Archive for Sports Medicine
Fractures
Posted by: | CommentsA podiatrist, like myself, is trained to handle almost all conditions concerning the foot. Not a week goes by in my office that someone does not come in with some sort of broken bone. If you feel you have broken a bone in your foot please seek medical attention immediately. Although it is true that some fractures do not require much care, it is also true that patients who put off the care of a fracture could have trouble getting the fracture to heal. The process is usually as simple as getting xrays (in office), diagnosis and treatment for the particular type of fracture present. Treatments range from splinting, protective shoe, walking cast and sometimes surgery. Yes, sometimes a fracture requires fixation using screw, pins and plates!
Signs of a possible broken bone in the foot are:
-Pain when walking.
-Bruising.
-Swelling.
-A change in foot or toe shape.
Occasionally, I have a patient come into my office with some of these signs but with no history of an injury or fall. Many times x-ray reveals that they have a fracture in their foot and they were not suffering with much pain. This particularly happens in patients with weak bones or osteoporosis. Please take these signs seriously and hopefully we can get you on the road to recovery as quickly as possible.
Ankle Sprains
Posted by: | CommentsAnkle sprains are about as common as shopping carts at the grocery store. Take a wrong step, walk on uneven ground, or be active in athletics, and sooner or later, you will probably have an ankle sprain. By definition, an ankle sprain is a type of injury involving some degree of ligamentous trauma, be it over stretching, partial rupture, or total tear. Along with this ligament injury is some level of ankle joint instability, which can become an invitation for future reinjury and weakness. Ankle sprains usually involve either the inside or outside aspects with the outer variety being the much more prevalent type due to its weaker structures and greater tendency for injury. The typical presentation of an ankle injury is acute pain, swelling, bluish-black bruising or discoloration, loss of motion, and one’s inability to weight-bear without discomfort. A thorough examination by a specialist is recommended in order to rule out other problems such as fractures, tendon ruptures, and discolorations.
The actual cause of an ankle sprain is trauma that creates excessive strain, stretching or tension on the inherent ligamentous structures resulting in subsequent injuries and disability. The ankle joint will only move so far and then something has to give. In certain isolated cases, a bone will fracture but in the vast majority of cases, a ligament is over stretched, partially tears, or totally ruptures. Pain is the unmistakable common denominator with simple weight-bearing often becoming an impossible task. The trained specialist in his or her examination will be able to largely assess the degree of injury, the probable mechanism of injury, and the chances for partial to total recovery.
The treatment approach to a sprained ankle is largely determined by how soon after the injury it is seen. Assuming that we are dealing with a fresh injury seen within hours to a few days of the trauma, our first line of treatment should be directed at reducing the soft tissue swelling. Immobilizing the injury site is used to limit unnecessary motion along with rest, elevation, ice, and compression to reduce the pain. Physical therapy and rehabilitation are then used to reestablish ankle joint stability and strength. Orthotics and braces are sometimes used for the purpose of supporting the foot and ankle while reducing any allowable abnormal range of motion. Surgery is occasionally used to strengthen the ankle joint ligaments in those cases involving chronic instability and a frequent history of sprains. Too often under addressed ankle sprains lead to a laxity of the ankle anatomy and recurrence of these ankle sprains can become more frequent.
Haglund’s Deformity – The Old Pump Bump
Posted by: | CommentsHaglund’s deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).
Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, any shoes with a rigid back, such as ice skates, men’s dress shoes, or women’s pumps, can cause this irritation.
To some extent, heredity plays a role in Haglund’s deformity. Inherited foot structures that can make one prone to developing this condition include:
- A high-arched foot
- A tight Achilles tendon
- A tendency to walk on the outside of the heel.
Symptoms
Haglund’s deformity can occur in one or both feet. The symptoms include:
- A noticeable bump on the back of the heel
- Pain in the area where the Achilles tendon attaches to the heel
- Swelling in the back of the heel
- Redness near the inflamed tissue
Diagnosis
After evaluating the patient’s symptoms, the foot and ankle surgeon will examine the foot. In addition, x-rays will be ordered to help the surgeon evaluate the structure of the heel bone.
Non-Surgical Treatment
Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Non-surgical treatment can include one or more of the following:
- Medication. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce the pain and inflammation.
- Ice. To reduce swelling, apply an ice pack to the inflamed area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
- Exercises. Stretching exercises help relieve tension from the Achilles tendon. These exercises are especially important for the patient who has a tight heel cord.
- Heel lifts. Patients with high arches may find that heel lifts placed inside the shoe decrease the pressure on the heel. This tends to reduce the tension on the back of the heel.
- Heel pads. Pads placed inside the shoe cushion the heel and may help reduce irritation when walking.
- Shoe modification. Backless or soft backed shoes help avoid or minimize irritation.
- Physical therapy. Physical therapy modalities, such as ultrasound, can help to reduce inflammation.
- Orthotic devices. Custom arch supports control the motion in the foot.
- Immobilization. In some cases, casting may be necessary.
If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. The foot and ankle surgeon will determine the procedure that is best suited to your case. It is important to follow the surgeon’s instructions for post-surgical care.
