The world of orthopedic surgery in Southern California is full of fascinating stories. Although the Southland is widely considered America’s cosmetic surgery capital, it isn’t widely known that the surgeons of San Diego and its neighbors also tend perform a number of other elective surgeries.

This news story caught the eye of many of you: a piece in the New York Times about a trend to improve the aesthetic and structural beauty of patients’ feet. One cannot make up some of the extraordinary branding terms that lard the article from top to bottom, including such gems as “toebesity” and “Cinderella procedure.” The purpose of these procedures is to fulfill a timeless desire; one doctor calls them:

“the final frontier” for those who have had work done on their faces. “My practice has exploded because of Manolo Blahnik, Christian Louboutin and Nicholas Kirkwood,” he said in a recent phone interview. “There’s nothing like opening a shoe closet that’s been closed to somebody for years.”

Suffice it to say, your foot is a complex mechanical structure that must bear and redirect hundreds of pounds every minute. Altering the basic geometry or stability of a foot to fit into a pair of shoes is a dangerous game. Far better to find ways you can achieve the look you want without altering an essentially functional body part.

As an orthopedic surgeon, I can say with confidence: Those feet were made for walking.


Hot on the heels of my last post about knee pain, I’d like to return to the very same space to discuss some ways you can manage shoulder pain, improve mobility, and avoid shoulder surgery altogether.

The key is strength, especially the kind of supple, dynamic strength that arises from stretching rather than brute-force workouts with kettle bells, dumb bells, or bar bells. In a recent New York Times column, people with rotator cuff injuries were offered the same basic advice, including stretching with bands and supporting your body through the full range of motion. And then came this especially useful tip:

Don’t wait to start the program, by the way, until your shoulders ache. “These exercises are excellent for preventing shoulder injuries,” Mr. Ellenbecker said, “in addition to rehabilitating injured shoulders.”

This exercises focus on strengthening the rotator cuff muscles and the muscles of the upper back.  Again, this is the holy grail of shoulder longevity and health.

Whether you’re heading for shoulder surgery or recovering from an orthopedic surgical procedure, basic stretches are the easiest way to keep your body moving comfortably, fluidly and without pain. To learn more, please contact the San Diego shoulder surgery experts here today.


As a San Diego orthopedic surgeon, I field a lot of questions about how to minimize joint pain from repetitive and everyday activities. One of the most common: “How can I minimize knee pain when I’m going down the stairs?”

The short answer is a healthy dose of stretching and exercise.

But a more detailed answer has recently surfaced in the New York Times’ Well column, which outlined a simple prescription:

This discomfort is magnified if you have weak quadriceps or thigh muscles, [Dr Bozic] added, since the force that might otherwise be absorbed by those large muscles moves through the knee instead. So to strengthen your quadriceps, try straight leg raises, [he] said. Simply lie on your back with one leg bent. Lift the other leg, straightened, at least six inches off the ground; tighten the thigh muscles and hold for a few seconds. Lower and repeat several times. Then do the same exercise with the other leg. Your physician or an athletic trainer can suggest other safe exercises that target those muscles.

Dr Bozik’s approach is a fairly simple answer.  The more complex answer lies in the practice of yoga and pilates.  Yogi and pilates practitioners learn to engage the ‘core’.  Strengthening the thigh muscles (one of which is the quads) and strengthening the ‘core’ takes you a tremendous way.  But the holy grail is a concept called ‘muscular co-contraction’; this activity entails teaching your core muscles to activate with the use of the thigh muscles.  This is what all exercises aimed at protecting athletes from ACL tears and preventing the resurgence of anterior knee pain is all about.  There, the genie is out of the bottle!  Further recommendations included stay in motion, avoid sitting in a chair all day, take a stretch break from computer work (say 5 min every hour) when you can.…if all else fails call it a bathroom break.

And if your knee pain should require knee surgery in San Diego? Contact the knee surgery experts here to schedule an appointment today.


Stanford University, that perennial hotbed of innovation, does not discover all of its new ideas in the computer lab. As a recent New York Times profile makes clear, Stanford has also developed one of the most unusual strength and conditioning programs in the country for college football players.

The program prizes flexibility over brute strength and mobility over locked bodies. The goal of strength coach Shannon Turley is to minimize injuries and enhance practical strength. But does it work?

From 2006, the year before Turley arrived on the Farm, as Stanford’s campus is known, through last season, the number of games missed because of injury on the two-deep roster dropped by 87 percent. In 2012, only two Cardinal players required season-ending or postseason surgical repair; this year, only one.

The science behind this approach is based largely on stretching, on deep and symmetrical strength exercises, and even on yoga. Plus there’s this:

Turley pays particular attention to his players’ Functional Movement Screen scores. The F.M.S. is a durability index, what Turley calls “a predictive, quantitative analysis of quality of movement.” That is the first test he conducts. It evaluates seven movements and scores players as balanced, functional, overpowered, dysfunctional and injury prone. It shows if a player executes a movement better with his left leg than his right, pointing out asymmetries.

It is a smart approach that has cut down on the sorts of knee surgeries and shoulder surgeries which can plague NFL prospects long before they ever hit the big time. As a San Diego orthopedic surgeon who has spent a lot of time with professional sports teams, I can attest that there is no substitute for enhancing the body’s natural ability to flex and twist without injury. Plus gaining a berth in the Rose Bowl isn’t too shabby either.

If you’d like to learn more about sports injuries, sports surgery and how to maintain an active life, please don’t hesitate to contact the sports medicine experts here today.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow