your physiology to heal.

There are some instances when both feet can be done at the same time. This decision is made after a detailed conversation with your surgeon, and an analysis on the limitations and requirements they compel us to consider a bilateral surgery. Ultimately a surgeon will help you decide on whether or not this is a good decision, taking into consideration all the factors, as well as your success and a quality outcome.

+ Whose decision is it whether I get one foot at a time or bilateral?

Although we like to collaborate on the decisions involved in the surgical process (whenever possible), certain decisions are weighed heavily by the surgeon and ultimately or approved or denied based on their analysis. With the decision of bilateral versus one foot at a time, your surgeon will have the final decision being that they have the comprehensive information necessary to help you decide on the best possible path to success.

+ Whose decision is it whether I get local anesthesia or sedation?

Although we like to involve patients and collaborate with them in the decision making process for their procedures, certain aspects of the medical decision-making need to be weighted more on the doctor’s side. The decision for anesthesia is one of them.

The factors that are considered when deciding on whether a patient is a candidate for sedation or not are complex. Ultimately our team is focused on your safety and will make a decision with the pre-op data and your history taken into consideration.

Similarly, the decision to perform a procedure under local anesthesia it’s not as simple as it seems. During the procedure there are many stimuli that could create anxiety for the patient and ultimately distract the surgeon from their work. This is an important factor that we consider before deciding on performing any procedure with local anesthesia.

With the advancements in technology and safety with sedation and conscious sedation techniques, the decision to perform conscious sedation/light anesthesia for procedures such as bunionectomies, and hammertoe correction has become routine and foot surgery.

If you have a concern about the method of anesthesia (local versus sedation) please make sure to review this topic in detail with your surgeon during the preoperative consultation.

+ What’s the difference of the evo procedure compared to other techniques?

The procedures we perform were developed by Dr. Sadrieh to optimize the recovery experience as well as improve the aesthetic outcomes. Our practice has focused on the aesthetic approach to foot surgery since 2001 and the creation of the side incision technique by Dr. Sadrieh is unique to evo.

The use of special techniques with our bunion and hammertoe corrections also play a role in improving the patient experience during the recovery process and providing a simpler, shorter experience for the patient. As an example, our bunion and hammertoe patients are able to walk right after surgery using the surgical shoe, and transition to athletic shoes around the 2nd week after surgery. Usually at the 4th week after surgery the patient is permitted to begin resuming athletic activity.

Our toe reconstruction procedure is unique to our practice and the only procedure in the world that is able to recreate a toe after failed hammertoe surgeries from traditional techniques.

+ What caused my bunion?

Bunions are caused by a variety of factors. Usually the main reasons for the development of a bunion are genetics, and the contribution of activities and shoes during the younger years of life.

The most common cause of bunion development is genetics. The structure of your foot, much like the rest of your physical appearance, is determined by your genetics. Genetics also act as a predisposing factor for the development of bunions. Often times patients inherit the genetic predisposition to developing bunions, but because of childhood shoe and activity management, the formation of a bunion deformity is prevented.

To determine the underlying reason for your bunion deformity, a consultation with the doctor and examination of your foot would be necessary.

+ Is there a non-surgical solution for a bunion?

There are a variety of non-surgical management options for bunion pain. Most if not all of these methods will not solve the bunion problem. Management of the symptoms is the what conservative solutions provide.

To correct the structure, the only option is a surgical procedure. It is this point that has focused our efforts in improving the surgical procedures, experience and outcomes for our patients. One of the key principles in our philosophy is to resolve problems definitively rather than “band-aid” them. The reason is that when the inevitable time to correct the problem arrives, the patient may be much older and not in an optimum condition for an excellent corrective effort.

+ Will wearing specific shoes or orthotics help correct my bunion?

The use of supportive shoes and functional orthotics (inserts) has been shown to help reduce the speed of bunion development and reduce the symptoms. However these management techniques will not correct the bunion deformity. The efficacy of these techniques also varies from person to person. It is important to consult with your doctor so you have a better understanding of what type of bunion deformity you have and how other factors, such as your lifestyle, activities, and shoes play into the development of your bunions.

+ What is the recovery like compared to traditional bunion surgery?

The evo recovery experience is designed around our philosophy… provide our patients with a simpler, shorter recovery that does not disrupt their essential life functions, as well as provide them with a aesthetic result that does not compromise beauty for function.

The evo patient is able to walk on the surgical foot right after their procedure using a surgical shoe, with weight bearing focused on the heel.

Around the 2nd week, when the sutures are removed, and the patient transitions to an athletic shoe and begins to transition to normal weight bearing.

After the 4th week post op, and assessment by the doctor, the patient is allowed to increase their activity level to normal/athletic and begin “grooming” their foot to activities they participated in before surgery.

It’s important to note that the stages mentioned above can vary based on the patient’s response to the surgery an how much inflammation, swelling and tightness presents with the recovery process. If there is a delay or greater than expected response, your doctor will plan the appropriate treatment plan.

Traditional techniques on average have a recovery experience that is double or triple the timeline evo patients experience.

+ How long after surgery will I be able to wear heels?

High heeled shoes place increased pressure on the front of the foot at the 1st metatarsal joint. This is the region that bunion correction is performed, so the reason to there is a delay in wearing high heels is based on the progress and healing fo the 1st metatarsal joint and it’s peripheral tissues.

Usually after the 6th week you are able to transition to wearing shoes that have a heel. The type of high heel shoes depends on the amount of swelling and thickness of the peripheral tissues around the surgical site. It is recommended to transition to heels beginning with a low heeled shoe and increasing slowly over time with consideration to the response of the foot during the transition process.

+ Is a bunion procedure a permanent solution?

The majority of bunion correction performed with definitive techniques such as metatarsal osteotomies are permanent. The type of bunion correction you decide on with your surgeon is based on a variety of factors. The risk of recurrence is something your surgeon will discuss with you, should your bunion be the type that has a higher chance of coming back.

However, the majority of evo bunion procedures are definitive, and are permanent. The utilization of an osteotomy and change in the position of the head of the 1st metatarsal, as well as use of unique techniques developed by Dr. Sadrieh, give these procedures a high success rate and permanent result.

+ How do I know If I’m a candidate for, or need a joint replacement?

Joint replacement is performed when the surface of the 1st metatarsal joint has lost greater than 50% of its cartilage. The is determined during the procedure when your surgeon has a chance to directly observe the joint surface.

The quality of bone as well as type of bunion deformity also determine if you are a candidate for a joint replacement procedure. If you have the type of bunion that requires a joint replacement, your doctor will discuss this during your pre-operative consultations, and outline the procedure technique, recovery and expectations.

It’s important to note, that part of the evo philosophy over the past 20 years has been to develop techniques that provide a simpler recovery experience as well as more reliable and aesthetically pleasing results, allowing patients to intervene and treat bunions before they progress into an arthritic state requiring joint replacement. We believe performing a corrective surgery which could prevent deterioration of the joint surface, is far superior than a joint replacement surgery.

+ Will my shoe size change after my surgery?

If the width of your foot contributes to your shoe size decision, then you will experience a reduction in your shoe size. The average patient does not change in shoe size, but rather is able to wear their shoes more comfortably and for longer amounts of time without discomfort.

It’s also important to note that during the recovery process, you might need to wear a lightly larger or wider shoe due to swelling and thickness. The development of swelling and tissue thickness is normal during the recover process and will be managed by your doctor should is continue or present at an excessive level.

+ What can I expect my scar to look like?

We pride ourselves for developing procedures that are focused on the aesthetic appearance of the foot after surgery. The development of aesthetic foot surgery by Dr. Sadrieh back in 2001 is the cornerstone of the evo philosophy.

We expect your scar to be close to invisible!

All of our procedures are performed with plastic surgical closure, and running sub-cuticular closures (stitches underneath the skin). Dr. Sadrieh’s commitment to beautiful, hidden scars is the underlying principle to our management of scars should they develop. Some types of skin have a tendency to develop scars regardless of the kind of closure performed. In these cases we will make the effort to manage and reduce the scar formation to provide an aesthetically pleasing result.

+ Is the screw for a tailors bunion the same as the screw for a regular bunion?

The screws used to fixate (connect and hold) the bone cuts in bunion and tailors bunion surgery are made of the same material, titanium.

The basic structure of the screws are the same, however the screw used for a tailors bunion is much smaller due to the smaller bone (on average). The length of the screws varies from person to person based on the size of the bone. All of the screws we use will be set flush to the bone to the patient does not feel the screw after surgery.

+ Since my surgery, the incision area is still numb. Is that normal?

Although our technique is designed in way that avoids surgical work near the main nerve branches of the surgery sites, there are still small branches and tributaries that are involved in the surgical dissection. These small branches heal like the rest of the tissues, however in isolated cases, scar tissue develops around the site and prevents these tiny nerve endings from healing resulting in numbness.

Most of these cases eventually return to sensation as the body continues with the remodeling process and regenerates new tissue in the area.

+ What’s the difference of the evo procedure compared to other techniques?

There are a variety of hammertoe correction techniques. The evo procedure was designed by Dr. Sadrieh in 2001 and differs in a variety of ways.

There are 2 main types of procedures that are used to correct hammertoes:

1. Arthroplasty - removal of a portion of bone, leaving a gap between two bones of the toe.
2. Arthrodesis - removal of a portion of bone, followed by fusion of the two bones in the toe.

Arthrodesis is the more stable of the two techniques since once the two bones are connected, the end result remains stable through time and does not deviate. With

Arthroplasty, the toe can shrink, deviate in position, or become floppy. This is because after the removal of the portion of bone from the toe, the expectation is that the empty region fills in with scar tissue (pseudarthrosis) and ‘acts’ like a soft bone replacement. This however, usually is not the case.

Both procedures are performed with an incision on the top of the toe, which is unsightly, and become painful.

Also, both procedures use a K-Wire (a long straight pin) to hold the toe in a straight position while it heals. This pain has to be left in the toe for 4-6 weeks while the healing is completed. This puts the patient at risk for pin tract infections, and more importantly, once the pin is removed, if the bone has not healed completely, the control and stability of the toe is compromised and a failure can develop.

The evo hammertoe procedure (and toe shortening) differs first because we invented the side incision technique. This allows for a cosmetic, beautiful result without a scar on top of the toe.

The second difference is the type of stabilization. Since 2001 we have used internal fixation (a device inside the toe) to stabilize the toe so we have ongoing maintenance of the position until the bone is healed. This provides excellent stable results on every case.

This also translates to a shorter recovery experience… on average evo hammertoe patients keep the foot dry for 2 weeks, and get back into shoes after 10-14 days. The traditional procedures above, require the patient to be in a post op shoe for 4-6 weeks.

+ Can I shorten multiple toes at the same time?

Yes, we can. However it’s important to design the procedure with your surgeon so that the length decisions can be made with the long term goals in mind.

+ Will my shoe size change after getting toe shortenings?

Your shoe size can get smaller depending on how much shortening you want or require. This will all be discussed with your surgeon before the procedure.

+ How many shoe sizes can I expect to go down after surgery?

This will depend on what you discuss with your surgeon, and the amount of length that can be managed safely and reliably.

+ Will I still be able to bend my toes after this procedure?

The toe is comprised of three joints, which include: metatarsal phalangeal joint (the joint at the base of the toe), proximal interphalangeal joint (the joint in the middle of the toe), and the distal interphalangeal joint (the joint closest to the tip of the toe). In most cases, the proximal interphalangeal joint (middle joint) is fused and you will not be able to bend this joint. This will not prevent your normal use of the toe. You will still be able to bend the metatarsal phalangeal joint, which is important for walking, and the tip of the toe.

+ Will my scar be visible?

The scar will not be visible because of our side incision technique. Even though it will not be visible, we still utilize a plastic surgery type closure to allow for a beautiful, cosmetic scar.

+ I had hammertoe correction but I still have corns, how long until they go away?

It can take up to 6 months for the skin to completely remodel and heal.

+ Does the doctor have to “break” my toe during surgery?

The surgeon will resect and remove the joint surfaces in a clean and concise method that does not involve “breaking” the toe.

+ What’s the difference of the evo procedure compared to other techniques?

There are a variety of hammertoe correction techniques. The evo procedure was designed by Dr. Sadrieh in 2001 and differs in a variety of ways.

There are 2 main types of procedures that are used to correct hammertoes:

1. Arthroplasty - removal of a portion of bone, leaving a gap between two bones of the toe.
2. Arthrodesis - removal of a portion of bone, followed by fusion of the two bones in the toe.

Arthrodesis is the more stable of the two techniques since once the two bones are connected, the end result remains stable through time and does not deviate. With

Arthroplasty, the toe can shrink, deviate in position, or become floppy. This is because after the removal of the portion of bone from the toe, the expectation is that the empty region fills in with scar tissue (pseudarthrosis) and ‘acts’ like a soft bone replacement. This however, usually is not the case.

Both procedures are performed with an incision on the top of the toe, which is unsightly, and become painful.

Also, both procedures use a K-Wire (a long straight pin) to hold the toe in a straight position while it heals. This pain has to be left in the toe for 4-6 weeks while the healing is completed. This puts the patient at risk for pin tract infections, and more importantly, once the pin is removed, if the bone has not healed completely, the control and stability of the toe is compromised and a failure can develop.

The evo hammertoe procedure (and toe shortening) differs first because we invented the side incision technique. This allows for a cosmetic, beautiful result without a scar on top of the toe.

The second difference is the type of stabilization. Since 2001 we have used internal fixation (a device inside the toe) to stabilize the toe so we have ongoing maintenance of the position until the bone is healed. This provides excellent stable results on every case.

This also translates to a shorter recovery experience… on average evo hammertoe patients keep the foot dry for 2 weeks, and get back into shoes after 10-14 days. The traditional procedures above, require the patient to be in a post op shoe for 4-6 weeks.

+ Can I shorten multiple toes at the same time?

Yes, we can. However it’s important to design the procedure with your surgeon so that the length decisions can be made with the long term goals in mind.

+ Will my shoe size change after getting toe shortenings?

Your shoe size can get smaller depending on how much shortening you want or require. This will all be discussed with your surgeon before the procedure.

+ How many shoe sizes can I expect to go down after surgery?

This will depend on what you discuss with your surgeon, and the amount of length that can be managed safely and reliably.

+ Will I still be able to bend my toes after this procedure?

The toe is comprised of three joints, which include: metatarsal phalangeal joint (the joint at the base of the toe), proximal interphalangeal joint (the joint in the middle of the toe), and the distal interphalangeal joint (the joint closest to the tip of the toe). In most cases, the proximal interphalangeal joint (middle joint) is fused and you will not be able to bend this joint. This will not prevent your normal use of the toe. You will still be able to bend the metatarsal phalangeal joint, which is important for walking, and the tip of the toe.

+ Will my scar be visible?

The scar will not be visible because of our side incision technique. Even though it will not be visible, we still utilize a plastic surgery type closure to allow for a beautiful, cosmetic scar.

+ Does the doctor have to “break” my toe during surgery?

The surgeon will resect and remove the joint surfaces in a clean and concise method that does not involve “breaking” the toe.

+ What’s the difference of the evo procedure compared to other techniques?

Toe lengthening or reconstruction is one of the procedures that still has difficulty, and the challenges associated with it in comparison to other foot surgeries. Over years of innovation and development, we have created a procedure that is able to offer a solution for patients suffering from genetically short toes; short toes as a result of a complications from traditional hammertoe procedures, or short toes due to failures from prior surgeries.

There are 3 primary methods used to lengthen toes. It’s also important to note that lengthening toes happens in two regions: 1. Brachymetatarsia corrected with lengthening of the metatarsal, 2. Brachyphalangia or complications from prior hammertoe surgery corrected with lengthening of the toe.

In the case of brachymetatarsia, the different procedures performed are lengthening by external fixator, lengthening with bone graft, and lengthening with the use of a spacer implant. The evo procedure is unique in that the space implant is created from a material called Silastic. The space is shaped specifically for the deformity intra-operatively and is unique for every patient. The use of this spacer technology allows for a one step lengthening and has a shorter recovery process.

If we are lengthening a short toe that is a result of a prior surgery, complications from traditional hammertoe procedures, or genetically short bones (brachyphalangia), the procedure is modified by creating a smaller implant to fill the space need to lengthen the toe. Sometimes due to the nature of prior surgery complications it may be necessary to perform these procedures in stages to obtain full length.

The key difference between the evo procedure and traditional lengthening is that we use a synthetic implant that is custom made for the length needed, and is able to be performed in one step. The average recovery process for this procedure is much shorter since once the skin is healed the patient is able to wear athletic shoes and around the 6th week the patient is able to return to athletic activities.

+ Why did my toe become short after my hammertoe surgery?

Most likely you had an arthroplasty (removal of bone) instead of an arthrodesis (removal of bone, followed by fusion). With an arthroplasty, the toe can shrink, deviate in position, or become floppy. This is because after the removal of the portion of bone from the toe, the expectation is that the empty region fills in with scar tissue and ‘acts’ like a soft bone replacement. This however, usually is not the case because there is no stability.

+ What causes brachymetatarsia?

Brachymetatarsia is caused when the metatarsal growth plate closes early, resulting in premature stoppage of growth. Most of the time this is a congenital condition, but it can also be an acquired deformity following, trauma, infection, tumor, or prior surgery. The fourth metatarsal is most commonly affected.

+ How do I know if I have brachymetatarsia, or just a short toe

You will know if you have brachymetatarsia by looking at the plantar sulcus, which is the area at the base of the toes. With brachymetatarsia the region at the base of the toes indents where the ‘short toe’ is… this is because the bone behind the toe (the metatarsal) is the reason for the short appearance, not the toe itself.

A short toe is usually caused by either a complication from prior surgery, or a genetically short toe. In either case, the metatarsals are not effected and are full length, which keeps the sulcus in line with all the toes.

+ What’s the difference with the implant used for this procedure compared to other options?

Typically, there are two different procedures based on how much lengthening needs to be achieved. When less lengthening is required, the short metatarsal is typically cut and a piece of bone is grafted between the two ends. Some doctors harvest this from other body parts, such as part of your ankle bone. This can lead to other problems and pain from the donor site.

In some cases when more lengthening is required, an external fixator may be attached to the metatarsal with pins to gradually lengthen the bone. With this method, the patient has to adjust the device a few times a day per doctors orders. This is uncomfortable and does not give you a cosmetic result. You would also most likely have to stay off the surgical foot for 3 months.

The procedure performed at evo was developed by Dr. Sadrieh to optimize the recovery experience as well as improve the aesthetic outcomes. A special implant is custom created to fit your bone structure and anatomy in order to obtain the length necessary. This mitigates the need to operate on another body part to harvest bone.

+ Is it possible to hide the scar for a toe reconstruction?

The incision is closed with a plastic surgery technique which results in a small, beautiful scar. Unfortunately, it is necessary to perform this incision on the top of the toe in order to achieve a more reliable, successful result.

+ Can I choose my anesthesiologist?

We work with hand selected anesthesia providers who have shown to practice with compassion and care. They practice with the same ethos and philosophy as evo doctors. Although we would love to have our patients choose their anesthesia providers, the logistics are not possible at this time. We will try out best to accommodate requests if possible.

+ What is the difference between sedation and general anesthesia?

Sedation is also known as “monitored anesthesia care” or “twilight”. The patient is asleep and nearly unconscious, but has the ability to breath on their own. They will still be unaware of the surroundings and will not remember the actual surgery. The patient is also given a local anesthetic to the foot so they will not have any pain. With general anesthesia, the patient’s airways are taken over and monitored by the anesthesiologist, rather than breathing on their own.

+ Why is it so important that I don’t eat or drink before my surgery?

It is very important not to eat or drink 8 hours prior to the surgery. With anesthesia, your body’s reflexes are temporarily stopped. If your stomach has food and liquid in it, there is a risk of vomiting. This can also lead to aspiration, which is when food or liquid from the stomach gets into the lungs.

+ If I can’t eat or drink the morning of my surgery, how am I supposed to take my meds?