Achilles Tendonitis
Posted by: | CommentsThe calf muscles are attached to the heel by the Achilles tendon. This is primarily the thickened cord or fibrous band that runs down the back of one’s leg and attaches to the heel bone. The main function of this complex is to force the foot downward in gait and thus propel one forward. Achilles tendonitis is a common diagnosis for all podiatrists and Dr. Sowell is no different. Athletes, housewives, factory workers and professionals are just a few of the types of patients who suffer from Achilles tendonitis. The cause may be varied. Sometimes it is to injury from a direct impact, from over-use or excessive training, or can just start hurting as a result of shoe pressure. The patient with an Achilles tendonitis will most often have pain and swelling in the lower portion of the tendon just above the heel, will have discomfort when moving the foot upwards thus stretching the tendon, and will probably note that the condition has worsened over time.
It is hard to predict who will suffer from Achilles tendonitis but there are certain factors, which seem to be likely. Trauma or injury to the Achilles tendon itself is an obvious cause of subsequent tendonitis. An altered gait, high heels over a long period of time or limb length discrepancy can also create excessive strain upon the Achilles tendon resulting in localized swelling and pain. Over use, excessive training and improper stretching can also result in Achilles tendon injuries. The bottom line though, in most cases of Achilles tendonitis, is the same…pain, reduced range of motion, localized swelling, and a potential long-term problem that is usually slow to respond to therapy.
In discussing the treatment approaches to an Achilles tendonitis, we must first mention the necessity of a thorough examination by a specialist. Fractures of the heel bone, partial ruptures of the tendon itself, and localized soft tissue problems must all be carefully considered and ruled out. The specific treatment of an Achilles tendonitis might include physical therapy, shoe padding (lifts to raise the heel), possible orthotics, oral anti-inflammatory medication, some form of immobilization, and reduced physical activity until the condition improves. Surgery, although mentioned for completeness is rarely used. It should be mentioned that this painful and often disabling condition, while frequently slow to respond, will usually improve and resolve with therapy over time.
Patients often find themselves in a “catch 22” where the tendon needs to be lengthened through a progressive stretching program but said program only aggravates the condition. With careful diagnosis and addressing of symptoms, Dr. Sowell can determine the best way to proceed and hopefully return the patient to activity sooner than expected.
Orthotics at Sowell Podiatry in Nacogdoches and Carthage Texas
Posted by: | CommentsFoot orthotics are supportive devices that are designed specifically for the purpose of improving one’s postural stability, reducing shock impact, and/or improving weight distribution. In most cases, these devices are functional in the sense that they also improve one’s biomechanical performance during gait. An impression of some sort, is usually taken of your feet, and used in the selection and fitting of a prescription orthotic. The particular information regarding anticipated cost, durability, and use may vary depending upon the type of orthotic and should be discussed with your foot specialist.
What do they do?
Imagine if you will, standing barefoot in moist sand with the arch being filled by the smooth sandy undersurface. The heel and ball of the foot leaves a mild depression in the sand while the toes grip the ground without resistance. If one could stand like this for lengthy periods of time, he or she would probably not have sore feet, would experience less fatigue and probably would not have many of those commonly encountered forefoot skin problems such as corns, calluses, and ingrown toenails. The problems come from standing on cement, asphalt, or other non-yielding surfaces, our wearing confining shoes, which further limit foot flexibility, and from lengthy periods of ambulation, which add fatigue and strain to one’s body.
Orthotics assist in restoring supportive comfort by bringing the ground surface up to the foot. They serve to improve postural stability, distribute one’s weight more evenly, and improve the mechanical functioning of the foot and ankle. Although orthotics do not cure every ache and pain in the foot, they are a wonderful approach in providing maximum comfort through improved biomechanics. Standing comfortably in sand is not necessarily an unreachable feeling even while wearing your everyday shoes.
Limb Length Discrepancy at Sowell Podiatry
Posted by: | CommentsA limb length discrepancy is a condition in which one leg is longer than the other. Some people have this condition and are completely unaware of it, while others experience a great deal of pain and discomfort. This condition can alter the way you walk, can affect weight distribution during gait, and can in some cases, cause knee and hip problems. It is normal to have slight variations in the length of the lower limbs. However, in certain cases, this variation can and will produce clinical symptoms. Foot specialists deal with and treat limb length discrepancies on a regular basis and are specialized in this area of dysfunction.
As a general rule, patients find it interesting that the long limb gets the worst of it! In gait the longer leg has to work much harder, travel much farther and therefore wears out much earlier. Patients often start to put these pieces of the puzzle together when they realize why they have been having problems in only one foot or leg.
What causes it?
Limb length discrepancy may be caused by a number of factors. Developmental alterations in the womb ca affect how the legs are formed. Persistent resting and sleeping positions of the growing child can result in limb length variations. Trauma can also cause a difference in the length of one’s legs. If a bone breaks in the lower leg, this may be enough to stop the growth of normal bone and cause a limb length discrepancy. Hereditary factors may also lead to this deformity. If limb length discrepancies run in the family, this may also increase one’s risk of developing this condition.
How is it treated?
Limb length discrepancies can be treated by a number of methods. If the dysfunction does not cause any pain or symptoms, it may go untreated. However, if this dysfunction causes pain, discomfort, or difficulties with ambulation, the condition should be treated. A thorough examination by a trained specialist should be the first step in any treatment plan. After a thorough examination, special orthotics or shoe modifications may be made to reestablish limb length equality and improved function. The orthotics may consist of a simple heel lift or may be customized to the patient’s foot. These modifications should help to effectively treat the deformity as well as to decrease the compensatory discomfort.
