New York Yankees shortstop and captain, Derek Jeter will miss the rest of the playoffs after suffering a fractured left ankle while trying to make a play in the 12th inning of Saturday night's 6-4 loss to the Detroit Tigers in Game 1 of the American League Championship Series.
Jeter walked off the field with the help of Yankees manager Joe Girardi and the trainer. X-rays revealed an ankle fracture. This will take at least 2-3 months to heal and then rehab. He is done for the season.
Ankle fractures can be tricky and depending on the angle and separation of the fragment, he could require surgery to put the pieces back together so they can heal in the correct position.
Any time you fall down or twist your ankle, an x-ray should be taken. Yes, you can walk on some ankle fractures and delayed diagnosis can lead to a much more complicated recovery and even long term disability.
Got ankle pain? Contact us for an appointment. For more information on ankle fractures, click here.
Sunday, October 14, 2012
Tuesday, June 26, 2012
Got Bunion Pain?
Do you have pain in your bunions? Are they slowing you down? Don't be afraid to go to the podiatrist. Help is on the way. Does the conversation with your family sound like this couple?
Sunday, June 10, 2012
Stem Cells Now Used to Treat Foot and Ankle Pain
For a very long time, I have been watching the stem cell research and debates and patiently (not really) waiting for a useful application in the foot and ankle. Whether you are for or against this topic, this blog is not a debate on its use. My blog today is to tell you about the patients I have used it on and their success.
I began to use it in my practice last December with skeptical ideas on how successful it could be. I've been pleasantly surprised at the results. Let's start with what the stem cells are.
I use AmnioMatrix. This is amniotic fluid taken from mothers who have consented to have the fluid removed during C-sections. There is absolutely no harm to mom or baby and this is not done prior to birth. The fluid is then cryopreserved with no additives keeping the cells live for use when they are thawed and injected. So why these cells? Their job in the baby making process is to protect the fetus and help with development. When you hear the term "my water broke", that's amniotic fluid. When placed in an adult to the site of an injury or chronic pain area, these cells recognize what is missing or not normal and begin a healing process. If you want to read more of about this, Applied Biologics will answer a lot of questions.
What have I used it for so far? Plantar fasciitis, Achilles tendonitis, neuromas, non-healing fractures, non-healing ulcers
So let's talk about some patients that have benefitted from this product.
The first one is Amy. She is a very active 45 y/o mom and business professional who began having pain in her Achilles tendon after a long run. This progressed to a large knot on the back of her Achilles tendon above where it inserts on the back of her heel. We call this Achilles tendonitis or tendonosis. She attempted resting, icing, physical therapy, good shoes. No steroid injections are performed in a tendon area because this can cause rupture of the tendon. I sent her for an MRI which came back as small micro tears in the tendon. This means the tendon isn't completely torn, just very tiny tears causing the swelling and pain. During all of this, she was not able to work out and her mood had dropped significantly at home and work. We talked about her options and in the past, surgery to clean out the tendon was her only resort. She decided to try the amniomatrix instead.
This did require surgery, but minimally invasive. I made a very small incision on the side of the bump on her Achilles tendon. I opened the protective sheath around the tendon and made several small holes in the bump called a microtenotomy. This allowed a portal for the stem cells to reach inside the tendon. I injected the AmnioMatrix stem cells all around the tendon, then carefully closed the sheath and skin.
She did very well during her recovery. She had no pain at post op day 5 and never really had swelling or bruising. She used her walking boot for 3 weeks and was able to walk without crutches at post op day 3. After crutches, she wore tennis shoes for 2 months and made sure not to do a lot of barefoot walking. She started a light exercise program at week 4 and has progressed back to running at her normal pace with pain. And her mood is dramatically better.
The next patient I want to talk about is Kathleen. She is a 50 y/o financial advisor who suffered a fracture of one of her sesamoid bones. The sesamoids are 2 small bones that lie under your big toe joint and help propel you forward when you walk. I treated her like I would any fracture by placing her in a walking boot to reduce pressure and pain and ice. Normally bone heals at 4-6 weeks. After 3 months, she had no improvement in pain and X-rays showed the bone was not healing. I ordered an MRI which showed the fracture without surrounding edema which means it had stopped healing. Normally, the next step is surgery to remove the injured sesamoid. But she was not happy with the possibility that her big toe would drift after surgery. So we discussed amniomatrix.
This also required a small surgery. Under anesthesia, I used a large pin and drilled several holes through the fracture line and the bone. This was done under a live X-ray in the OR. I then injected the entire area with AmnioMatrix. Post op she wore her boot for 6 weeks. Was pain free at week 2, could move her toe without pain at week 3. She started wearing tennis shoes at 6 weeks and began gradual increase in her activity. She remains pain free and is doing very well in regular shoes.
I've got lots of stories like the 2 above and over the next several weeks will be sharing those with you so check back often. If any of these stories make you say "Hey, that's me", come see me!
I began to use it in my practice last December with skeptical ideas on how successful it could be. I've been pleasantly surprised at the results. Let's start with what the stem cells are.
I use AmnioMatrix. This is amniotic fluid taken from mothers who have consented to have the fluid removed during C-sections. There is absolutely no harm to mom or baby and this is not done prior to birth. The fluid is then cryopreserved with no additives keeping the cells live for use when they are thawed and injected. So why these cells? Their job in the baby making process is to protect the fetus and help with development. When you hear the term "my water broke", that's amniotic fluid. When placed in an adult to the site of an injury or chronic pain area, these cells recognize what is missing or not normal and begin a healing process. If you want to read more of about this, Applied Biologics will answer a lot of questions.
What have I used it for so far? Plantar fasciitis, Achilles tendonitis, neuromas, non-healing fractures, non-healing ulcers
So let's talk about some patients that have benefitted from this product.
The first one is Amy. She is a very active 45 y/o mom and business professional who began having pain in her Achilles tendon after a long run. This progressed to a large knot on the back of her Achilles tendon above where it inserts on the back of her heel. We call this Achilles tendonitis or tendonosis. She attempted resting, icing, physical therapy, good shoes. No steroid injections are performed in a tendon area because this can cause rupture of the tendon. I sent her for an MRI which came back as small micro tears in the tendon. This means the tendon isn't completely torn, just very tiny tears causing the swelling and pain. During all of this, she was not able to work out and her mood had dropped significantly at home and work. We talked about her options and in the past, surgery to clean out the tendon was her only resort. She decided to try the amniomatrix instead.
This did require surgery, but minimally invasive. I made a very small incision on the side of the bump on her Achilles tendon. I opened the protective sheath around the tendon and made several small holes in the bump called a microtenotomy. This allowed a portal for the stem cells to reach inside the tendon. I injected the AmnioMatrix stem cells all around the tendon, then carefully closed the sheath and skin.
She did very well during her recovery. She had no pain at post op day 5 and never really had swelling or bruising. She used her walking boot for 3 weeks and was able to walk without crutches at post op day 3. After crutches, she wore tennis shoes for 2 months and made sure not to do a lot of barefoot walking. She started a light exercise program at week 4 and has progressed back to running at her normal pace with pain. And her mood is dramatically better.
The next patient I want to talk about is Kathleen. She is a 50 y/o financial advisor who suffered a fracture of one of her sesamoid bones. The sesamoids are 2 small bones that lie under your big toe joint and help propel you forward when you walk. I treated her like I would any fracture by placing her in a walking boot to reduce pressure and pain and ice. Normally bone heals at 4-6 weeks. After 3 months, she had no improvement in pain and X-rays showed the bone was not healing. I ordered an MRI which showed the fracture without surrounding edema which means it had stopped healing. Normally, the next step is surgery to remove the injured sesamoid. But she was not happy with the possibility that her big toe would drift after surgery. So we discussed amniomatrix.
This also required a small surgery. Under anesthesia, I used a large pin and drilled several holes through the fracture line and the bone. This was done under a live X-ray in the OR. I then injected the entire area with AmnioMatrix. Post op she wore her boot for 6 weeks. Was pain free at week 2, could move her toe without pain at week 3. She started wearing tennis shoes at 6 weeks and began gradual increase in her activity. She remains pain free and is doing very well in regular shoes.