You can take a small sip of water to take your medications.

+ What if I feel pain while I’m sedated and I can’t move or inform the doctor of my pain?

The possibility of this happening is extremely low since once your anesthesia provider has sedated you, your surgeon will numb the surgical region comprehensively using long acting local anesthetics. We have a 100% trend of our patient never feeling pain during their surgery.

+ I recently had labs done for a different reason, will those work for my sedation pre-op?

As long as the labs meet the list of requirements for your procedure, and they were drawn within the time frame required for your procedure, they can be used for your pre-op clearance.

+ Do have have to get new blood drawn for each surgery?

If your procedures are performed further than 3-4 weeks apart, you might be required to have new labs drawn. Ultimately the decision is made by your surgical team, in assessing your safety. In most cases it’s best to comply with the suggested standards and draw new labs.

+ Why do I need to get a chest x-ray?

A chase x-ray may be indicated for patients with known pathology, congestive heart failure, or recent pneumonia.

+ What if I don’t have time before my surgery to see my primary care physician?

We follow the standard requirements for pre-operative history and physical examination: Any patient scheduled for surgery or an invasive procedure must have a complete history and physical examination (H&P) completed within 30 days of the procedure date.

+ Are there specific primary care physicians that I am allowed to see?

We recommend you consult with your own primary care physician since they are most familiar with your health history. However, you can visit any primary MD to have a complete history and physical performed.

+ I lost the paperwork for my history and physical, can I get new copies sent to me?

Yes, please send a text message to our team and we will forward another H&P Rx to you.

+ If I’m sedated and there is a complication with my surgery, will my doctor wake me up to discuss options with me?

We will not wake you during the procedure to speak with you. If there are problems during surgery, they will be managed, and the procedure completed safely. When you are awake in recovery your doctor will visit you to provide a summary of the procedure and if there were problems, they will share them with you.

+ Why do I have to pre op with the surgeon and my primary care doctor?

Pre-op visits serve different purposes for different specialties. Your surgeon will need to see you for a pre-op consultation to review the details of the procedure with you and provide you with information so you can consent to the procedure. Your primary care doctor will need to consult with you to perform the pre-op history and physical examination, for the anesthesia clearance.

+ Will I need crutches?

On average during the recovery of our procedures, patients do no need crutches. There are instances that crutches would be helpful. Some people find that crutches provide stability and support which gives them more confidence getting around the first 2 weeks of their recovery. Although it is not a necessity for a successful result, using them does not hurt the recovery process either.

+ Can I get a wheelchair?

Yes, we can provide a wheelchair if we have one in our loaner inventory. However like crutches, wheelchairs are rarely needed for the average recovery. Most patients are able to walk as instructed during the first two weeks, without the assistance of crutches, or a wheelchair.

If you however feel more comfortable not weight bearing and having the protection of a wheelchair, please make sure to discuss this with your doctor and we can look into making the appropriate accommodations.

+ After surgery, when do I need to come back to see the doctor?

The recovery process has some required follow up visits, after which the follow up schedule becomes flexible based on your individual recovery and response. The following schedule is for the average patient:

1st post op visit Time: Around 1 week after surgery Type of visit: In-person Necessity: Required

2nd post op visit Time: Around 2 weeks after surgery Type of visit: In-person Necessity: Required

3rd post op visit Time: Around 4 weeks after surgery Type of visit: In-person or Video Call Necessity: Required

4th post op visit Time: Around 8 weeks after surgery Type of visit: Video Call or In-person Necessity: Required

5th post op visit Time: 12 weeks after surgery Type of visit: Video Call Necessity: Preferred

6th post op visit Time: 16 weeks after surgery Type of visit: Video Call Necessity: If needed

Further visits may be needed to manage issues like swelling, or range of motion limitation. The above is an average follow up with no recovery challenges.

Other than the visits that have to be conducted in person, all visits can be completed via telemedicine, and if needed, you can schedule to come at a later time if the doctor deems it’s best to examine the foot in person.

+ Are my sutures absorbable?

The sutures used to close the skin are not absorbable and will need to be removed. The reason for this is that absorbable sutures are made of a protein material. In order to absorb this material, the local physiology has to literally digest this material. This is done by an inflammatory reaction which could result in increased scarring. To reduce the chances of scarring at the incision site, we use removable sutures and take them out around the 2nd week, once the skin is healed.

There are absorbable sutures inside your surgery, these are at the level of the subcutaneous tissues, the joint capsule, the tendons and other deep tissue layers.

+ Why can’t the doctor use absorbable sutures?

We can use absorbable but prefer not, for the reasons outlined in the last question.

+ Do I have to sleep in my post op shoe?

Although we recommend you use the post op shoe when you sleep for the first week or two, it is not a requirement. We recommend this since most people get up at night to go to the restroom, or move in their sleep and could injure their foot. The shoe has a stiff sole, designed to reduce movement at the bunion joint. It also acts like a bumper for your foot preventing excess pressure on the surgical sites.

If the shoe bothers you at night, impacts your ability to sleep comfortably, or causes too much heat or sweating, then remove it when you sleep. But make sure to keep aware that it is off, and if you wake up at night to use the restroom, make sure to put it back on.

+ Do I have to wear my post op shoe all the time?

Yes. The post op shoe must be on your foot at all times. This is particularly important when you are walking. There may be times when you have the shoe off: when you are sleeping, if you are resting and not weigh bearing for an extended period of time, or showering (more on this later); overall whenever you are awake and active, the shoe needs to stay on.

+ Is it ok to walk short distances without my post op shoe?

As long as you are walking slowly, in the method shown to you by your doctor, yes. Short distances and slow paced activity is good to get the blood flow moving and help with your recovery. There is no actual distance however that we can recommend since the response to activity varies from patient to patient, so please keep in mind to pay attention to the swelling and inflammatory response of your foot. If you are too active, it will become inflamed, swollen and cause discomfort.

+ I bumped my surgical foot, should I go to urgent care?

In most cases, no. The first you need to do if you bumped your foot is connected with your doctor. Send a message using the patient messaging system, as well as a picture of your foot and your doctor will get back to you to discuss what happened.

Remember, this is only if you bumped your foot and you are ok. If you have injured yourself significantly and think it may be a medical emergency, please call 911, and after that your doctor.

+ My foot itches, can I unwrap my dressing and then re-wrap it?

It’s preferred you keep the dressing intact without disrupting any of the layers if there is itching. If the itching is mild, connect with your doctor and they can recommend solutions to help calm the sensation. If the itching is severe, it is crucial that you connect with your doctor and discuss what you are feeling so they can determine the cause.

+ Why can’t my dressing get wet?

The dressings are a complex layered system of protection for your incisions. Getting the dressings wet will compromise the barriers and layers put in place by your surgeon at the end of your procedure, as a result mobilizing bacteria and increasing the risk for infection. Sometimes significantly. It is important… keep your dressings dry.

