Frank Giangrasso, 63, of Hicksville, NY, worked seven days a week delivering Italian bread to customers on Long Island for his family business. The job required a lot of time on his feet, which wasn’t a problem until a couple of years ago, when Frank began experiencing some numbness in his right foot and toes. “I was working every hour of the day,” said the father of two adult boys and grandfather of two. “But physical things like that didn't stop me. I just didn't pay attention to it.”

However, a year later, Frank noticed a bump on the bottom middle of his right foot. It started to irritate him as the weeks passed, so he used orthotics to help cushion his feet as he worked. When the bump started getting bigger, he knew he had to see a doctor.

“He looked at it and he said, ‘I think you're diabetic.’" Blood tests confirmed that Frank had type 2 diabetes.

In July of 2017, he started seeing an endocrinologist, who happens to be his niece. She prescribed the anti-diabetic medication metformin, and helped Frank develop a healthy eating plan to reduce his blood sugar. Frank took his diagnosis in stride, cutting out soda and ice cream, and eating more fruits and vegetables.

In the meantime, Frank’s brother-in-law (who is also a doctor) did some online research and suggested making an appointment with Adam Bitterman, DO—an orthopedic surgeon, and foot and ankle specialist at Orthopaedic Institute at Huntington.

Dr. Bitterman examined the bump on Frank’s foot and said it was the result of diabetic Charcot arthropathy, a condition in which poor circulation in the feet can cause the bones and soft tissues in joints to disintegrate. “Because of accompanying nerve damage, patients often can’t feel how serious the injury is,” Dr. Bitterman explained, adding that without surgery, Frank’s foot would likely become increasingly malformed with a higher chance of wound breakdown and infection. It would also develop ulcers, an entry point for infection that could potentially cause him to lose his leg.

The possibility of losing his leg alarmed Frank, but he understood that surgery was his best option. In January 2018, Frank had a foot osteotomy, in which Dr. Bitterman carefully broke selected malformed bones of the right foot and realigned them. He then surgically attached a large external metal frame to the foot called a ring fixator, which stabilizes the bones so they heal correctly. The procedure took about six hours.

“I woke up and had pins in my leg, starting from maybe six inches below my knee, and I couldn't walk,” said Frank. "But Dr. Bitterman prepared me for how the fixator would look and feel, why the device was necessary and the recovery process.”

After a weeklong hospital stay, Frank moved to an inpatient rehabilitation center, where he kept weight off of his foot as it healed. When he returned home seven weeks later, he participated in physical therapy sessions through the Northwell Health At Home program, and used a walker and crutches to get around the house. A visiting nurse cleaned the fixator’s entry points on the leg and foot, and changed Frank’s bandages several times a week for about three months. He visited Dr. Bitterman for monthly follow-up appointments to ensure bones and tissue were healing properly. In April of 2018, the fixator came off and Frank wore a cast on his knee for four to five weeks.

Frank attended outpatient physical therapy to work on his mobility. After 20 visits, he started going for walks near his house. He continues to do his own physical therapy exercises at home. “Even today, if I get up quickly, my balance is not 100 percent yet,” said Frank. “Dr. Bitterman said it could take a year or more to fully recover.” 

The doctors and other providers at Orthopaedic Institute at Huntington were a large part of Frank’s recovery process. He was so impressed with the care he received, he made a deal with the administrative staff. “I started to bring them bread every time I went for a visit,” he said. “I still go there once a month with a package of goodies because I appreciated the way they treated me.”