Foot and Ankle Procedures

VNUS Closure - Radio Frequency Ablation

What is VNUS Closure - Radio Frequency Ablation

The VNUS Closure procedure is offered for treating larger varicose veins. The Closure procedure is performed on an outpatient basis by using radiofrequency (RF) energy applied to the inside vein walls of the damaged vessel. This same-day out patient minimal invasive procedure is an alternative treatment option to traditional vein stripping surgery.


RFA is a treatment for:

venous reflux, also called chronic venous insufficiency, the root cause of varicose veins and achy, tired legs.

A needle size thin catheter is placed in the diseased vein without incisions. The catheter then delivers radiofrequency (RF) energy which causes the diseased vein walls to shrink and close.

Once the diseased vein is closed, blood is re-routed to healthy veins. The circulation actually improves after the vein closure! The procedure takes about 20 minutes and is a minimal invasive procedure.  There is virtually no postoperative discomfort.


Patients who undergo the Closure procedure often resume normal activities quickly with excellent cosmetic and therapeutic results. Following the procedure, the leg is wrapped in an Ace bandage for 24 hours. Patients are encouraged to walk, which help improve circulation. Patients who undergo the Closure procedure can resume normal activity the same day. Full activity including strenuous exercise can resume after 7 days.

Most people notice an improvement in their symptoms within several days of having the procedure.  Studies have shown that the Closure procedure has a 95% long term success rate.

Is RFA covered by insurance?

The procedure is approved by the FDA and is covered by medical insurance plans and Medicare.

Hammertoe Surgery
Ganglion Cyst Surgery
Soft-Tissue Biopsy
Achilles Tendon Rupture
Ankle Ligament Surgery
Ankle Fractures
Equinus Deformity
Posterior Tibial Tendon Dysfunction (PTTD)
Chronic Ankle Instability
Heel Pain (Plantar Fasciitis)

Unique Surgical Procedures done by Dr. Goswami.

These procedures are not typically performed by most foot & ankle surgeons.

Ankle Arthroscopy with Stem Cell Application for Talar Dome Lesion

What Is a Talar Dome Lesion?   

The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). “Osteo” means bone and “chondral” refers to cartilage.

Talar Dome

Talar dome lesions are usually caused by an injury, such as an ankle sprain. If the cartilage does not heal properly following the injury, it softens and begins to break off. Sometimes a broken piece of the damaged cartilage and bone will float in the ankle.

Signs & Symptoms

Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. The signs and symptoms of a talar dome lesion may include:

  • Chronic pain deep in the ankle—typically worse when bearing weight on the foot (especially during sports) and less when resting
  • An occasional clicking or catching feeling in the ankle when walking
  • A sensation of the ankle locking or giving out
  • Episodes of swelling of the ankle—occurring when bearing weight and subsiding when at rest


A talar dome lesion can be difficult to diagnose because the precise site of the pain can be hard to pinpoint. To diagnose this injury, the foot and ankle surgeon will question the patient about recent or previous injury and will examine the foot and ankle, moving the ankle joint to help determine if there is pain, clicking or limited motion within that joint.

Sometimes the surgeon will inject the joint with an anesthetic (pain-relieving medication) to see if the pain goes away for a while, indicating that the pain is coming from inside the joint. X-rays are taken, and often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury.

Operative Treatment

Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. A variety of surgical techniques is available to accomplish this. Most surgeons do not attempt to optimize the healing potential upon debridement and repair of the lesion.

My Unique Technique:

Upon removal or debridement of the osteochondritis lesion, we replace the dead defective tissue with either an autograft or allograft tissue. Additional option includes stem cell injection into the ankle joint in association with microfracture to promote cartilaginous growth to the ankle joint. The combination of microfracture with stem cell application provides significant promotion for cartilage replacement and provides the patient a much better surgical outcome as the stem cells are replacing the cartilage of the ankle joint.

The addition of stem cells, allograft or autograft tissue provides the benefit of a more dynamic assessment of the lesion and the severity of lesion instability and assessment of injury to the overlying cartilage. These techniques would also be applied to defects that are larger than 5mm. Most of these operative treatments are performed as an arthroscopic outpatient procedure. Often patients need to undergo a period of non-weight bearing with either cast or brace immobilization to promote healing for approximately 6-8 weeks after surgery.

PRP with Radiofrequency for Plantar Fasciitis
Plantar Fascia Ultrasound guided Percutaneous Plantar Fasciotomy
Regenerative Medicine Injectable Micronized Amniotic Membrane Allograft