Learn how to use the shower boot before you get the procedure done so you can accomplish a perfect 2 week dry period with your foot.

+ What do I do if I get my foot wet?

It really depends on how wet your foot is… if the top layer of the dressing are wet, then refer to this video and follow the instructions. Once you have successfully completed the steps, inform your doctor that the dressing got wet, and you changed it as instructed in the video.

If your dressings are completely soaked, please get a hold of your doctor immediately, so they can instruct you on next steps and coordinate time to replace the dressing for you. Most likely you will perform a dressing change at home, as well as come in for a better replacement in the office.

Wet dressings increase the risk for infection, but this is only the case if the deep layers are soaked, creating an environment that allows for bacterial growth and increased risk for infection.

+ My sutures are out, and now my incision has re-opened. What should I do?

Usually the surface level opening of incisions is normal since very top layer of skin can appear to be open, but really it’s skin that has not been exfoliated due to the time in dressings and appears to be open. The skin underneath this opening is closed and immature.

If there is a concern for an opening incision, please take a well lit, focused picture of the region with your smartphone, and send it to your doctor using our patient messaging system. This way your doctor can appreciate the situation and advise you on the correct course of action.

+ Why is my incision scar red and bumpy?

It’s normal for the incision to appear red, and look bumpy during the first 6 months of healing and remodeling. Over time, the incision should lose the color and flatten out. Some skin types however have an increased likelihood of scarring, regardless of the type of closure or materials used. If that’s the case with your skin, your doctor will discuss the steps that we will take to manage and try to resolve the scar formation.

+ Where can I get another shower boot?

If your shower boot is damaged, or there is an issue with the one you were provided, please connect with your surgical concierge and they will coordinate getting a replacement for you.

+ Can I wear a regular sock over my dressing?

Yes, you are allowed to replace the off white colored surgical stockinette with a regular sock. Please keep in mind that this sock needs to be larger than your normal socks so that it allows for the bulky dressing covering your surgical site.

Also please make sure to pay attention when you are applying the sock. It is important that you do not disrupt the dressing, or “pull” the dressing back by pulling the sock up, as well as “pull” the dressings down when you are removing the sock. If you are unsure that you can do this successfully, do not risk disrupting the dressings. Leave the surgical stockinette on until your follow up appointment with your surgeon.

+ Is it ok if my feet sweat?

Sweating is normal and on average it is ok. If you have hyperhidrosis or excess sweating of the feet, please communicate this to your doctor so they can make the appropriate accommodations for your post op dressing change schedule.

Some patients will sweat more than usual because of the dressings and the post op shoe. If you feel that the amount of sweating has become excessive and is soaking the dressings, then contact your doctor.

+ What can I do if my dressing is so tight that my foot is throbbing?

Sometimes during the post op course, the inflammation and swelling can exceed our expectations, which can cause pressure against the dressing and throbbing. This can also cause discomfort. If you are experiencing this, contact your doctor using the patient messaging system, and they will provide instructions on how to loosen the dressings.

Usually the steps in this video relieve the pressure and the throbbing. Please make sure your doctor has approved performing these steps before you do them.

If this does not work, then your doctor will have you come in for a change of the dressings to loosen them and relieve the pressure. Please remember that a certain amount of compression is helpful and if it is tolerable without pain, then it is normal. Ultimately you will make this decision by discussing your experience with your doctor and they will help decide the best course of action.

+ How much walking is ok while I’m post op? Can I go shopping?

No, you cannot go shopping! Your activity during the first 4 weeks of your post op course is important since it could cause excess inflammation, resulting in pain; or worse real problems with your surgery. As a general rule, you should limit your activity to short, essential distances only. This means getting around your home, and if you’re up to it, from the house to the car, and the car to the restaurant (assuming you’re dropped off right in front).

+ I can see blood coming through my dressing. Do I need to come in to see the doctor?

Bleeding is normal during the first few weeks of the recovery process. Although the amount of bleeding varies from patient to patient, we want to make sure that the amount you are experiencing is not above average. If the bleeding does not stop after one day, please contact your surgeon to discuss how to manage the situation. If the bleeding stops after one day, but the amount of visible blood coming through the dressing is larger than 2 cm, take a picture of the region and send it to your surgeon via messaging so they can be updated on the status of the dressing.

+ How long after surgery will I be able to wear heels?

The average patient can transition to normal shoes after 4 weeks (or when you surgeon allows you) however the transition to high heels shoes is usually limited to when the swelling has subsided significantly. The ability to put normal pressure on the front of the foot is based on the healing status of the bone osteotomy, as well ask the comfort of the patient. This is usually after pressure on the front of the foot, so

+ How long after surgery will I be able to work out?

The normal time a patient can return to athletic activity is 4-6 weeks after there procedure. Of course it’s important to note that this might vary due to different scenarios like swelling.

+ After I get my sutures out can I get my foot wet and start swimming?

Swimming and activities that require “soaking” of the foot are not allowed until 3-4 weeks after the procedure, or usually 1-2 weeks after the skin has healed and the sutures have been removed. This is due to the time it takes the incision that has healed, to mature. Skin maturation is process that is important in helping reduce scar formation, as well as re-opening of the wound.

+ When is it safe to fly after surgery?

It is safe to fly a few days after surgery, however this is not optimal. It’s best to discuss your travel plans with the doctor during your pre-op visit so they have a better understanding of your intention and can help craft the optimal recovery schedule for you.

+ Do I have to finish all my medication?

You do not have to finish all of the medications the doctor prescribed you. You are required to complete the antibiotic and the anti-inflammatory medications. The pain medication is provided to help if you have pain, you are not required to finish it.

+ Does it hurt to get the sutures out?

Using the data from our post-op patient surveys, the average patient experience during suture removal is comfortable. Patients relate that the feeling is similar to a tugging sensation, with little if any pain. When patients have experienced pain during the suture removal process, it has been around a 2 out of 10 (scale of 1 to 10; lowest to highest).

If you have apprehensions about the suture removal visit, please discuss them with your doctor and they will review the process with you and prepare you before.

+ For how long after surgery do I have to elevate my foot?

It is optimal to elevate your foot whenever you are resting and not walking, particularly during the first 3 days. Throughout the first few weeks of your recovery, keeping your foot elevated will help reduce the swelling burden on the surgery and make the process easier.

When you elevate, you do not have to elevate the foot too high, usually extending your foot on a step stool or an ottoman will suffice.

+ When can I start using the scar gel?

You can begin using the scar gel after the incision has healed, and the sutures have been removed. Your doctor might place stere-strips on the incision after this step, so if that is the case, you will apply the scar gel after those stere-strips come off.

Please remember, when you apply the scar gel, you do not need to use a lot during each application. The best technique is to apply a small drop (the size of a pea) and then gently smear it on the incision and and wait for it to dry out.

+ Why do I have to take all those surveys? Does anyone actually read them?

We actually do read them! We are required to send post op surveys for our Joint Commission Accreditation. We know how busy your lives are, and truly appreciate the time you take to complete the surveys for us. These are instrumental in our development of creating the best patient experience.

+ I took all my anti-inflammatories and Arnica and I’m still swollen. Should I refill my prescriptions?

Possibly, it’s best to communicate with your doctor first. Remember that swelling is a normal part of the surgery recovery process. If the doctor determines that your swelling is abnormal or more than normal they will decide on how to help reduce it.

+ It’s been a couple weeks since my surgery and it still hurts to put weight on the front of my foot? Is that normal? Do I need to come back to see the doctor?

Pain and discomfort when putting pressure on the surgical site can be normal. Usually pain in the surgery site is related to inflammation, swelling or a tight dressing. If you’re concerned about the discomfort you’re experiencing, message your doctor and they will discuss it more in detail with you and determine if you need to come in earlier for a follow up.

+ Is ok to take over the counter medicine for pain?

Yes, over the counter (OTC) pain medicine is ok to take, however please let your doctor know what you are going to take, and how much. It’s important to make sure you are not taking too much of a particular medication, or taking medications that have interactions.

+ I can see bleeding through my dressing. Should I clean or change my dressing?

Bleeding after surgery is normal and expected. The amount of blood can vary from patient to patient, as well as procedure. The decision to change the dressing earlier than scheduled is based on a variety of factors that the doctor will decide.

If you have bleeding through your dressings, please take a clear, focused picture with your phone, and send it to your doctor via messaging. The doctor will then follow up and help coordinate the changing process.

DO NOT change the dressing yourself until you have connected and discussed it with your doctor.

+ When is it ok to call or text the doctor directly?

It is always ok to text or call your doctor directly! Please note however, that the doctor will respond to your question when they are free. If the doctor is with patients, there may be a delay in response… if your question is urgent, please message the office team and they will facilitate for you.

If you are messaging your doctor after hours and it is not an emergency, the doctor will respond as soon as possible.

+ How long after surgery is it normal to still have bruising?

Bruising is normal after injections and surgery. It’s caused by tiny capillaries that burst or are injured and bleed into the surrounding tissues. The removal of a bruise is done by a metabolic process locally, and could take 6 to 8 weeks, depending on your bodies ability to metabolize the bruising.

+ Will I be able to bend my toes like normal after surgery?

This depends on which surgery, which toe and specifically which joint we are referring to.

If we are referring to a bunion surgery, you will be able to move your toe normally once the swelling has reduced and the range of motion has returned back to normal.

If we are referring to hammertoe surgery, the joint that was fused will no longer have movement, but this will not prevent your normal use of the toe, and bending it at the important joint, the metatarsal phalangeal joint.

+ Will I still be able to be active and athletic like I am now after my foot is healed?

Yes, you should be able to continue your athletic activities around the 4th to 6th week after your surgery. The approval to participate in athletic activity will be given to you directly by your doctor. Once you have been given the okay to begin athletic activity, it’s important to remember that you just finished the first phase of healing and your foot will be swollen and still engaged in the next phases of the healing process.

With this in mind, if your foot swells as you increase your activity, it is normal. Listen to your body and reduce the intensity of your activity so the foot has a chance to continue with the healing process, without continued irritation.

Once you figure out the “sweet spot” of how active you can be without irritation to your foot, continue with that level until your body shows it can handle more. Your attention to the feedback your foot give you as you increase your activity, is one of key components of your success during the recovery process.

Ultimately we expect you to return to your level of activity before surgery (and possibly more) if everything progresses as expected and you do not experience difficulties with your recovery and healing.

+ What causes an infection?

An infection is caused by bacteria that enters your body during or after surgery. The bacteria can be on your skin and spread to the surgical wound or can be from the environment around you. There are certain factors that may increase your risk of an infection, such as problems with your immune system, being overweight or smoking.

+ How can I prevent an infection?

To prevent infection, we need to prevent bacteria from populating the incision site. Of course, this is difficult since our skin is normally colonized with bacteria. The sterilization technique we use will provide a 5-7 day window that stunts the bacterial growth.

The prescription for antibiotics given to you by your surgeon will also reduce the chances of bacterial growth. It’s important you take the Rx as instructed by your doctor.

The most important part you can play in preventing infection after surgery is to keep the dressings clean and dry. You do this by using the shower sock provided to you before surgery to keep the foot dry when you shower. It is vital to practice with the shower sock before having surgery so you know how to use it and what to expect. Another helpful step is to reduce the time you spend in the shower. Keeping your showers to just a few minutes will help reduce the chances of failure with the shower sock.

+ What steps does your office take to prevent infection?

It’s not a secret that our founder has a little OCD when it comes to precision and cleanliness :-)

This inspired our infection control protocols… some of which are unique to evo.

We keep a low volume model, which reduces the hustle and bustle in the office, reducing the chance for error and keeping the quality of the work we do high.

We clean every patient contact surface between patients.

We practice one of the newest techniques in surgical facilities: one bed, one patient. Because of our one operating room model, we’re able to keep our patients in one bed, reducing the chances for contamination between patients.

We use a double surgical scrub, prepping the surgical foot twice before the surgery.

The first scrub is performed with Hibiclens (4% Chlorhexidine Gluconate) a few minutes before the procedure. Strong clinical evidence supports Hibiclens efficacy. Unlike other non CHG antimicrobial soaps, Hibiclens not only begins killing germs immediately, it bonds with the skin and keeps on killing microorganisms, even after washing, to provide extended protection against a wide range of bacteria, including MRSA (1). It also continues killing germs for up to 24 hours (2).

The second scrub is performed with 3M Duraprep (Iodine Povacrylex/IPA). Duraprep provides both rapid bacterial kill and long lasting antimicrobial persistence. It contains 3M Prep Protection Film, which dries to form a persistent and durable layer of protection on the patient's skin. 3M Prep Protection Film was scientifically formulated to protect the prep from removal during surgery. The 3M Prep Protection film acts as a primer that helps an antimicrobial incise drape adhere to the patient's skin and protects against incise drape lift.

A proper skin prep reduces a patient's bacterial load throughout the perioperative process, providing both immediate and lasting protection.