I've got lots of stories like the 2 above and over the next several weeks will be sharing those with you so check back often. If any of these stories make you say "Hey, that's me", come see me!
Sunday, April 8, 2012
So You Think a Broken Toe Isn't Serious?
So you think a broken toes is no big deal? Just last week I had a runner come in 6 months after breaking her 5th toe by kicking a shopping cart. She didn't have it x-rayed because in her words, "I didn't think there was anything you could do for a broken toe".
Here she was six months later because not only was she having a hard time fitting her still swollen toe in a high heeled shoe for work, but now it was bothering her in her running shoes. Pain when running will always bring a runner in the office!
What had happened is that she had an oblique fracture of her proximal phalanx which was displaced and healed in an abnormal position. In English, she broke her 5th toe and the bone healed crooked making a big lump that rubbed on her 4th toe causing a blister then a large corn in between the toes.
These types of corns known as "heloma molle" are very painful and can often get infected. In a diabetic or other patients with poor immune systems, these can even lead to a toe amputation! In my runner's case, she was treated conservatively with a silicone toe sleeve to pad it off until she had time to have an arthroplasty of the toe which is a surgery that removes part of the poorly healed bone and alleviates the rubbing. This surgery could have been prevented by seeking help earlier as soon as she broke her toe.
Take home message: if you think you broke your toe, have it x-rayed and see your favorite podiatrist. They may tell you it is broken, but straight; or they may need to numb it up and pull it back into the correct position, so you can avoid surgery that will keep you laid up for weeks!
Here she was six months later because not only was she having a hard time fitting her still swollen toe in a high heeled shoe for work, but now it was bothering her in her running shoes. Pain when running will always bring a runner in the office!
What had happened is that she had an oblique fracture of her proximal phalanx which was displaced and healed in an abnormal position. In English, she broke her 5th toe and the bone healed crooked making a big lump that rubbed on her 4th toe causing a blister then a large corn in between the toes.
These types of corns known as "heloma molle" are very painful and can often get infected. In a diabetic or other patients with poor immune systems, these can even lead to a toe amputation! In my runner's case, she was treated conservatively with a silicone toe sleeve to pad it off until she had time to have an arthroplasty of the toe which is a surgery that removes part of the poorly healed bone and alleviates the rubbing. This surgery could have been prevented by seeking help earlier as soon as she broke her toe.
Take home message: if you think you broke your toe, have it x-rayed and see your favorite podiatrist. They may tell you it is broken, but straight; or they may need to numb it up and pull it back into the correct position, so you can avoid surgery that will keep you laid up for weeks!
Wednesday, February 29, 2012
Do My Swollen Legs Need Compression?
I recently had a patient who came into the office telling me that his feet and ankles hurt. When I asked him to describe his pain, he described it as “not really painful anywhere in particular, just uncomfortable because they are tight all over”. He also mentioned that “my legs get tired”. Well, the foot bone is connected to the leg bone, as is all the skin and what’s underneath as well!
Looking at this guy’s legs, feet and ankles, what was most obvious was the swelling! His exam showed no issues with bone, tendon or ligament. He just had some swelling!
Swelling (aka edema) is an excessive collection of fluid in the soft tissues of your body. In the legs, it can cause that dull, achy, heavy and tired feeling. This feeling gets worse towards the end of the day or after standing for a long period of time. Does this sound familiar? Though you might have gotten use to it, this is not normal and should really be treated.
There are many causes of swelling in the lower extremity. Some of these include high blood pressure, congestive heart failure, liver or kidney problems, medications and varicose veins.
It is important that you visit with your primary care physician to try and nail down the cause of your swelling. Once you have done so and are being treated for the underlying condition, your podiatrist can help you to get some of the fluid off of the legs. The best way of doing this from our end is with the use of compression socks or stockings.
