On the move once more

Irene Soto wanted her total ankle replacement surgery at Eisenhower Health — and nowhere else.

For Irene Soto, 66, the seemingly simple act of walking around the block without pain is now an occasion for celebration and gratitude. 

Achieving that milestone required a nearly six-year journey of dogged determination to get the medical care she wanted — namely, a total ankle replacement performed by an expert surgeon who won’t shy away from a difficult case. 

In October 2018, she met that person in David Friscia, MD, Board Certified in Orthopedic Surgery and Director of Foot and Ankle Surgery at Eisenhower Desert Orthopedic Center. “He saw a challenge in my problem,” Soto remembers, “but he also saw opportunity.”

“I enjoy taking on complex surgeries,” says Dr. Friscia, “and achieving real patient satisfaction.”

Soto’s appreciation of Dr. Friscia is magnified by the fact that two orthopedic surgeons and a podiatrist (all at other facilities) said ‘No’ to replacing her faulty ankle. They advised that she opt for an ankle fusion, which would freeze the joint in place. “But I didn’t want to walk like a zombie,” says Soto, “so I kept looking."

Her troubles began one fateful day in September 2014, when Soto was attempting to hang a curtain rod in her Eastvale home in Riverside County, with one foot on a step ladder and the other on a TV cabinet. 
She felt her foot begin to slip off the cabinet and couldn’t halt the inevitable fall. When she landed, she not only fractured her right ankle, she dislocated it. “My foot twisted in an awkward position,” Soto says. 

Mending a Bad Break
To complicate matters, she had broken her talus, an important bone of the ankle joint that links the foot and the leg and gives the ankle stability. An orthopedic surgeon near her home repaired the ankle, implanting metal plates and screws for support. 

Over time, that repair deteriorated. The screws began breaking and arthritis pain in the injured ankle intensified. Soto found herself walking on the inside of her foot, causing problems with her knee. She had to give up favorite activities like working out and dancing. She had moved south from Northern California to take care of her elderly mother, but even that was increasingly arduous.

Then, in fall 2018, Soto’s sister, Mary Lou Montagna, who lives in Rancho Mirage, spotted a newspaper announcement that Dr. Friscia would be addressing total ankle replacement in one of Eisenhower Health’s-community education lectures.  

Montagna attended and told Dr. Friscia about Soto, whom he invited to come see him. A few days later, Soto sat in front of the doctor she calls “the best thing that happened to me.”

“In the past, the answer to Irene having a total ankle replacement would be no,” says Dr. Friscia. 

The task would require a reconstruction and realignment of the foot and ankle prior to the definitive ankle replacement, both of which Dr. Friscia is highly experienced with and comfortable. He is also inspired by the philosophy that, “People do better with motion.” 

Not only had Soto found the right surgeon, she had arrived at the right place and right time. “Foot and ankle surgery has been revolutionized in the past couple of decades and we can treat many conditions more effectively,” says Dr. Friscia. “Most of the procedures we do today didn’t exist 20 to 30 years ago.”
Eisenhower Desert Orthopedic Center, which has performed the most total ankle replacements of any facility in the Inland Empire and is one of the higher volume centers in Southern California, includes 16 orthopedic surgeons, all fellowship-trained and board certified, who together represent almost every orthopedic subspecialty. With an expansion that is nearly complete, the Center’s state-of-the-art facilities will soon include eight operating suites. 

Testing Innovative Options
Eisenhower Health also has an active orthopedic research program. It is one of 10 national sites for an ongoing 10-year study of the INFINITY™ Total Ankle Replacement system. Dr. Friscia serves as principal investigator. The Prophecy™ navigation system — used in conjunction with the INBONE™, INFINITY and INVISION™ systems — is used to make custom, 3-D printed, sterile patient-specific intraoperative cutting guides to aid in alignment and make the procedure more precise.  

In March 2019, Soto reported to Eisenhower Health for the first in a two-phase procedure in which Dr. Friscia removed the old hardware inside her foot and straightened its alignment. The second phase took place in January 2020, when Dr. Friscia implanted the INVISION™ Total Ankle Revision System, designed specifically for revision surgery.

After rest and physical therapy, Soto reports that the arthritis pain in her ankle is gone and she’s ready to go dancing. She has advice for others considering this type of surgery. “Get a second opinion or a third or fourth. Exhaust whatever avenues you have to see what can be done.” 

To contact Eisenhower Desert Orthopedic Center, please call 760.773.4545 or visit EisenhowerHealth.org/EDOC.