But not all preps perform the same during surgery. Preps need to stay on the skin to remain effective. Preps can be removed during surgery by saline irrigation, dabbing with sponges or gauze, or contact with bodily fluids. 3M DuraPrep surgical solution was scientifically formulated to protect the prep from removal during surgery. It contains 3M Prep Protection Film, which dries to form a persistent and durable layer of protection on the patient's skin. (3)

As a result, a study showed that 3M DuraPrep surgical solution is more resistant to removal by saline-soaked gauze than ChloraPrep Skin Prep. In fact, the same study showed that 3M DuraPrep surgical solution had significantly greater bacterial reduction than ChloraPrep Skin Prep after challenge by saline-soaked gauze in simulated surgery. (4)

(1) Climo, Michael W., et al. The Effect of Daily Bathing with Chlorhexidine on the Acquisition of Methicillin-resistant Staphylococcus aureus, Vancomycin-resistant Enterococcus, and Healthcare-associated Bloddstream Infections: Results of a Quasi-experimental Multicenter Trial. Critical Care Medicine. 2009;37(6):1858-1865.

(2) MBT Study No. 582-106, Study Protocol # 582.1.11.12.12.

(3) Roberts AJ, Wilcox K, Devineni R, Harris RB, Osevala MA. Skin preparations in CABG surgery: a prospective randomized trial. Comp Surg. 1995;14:724,741-4,747.

(4) Stahl JB, Morse D, Parks PJ. Resistance of antimicrobial skin preparations to saline rinse using a seeded bacteria model. Am J Infect Control. 2007;35:367-73.

+ What is the infection rate at evo?

Our infection control protocols are above and beyond! We use a technique for our pre surgical scrub that has two sterilization steps, with two different products. We also use an advanced wound care dressing that releases silver ions as it absorbs bleeding and drainage.

Providing our patients with all the tools they need (like the shower sock to keep your foot dry) and being available 24/7 to manage issues, we’re proud to have kept our infection rate below 2% for the last 11 years (that’s about 1, or 2 cases per year).

It’s important to understand that statistics, although important, are not actual determinants in the chances of getting an infection. What matters most is that we work closely together, and you follow the instructions provided by your surgeon. An of course, the most important part, is to stay in close communication with your surgeon and update them on issues, should they arise.

+ How can I tell if I have an infection?

Infections often present with redness, swelling, are hot to touch and may have pus or drainage. You may also have a fever. You should immediately contact your surgeon if you think you have an infection.

+ My foot is red and swollen, does that mean I have an infection?

Not necessarily, aggressive post-op inflammation can also present as red, hot, and swollen. It is important keep in communication with your surgeon, so we can manage the scenario and make decisions for you.

+ Are there any doctors in my state that do the same procedures as Dr Sadrieh?

The procedures created by Dr. Sadrieh are unique to our practice, and have not been taught to other doctors outside of evo advanced foot surgery.

+ Do I need to go to there for a consultation?

Although much of the initial information and discovery process before your procedure can be performed remotely leveraging technology, the ultimate decision making for the surgery and final diagnosis is made after an in-person consultation. It is strongly recommended that this consultation be performed at least 2 weeks before you have a procedure performed to provide ample time for questions and answers with your doctor, before surgery.

+ Can I have a doctor in my area change my dressings?

Although a dressing change seems like a simple step, due to the unique recovery process with our procedures, it is strongly recommended that the post operative dressing change and management process is only performed by your surgeon. In rare occasions, the doctor may approve the co-management of your recovery with a colleague closer to you. If this is the case, the doctor will refer you and remain in contact during your recovery.

+ Can I have a doctor in my area take my sutures out?

With the majority of our surgeries, we strongly recommend that your own doctor removes the sutures.

+ How long do I have to stay in Los Angeles?

The optimal window for you to stay in Los Angeles is 10-14 days. If you leave when the sutures are out, and the skin is healed, the risk level is significantly reduced. In special cases, the doctor may approve a 2 visit recovery, where you can leave after the dressing change and return for the suture removal… but this can only be determined by your doctor after consideration.

+ Will the doctor ever travel to my area so I can see him here?

Your doctor may travel to your area, and there may be a possibility that you can see each other for conversation and review.

+ How often will I need to get x-rays after I return home?

Our patient concierge will connect with you and coordinate post op X-Rays after your 6th week of recovery. In certain cases, further X-Rays may be ordered (if there is concern for unexpected problems, or trauma to the surgical site).

+ How will I stay in touch with the doctor for follow-ups after I return home?

You can always message the doctor if you have questions or concerns. Please following the messaging links in the Contact page of our site.

+ How will I remember to get x-rays at the right times and send them to the doctor?

Our concierge will follow up with you when the time comes for your post op X-Rays. Usually this is after 6th week.

+ Can I arrange transportation from my hotel to the doctor’s office for my appointments?

Yes, we encourage that you have transportation coordinated for your appointments so you have a smooth visit and recovery experience. It’s important to note that it is preferred you have someone with you on the day of surgery when you are heading back to your place of stay. If you are using a ride service, we will require that you sign a waiver allowing us to discharge you to a ride service from our facility.

+ Do you have suggestions on hotels in the area?

There are many excellent places to stay that are close to our location. To best fit the style of the place of stay to your needs, our concierge can provide recommendations on your pre-op visit with them. Please make sure to discuss this with your concierge so they can help guide you.

+ Will my insurance cover my procedure?

Most insurance plans have coverage for surgery, we can look into your benefits in advance and review the details with you.

+ What insurances does the doctor accept?

The doctor accepts most PPO plans with in and out of network benefits.

+ What can I expect my out-of-pocket to be?

Your out of pocket expenses will depend on the type of coverage and benefit level you have. We can verify your benefits and review them in advance. If you do not have insurance, we can review the out of pocket fees and different payment options.

+ Before my appointment, can someone from your office call me to tell me my benefits?

Isn’t this the same questions as above?

+ How much does the implant cost?

Depending on which type of implants the doctor uses for your procedure, the out of pocket fees can range from $1200 to $1500 each.

+ Is the procedure considered cosmetic by insurance companies?

Most of our procedures are not considered cosmetic, however this depends on your diagnosis. In most cases they are medically necessary.

+ If my insurance won’t cover Celebrex, do I still have to take it?

If your plan does not have coverage for the medication prescribed, you can talk to the doctor and ask if there is anything equivalent, or we can assist you with finding a pharmacy that has the medication reasonably priced.

+ What exactly is included in the cost of the surgery?

If this question is for a cash patient - Your pre-op appointment and all post op appointments are included in your out of pocket fees. We will also provide you with a post operative kit. If this is for an insurance patient - Your estimated out of pocket is based on your deductible and coinsurance.

+ If I need a revisional procedure later on, will that be an additional cost to me?

If you need to have a revision surgery, we will be sending a claim to your insurance company for the procedure taking place.

+ How much does a consultation cost?

The consultation fee depends on your coverage. You might have an office copay, which will be collected on your appointment day. Once the claim has been processed, depending on your benefits you will be billed.

+ Can I set up a payment plan?

You can arrange a payment plan through our payment processing system. You can also use a credit card, or apply for Care Credit and pay at your own pace without interest.

+ If I’m being seen as a cash patient, can I pay with a credit card?

