Archive for Sports Medicine
Peroneal Tendon Injuries
Posted by: | CommentsPeroneal tendons are two tendons that support two important foot muscles (peroneus brevis and peroneus longus) that originate on the outside of the calves. These two muscles allow you to roll to the outside of the foot while standing.
Peroneal tendons are also called stirrup tendons because they help hold up the arch of the foot. The two muscles are held in place by a band of tissue, called the peroneal retinaculum. Injury to the retinaculum can cause this tissue to stretch or tear. When this happens, the peroneal tendons can dislocate from their groove on the back of the fibula. The tendons can be seen to roll over the outside of the fibula, which damages the tendons.
Skiing, football, basketball, and soccer are the most common sports activities leading to peroneal tendon dislocation. In some cases, ankle sprains have also caused this condition. Patients usually have to use crutches after such an injury, in order to allow the retinaculum tissue to heal and the tendons to move back to their natural position on the fibula. Sometimes a splint or compression bandage is applied to decrease swelling. Anti-inflammatory medications and ice are often part of the treatment. Note: Please consult your physician before taking any medications.
In moderate to severe cases of injury, when the peroneal retinaculum is torn or severely stretched and susceptible to dislocation, surgery may be required.
A Quick Note on Athletic Shoes from Sowell Podiatry
Posted by: | CommentsRecently a new footwear company asked me to review their shoes. They have sent me a pair and I have been wearing them while walking each morning. I’ll write a detailed review at some point in the future but I wanted to share a few basic points about athletic shoes in general.
Athletic footwear should be fitted to hold the foot in the position that’s most natural to the movement involved. Athletic shoes protect your feet from stresses encountered in a given sport and to give the player more traction. The differences in design and variations in material, weight, lacing characteristics, and other factors among athletic shoes are meant to protect the areas of the feet that encounter the most stress.
Well-fitted athletic shoes need to be comfortable, yet well-constructed and appropriate for a given activity. A good fit will mitigate blisters and other skin irritations.
Sports-specific athletic shoes are a good investment for serious athletes, though perhaps a less critical consideration for non-athletes. Don’t wear any sport or other shoes beyond their useful life.
A running shoe is built to take impact, while a tennis shoe is made to give relatively more support, and permit sudden stops and turns. Cross training shoes are fine for a general athletic shoe, such as for physical education classes or health club exercising, such as on stair machines and weight-lifting because they provide more lateral support and less flexibility than running shoes. They also tend to be heavier than running shoes, but most people don’t need light, flexible shoes for cross-training. If a child is involved more heavily in any single sport, he or she should wear shoes specifically designed for that sport.
Our practice recommends sturdy, properly fitted athletic shoes of proper width with leather or canvas uppers, soles that are flexible (but only at the ball of the foot), cushioning, arch supports, and room for your toes. Try a well-cushioned sock for reinforcement, preferably one with acrylic fiber content so that some perspiration moisture is “wicked” away.
Athletic shoes need to be replaced after one year, whether or not they are worn, and after a certain amount of repetitive load is placed on them and wears them down. The American Academy of Podiatric Sports Medicine advises replacing running or walking shoes after 300 to 500 miles of wear, and replacing aerobic, basketball, and tennis shoes after 45 to 60 hours of wear. Athletic shoes should also be replaced if they show signs of unevenness when placed on a flat surface, display noticeable creasing, and/or when the heel counter breaks down.
Orthotics at Sowell Podiatry in Nacogdoches
Posted by: | CommentsOrthotics, also known as orthoses, refers to any device inserted into a shoe, ranging from felt pads to custom-made shoe inserts that correct an abnormal or irregular, walking pattern. Sometimes called arch supports, orthotics allow people to stand, walk, and run more efficiently and comfortably. While over-the-counter orthotic are available and may help people with mild symptoms, they normally cannot correct the wide range of symptoms that prescription foot orthoses can since they are not custom made to fit an individual’s unique foot structure.
Orthotic devices come in many shapes, sizes, and materials and fall into three main categories: those designed to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.
Rigid Orthotics
Rigid orthotic devices are designed to control function and are used primarily for walking or dress shoes. They are often composed of a firm material, such as plastic or carbon fiber. Rigid orthotics are made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot. Rigid orthotics control motion in the two major foot joints that lie directly below the ankle joint and may improve or eliminate strains, aches, and pains in the legs, thighs, and lower back.
Soft Orthotics
Soft orthotics are generally used to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. They are usually effective for diabetic, arthritic, and deformed feet. Soft orthotics are typically made up of soft, cushioned materials so that they can be worn against the sole of the foot, extending from the heel past the ball of the foot, including the toes. Like rigid orthotics, soft orthotics are also made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot.
Semi-Rigid Orthotics
Semi-rigid orthotics provide foot balance for walking or participating in sports. The typical semi-rigid orthotic is made up of layers of soft material, reinforced with more rigid materials. Semi-rigid orthotics are often prescribed for children to treat flatfoot and in-toeing or out-toeing disorders. These orthotics are also used to help athletes mitigate pain while they train and compete.
Heel Pain in the Young Athlete – Sowell Podiatry – Nacogdoches
Posted by: | CommentsEvery year I see a dozen, or so, young athletes that are having problems when playing. Typically they are running on their toes to avoid heel pressure and play explosive sports with increased heel pressures. Of course these children need to be assessed and properly diagnosed to rule out more severe conditions, but I want to discuss calcaneal apophysitis today as spring begins!
We can often learn a good deal about a particular medical condition if we understand the terminology used in its description. The term, calcaneal, refers to the heel bone while apophysitis describes an inflammation of the heel’s growth center in a child. A calcaneal apophysitis is a condition usually seen in young athletic or physically active children of the age group 8-15. The heel is painful with running or jumping, is usually not swollen visually or discolored, and seems to get progressively worse without treatment. A parent will often bring in a child because of limping during game play along with complaints by the child of discomfort in and around the heel.
Most authorities seem to agree that this condition results from acute or chronic (repetitive) trauma to the heel at a time of vulnerability due to natural growth periods. It should be noted that the heel area of the foot is under normal circumstances, not highly vascularized or well supplied by blood circulation. This means that the area of the foot will heal slower and might be subject to increased risk of injury. Acute trauma refers to a sudden impact or blow to the involved site while repetitive trauma involves cumulative stress over an extended period of time. The bottom line is similar however, with trauma to the growth plate area of the heel being the culprit.
The management of a calcaneal apophysitis condition involves protection and support of the heel in order to allow for normal developmental growth. This can be accomplished by padding the heel of the shoe, wearing protective cups, and in some cases to even further reduce weight-bearing by casting and or crutches. Often I’ll recommend alternating NSAIDs and applying ice before and after activity. The continuance of athletic competition during treatment is an issue that is largely dependent upon how the child responds to therapy initially. In most cases, where the symptoms reduce early on with treatment, the child might continue with physical activity. On the other hand, if the symptoms persist well into the therapy period, then reducing or eliminating continued physical activity might be necessary. This condition in most cases, can be readily managed once identified and properly treated and almost always resolves over time.
Ankle Sprain – Ankle Pain in Nacogdoches Texas
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 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.
Ice Massage for Plantar Fasciitis – Heel Pain – Dr. Mark E. Sowell, DPM
Posted by: | CommentsOne of my favorite ways to ice the bottom of the foot, particularly the plantar fascia, is to freeze a water bottle. Simply take a water bottle, throw it in the freezer and let it freeze. Every day after that, simply place it on the ground in front of you (on its side) and roll it back and forth like a rolling-pin. Roll it from the ball of the foot back to the pad of the heel. This will completely cover the length of the plantar fascia and should relieve the symptoms of its swelling. If you press downward on the bottle, with your foot, while you roll it back and forth you also get a pretty good massage along with the effect of the ice.
The plantar fascia is a dense fibrous band that runs along the plantar surface (bottom) of the foot and is fairly easy to recognize. Simply lift the big toe and the medial slip of the plantar fascia will become more prominent in the arch and if you follow it back to the heel this is the most common place for the plantar fascia to be painful. Most people with plantar fasciitis have pain when the get up in the morning or when they get up after sitting for a few minutes. Hope this helps!
