Bryce Karulak, DPM

09/22/2026

Sometimes things go really well in surgery. Sometimes they don't. Sometimes you complete a surgery knowing that while extremely challenging, it came out really well only to have your patient come back the following week and have destroyed what was accomplished. Honestly, I don't get mad; but, I do feel bad for the patient because they have complicated their recovery in ways they do not understand. This patient is a non compliant diabetic with signs of Charcot intra op during the initial fracture fixation surgery. She returns a week later with premature weight bearing and loss of reduction. She then is scheduled for revision surgery. Her weakened bone state allowed for an intra-operative fracture which required removal of the nail and screw fixation for reduction of the fracture and reinsertion of the nail. Everyone has complications, it's about how you deal with them for the patient's best possible outcome.

09/15/2026

One of my recent posts demonstrated use of a novel fixation device (Ossiofiber) in an 80 year old female. Many times we have cases we post and follow up can be hard to keep track of. I'm sure many of you wonder what is the integrity of an implant that dissolves over time? X-rays are pre surgical, 1 week post and 6 weeks post. She has returned to regular shoes.

08/25/2026

Here we have an 80 y/o female with a painful bunion and two painful hammertoes (2 and 3). She exhausted all the conservative care and wanted a procedure that would get her moving with less pain. We chose MIS bunion with Ossio Implants. She is weight bearing since day of surgery. Age is just a number!

08/18/2026

Have you ever wondered if CAM/ Fracture boots are effective for weight bearing after fracture? I have; and, when a patient returns after "weight bearing in a boot the whole time" but yet their fracture or operative site with fixation has lost correction, it makes me wonder; is it the patient or is the boot ineffective.

Today, I, at least, have my answer.

3 weeks ago, I was helping a friend cut down a downed tree in his backyard. I live out in the country and this is what I do for stress relief. Nonetheless and ironically, a large piece of wood I cut fell and landed on my foot causing the fracture seen in the x-rays. At first, all I could think about was a Lisfranc's but luckily I escaped with a 2nd met mid shaft fracture. Moderately painful weight bearing radiographs proved I did not have a concomitant lisfranc dislocation. I, like everybody else, did not want to remain NWB even though I would require my patient to do the same. This technically is an unstable fracture, and in this case, did not require surgery but should have easily moved with placing weight on the foot. I have a flatfoot type so I figured slight elevation of the 2nd met might not be an entirely bad thing for me as I do overload on the 2nd MTP. So for two weeks, I walked in the boot. I did invert the foot initially due to pain and took myself off of NSAIDs the day after the injury to increase the rate of healing of the fracture.

2 weeks later I get another x-ray. Not only is it mostly healed, there is also no callus or displacement. I was not expecting that especially since I would walk with an inverted foot around the house without the boot during those two weeks as well. So, now I have my answer; boots really do work well and decrease pain substantially. If used right, they will keep these type of fractures stable. So for the most part, I now realize that patients who come in with displaced operative fixation/ alignment, did not use the boot or used it incorrectly if they were allowed to weight bear. They also likely had pain control to a level that was beyond what they needed. After all, pain is protective.

Possible outliers for my health could be:
I swim 3-4 days a week
I started 10,000 IU of Vit D and 1000mg Vit C
I eat healthy but I do like pastries and will eat hospital food and the like 2-4 times a week
I cold plunge daily
I generally skip one meal a day
I am 43 years old
BMI is 26 (technically overweight)
Some of this may be causation (vit d and protected WB) but I believe most of it is association with fracture healing.

This makes me also wonder, what on Earth are patients eating? How non compliant are they?

I am open to any other explanations as well.

08/11/2026

08/11/2026

X-rays can be deceiving. Here you can appreciate the deformity in the ankle but note that it actually does not have as much of an effect as expected.

08/04/2026

I have this patient scheduled for surgery in the next week. Their history is MVA with ORIF of tibia for what was likely a Pilon although the history is from the patient only. The injury happened many years ago and they do not have any information regarding treatment protocols/ notes. However, their symptoms are as follows: fixed varus deformity, no ankle or subtalar joint pain, gastroc equinus, with no peroneal action of unknown origin but associated with the injury. The muscle action of the TA is intact with 5/5 strength. The patient complains of an unstable gait pattern with frequent sprains. Yes the x-rays are non weight bearing and if you have recently followed my posts, we recently fixed that in the clinic we moved into. However, they have a fixed deformity with subluxation of the ankle joint. They do not want a TTC fusion as I had suggested for correction since they are on the younger side and would prefer to keep ankle motion. So the proposed procedures are:
Gastroc recession
deltoid release with possible PT tendon lengthening
Lateral ankle ligament reconstruction
Split TA tendon transfer
Here is my question, would you rather perform an STJ fusion or Lateralizing calcaneal osteotomy? I ask since they will have a CFL repair which will inhibit their varus ROM in the STJ and therefore the ROM is not likely necessary and will contribute to stability. However, a lateralizing calcaneal osteotomy will help insure that they will be less likely to go back into varus in the future. Thoughts?

07/21/2026

Here is a recent surgery I performed for a pediatric patient for bunion correction. She was skeletally mature (no open growth plates) and we decided on a Minimally Invasive Lapidus Fusion. She saw me about 6 years prior but I asked the parents to wait until she was able to have this procedure to reduce the likelihood of bunion recurrence.