Yes, you can pay with a credit card for all services. We accept Visa, Mastercard, American Express, the Apple Card. You can also call or text our office and we can assist you with taking your payment information.

+ Is there an option to pay my bill online?

Yes, you can pay your bill directly through our online payment processor. After we have billed for our services, you will received a text message from our payment processor with the remaining balance (adjusting for the payment made by your insurance carrier). This message will contain a link for you to make your payment directly from your phone.

+ Can I pay my bill over the phone?

Yes, you can pay your balance over the phone. You can call on of our team or send a text message and we will coordinate the payment for you.

+ What is the price difference between local and sedation?

Before determining the cost, you must discuss the decision of which form of anesthesia your doctor requires for your procedure.

If the doctor decides you are a candidate for local anesthesia, there are no additional fees for the anesthesia component of your procedure.

If the doctor determines your procedure needs to be performed with sedation, there may be out of pocket fees, which will depend on your insurance coverage.

+ How much will the prescriptions cost?

Your prescription coverage is part of the insurance plan you are covered by. Since we do not have access to this information, your pharmacist will be able to assist you determining the potential out of pocket costs.

+ What is an EOB?

The acronym “EOB” stands for Explanation Of Benefits. This document shows how the claim was processed. In most cases it takes 3-4 weeks for a claim to process, with exceptions. In some cases your insurance company might ask for documentation, which could delay the processing time.

+ Why did my insurance company send me a check?

In some cases, when you consult or have surgery with a doctor that is not contracted and out of network, your insurance will mail you the check. It is important to note, this check is for the doctor, for the services provided to you. You are required to forward this payment to the doctor per our financial policy.

+ How long does it take for a claim to be processed?

It usually takes 3-4 weeks for your insurance company to process a claim. In some cases, it can take longer depending on your insurance company’s request for documentation.

+ How come I keep getting EOB’s with the same date of service?

In some cases you will receive multiple EOB’s from your insurance company. This could happen if our billing department is appealing your claim, or has to re-submit your claim.

+ Where is the surgery performed?

We only perform surgery at our own surgical facilities. We have a lot of innovations to be proud of, but the one we’re most excited to share with our patients is our unique surgical experience. The design and flow of our surgical process is unique to evo, and does not exist anywhere else in the World. In fact, we’re so confident that this level of care is the best there is, we encourage the rest of our surgical colleagues to replicate it… every patient will benefit form the slow flow, one on one, human experience focused design we have implemented in our ultra premium facilities.

+ Why are the surgeries not performed at a hospital?

Our procedures are designed with the optimum patient experience in mind. This begins at the moment the patient walks into an evo. To make sure we can curate a complete end to end experience for our patients, we only perform our procedures at our own facilities. This give us full control to design the best, without compromise.

+ Is your facility accredited?

Yes, we are proud to have our facilities accredited by the Joint Commission. For over 40 years the Joint Commission has been the leading accreditation body for hospitals and out patient, ambulatory surgical facilities.

+ What makes your surgical facility special?

Whatever we say here, is just words! The only way to appreciate how special our facilities are, you have to experience the space… but we can say this: the evo surgical experience is a result of 20+ years of the unrelating pursuit of excellence by our founder, Dr. Ali Sadrieh. Every millimeter of our space has been thoughtfully designed by him, as an answer to the lack of a quality human experience in healthcare.

+ Can other surgeons perform surgery at your facility?

We built our facilities with the same ethos as the other aspects of our practice… they contribute to the excellent experience we believe our patients deserve. Since the entire evo system operates as one philosophic expression of excellence, our facilities are closed to outside surgeons, and only available to doctors who practice with the evo perspective: low volume = high quality.

+ Why is the fee for the facility separate from the fee for the surgery?

We appreciate how complicated the fee system in healthcare can be. To simply this, we can describe it this way: the facility fees are for the costs of our physical space, the team members as well as the materials we use to provide the best quality care. The professional fees are the fees charge by the doctor for the performance of the procedure, and the time and treatment during the post op timeline.

+ Does the doctor have before and after photos I can see?

We will take before and after pictures for your and send them to you via messaging. There are certain cases however, due to time constraints, or other factors that pictures may not be taken.

+ Can I sign-up for a consultation online?

Yes, you can access our online scheduling page here.

+ Why does the doctor only see patients 2 days a week?

We have built our practice dedicated to the slow flow principle… low volume = high quality. In order to allow for the optimum performance of our craft, we schedule only a few surgeries on surgery days, limiting our consultation time to 2 days per week. We believe that keeping the quality of our care at the highest level, is more important than volume.

+ Why is the wait so long for a new patient consultation?

This is one of the most challenging challenges for us… how can we increase the volume of patients we see, without compromising on the quality of the care we provide? It’s no secret that the more patients doctors see, the less time they have with each patient.

To respect those important moments we spend together during our initial discovery stage of the procedure design phase, our new patient consultations are scheduled for 1 hour, and our pre op sessions are scheduled for 30 minutes. This in effect reduces the number of patients we can accommodate for initial consultations, increasing the wait for an appointment.

We’re confident, our consultation with you will be worth the wait 🙏🏼

+ Can I speak to a patient that has had my same procedure?

We may be able to arrange a conversation with a prior patient for you. We’ve had the privilege of serving tens of thousands of people from around the world; many of whom would love to share their experiences with potential patients. The possibility of connecting you with a prior patient depends on the current status of prior patients available for conversation.

+ Does my implant have to stay in forever?

Most of the implants we use for our procedures are designed to remain in the body indefinitely. The removal of surgical implants, on some cases is an option that patients want to exercise. Please discuss this with your doctor.

+ Does my screw have to stay in forever?

Almost all of the screws we have placed for patients have remained in place. There are rare instances that we would suggest removal of screws.

+ Will my implant cause metal detectors to go off?

None of the implants we use at evo set off metal detectors.

+ Is the exposure to radiation from the x-rays safe?

The level of radiation exposure during X-Rays of the feet are very low. In addition, we have minimized the number of X-Rays we take during the post op timeline, so your concern for radiation exposure should be low. If you are concerned however, please discuss this with your doctor.

+ Do I have to take off my clothes and jewelry for surgery?

We recommend that you DO NOT bring any jewelry to your surgery day. You will have a private changing room where you can safely store your clothes and other personal belongings during the procedure.

On the day of your procedure, you will change from your regular clothes, to a surgical robe. You will not be required to remove your underwear.

+ What happens during my pre op appointment?

Pre op appointments are important, they are the time you will review the procedure in detail with your surgeon and have an opportunity to review the potential risks and complications of the prescribed procedure.

Pre op visits with your concierge are also important since you will have a chance to review the post op kit, recovery schedule and potential insurance questions and answers.

You will also have your pre op history and physical coordinated as well as any labs or imaging required before your procedure.