Compression (the amount of pressure or tightness you will feel) of the sock/stocking is listed in the form of “mmHg”. You should see this on every compression garment you purchase. The lightest form of compression is in the 15-25 mmHg range and goes up from there. The amount of compression and the actual length (knee-high to thigh-high) is chosen depends of how bad your edema is and to where it is most evident. Your podiatrist will typically start you on a low level of compression and work up to a higher level as needed.
A few things to keep in mind:
1. If you have heaviness in the legs and have noticed that you have less hair growth on your legs, cramping, pain and/or cold feet /legs, this could be a sign of arterial disease. If you area not sure whether or not you have arterial disease because you have never been checked for this, it is important to discuss testing for this with your podiatrist prior to using compression.
2. Remember to wash your garment preferable daily or at least every two days allowing them to air dry out of the sun or a dryer, both of which can break down the fabric. Have at least two pairs of compression garment to trade them out.
3. Inform your podiatrist the minute you notice any bruising in the lower extremity or any bluish discoloration to the toes.
4. Let your podiatrist know if the garment feels loose. As the swelling improves, the garment will feel looser. Depending on the level of swelling you have at that stage and your tolerance, your podiatrist may recommend a higher level of compression.
Looking at this guy’s legs, feet and ankles, what was most obvious was the swelling! His exam showed no issues with bone, tendon or ligament. He just had some swelling!
Swelling (aka edema) is an excessive collection of fluid in the soft tissues of your body. In the legs, it can cause that dull, achy, heavy and tired feeling. This feeling gets worse towards the end of the day or after standing for a long period of time. Does this sound familiar? Though you might have gotten use to it, this is not normal and should really be treated.
There are many causes of swelling in the lower extremity. Some of these include high blood pressure, congestive heart failure, liver or kidney problems, medications and varicose veins.
It is important that you visit with your primary care physician to try and nail down the cause of your swelling. Once you have done so and are being treated for the underlying condition, your podiatrist can help you to get some of the fluid off of the legs. The best way of doing this from our end is with the use of compression socks or stockings.
Compression (the amount of pressure or tightness you will feel) of the sock/stocking is listed in the form of “mmHg”. You should see this on every compression garment you purchase. The lightest form of compression is in the 15-25 mmHg range and goes up from there. The amount of compression and the actual length (knee-high to thigh-high) is chosen depends of how bad your edema is and to where it is most evident. Your podiatrist will typically start you on a low level of compression and work up to a higher level as needed.
A few things to keep in mind:
1. If you have heaviness in the legs and have noticed that you have less hair growth on your legs, cramping, pain and/or cold feet /legs, this could be a sign of arterial disease. If you area not sure whether or not you have arterial disease because you have never been checked for this, it is important to discuss testing for this with your podiatrist prior to using compression.
2. Remember to wash your garment preferable daily or at least every two days allowing them to air dry out of the sun or a dryer, both of which can break down the fabric. Have at least two pairs of compression garment to trade them out.
3. Inform your podiatrist the minute you notice any bruising in the lower extremity or any bluish discoloration to the toes.
4. Let your podiatrist know if the garment feels loose. As the swelling improves, the garment will feel looser. Depending on the level of swelling you have at that stage and your tolerance, your podiatrist may recommend a higher level of compression.
Sunday, February 5, 2012
Not Motivated to Exercise?
It is the first weekend in February and it is now that all those people who decided January 1st to start an exercise program have fizzled out and returned to the couch. Are you one of those individuals? Not motivated to exercise any more? If you are, I'm sure you are wondering why that happened?
Let's look at a few reasons to why this happens and how you can turn it around:
1. Your goal was to exercise 1 hour everyday of the week.
If you have not exercised in a while, this is really unrealistic. And attempting it will cause you to fail 99.9% of the time. Start with something you CAN do...20 minutes 3-4 times a week. Progress 5 minutes each week adding another day after every 3 weeks. This is gradual increase in exercise and will reduce your chances for heel pain and Achilles tendonitis.
2. You decided to lose 30 lbs in the first month.
For healthy weight loss, 1-2 lbs per week is the best. So how do you do this if you don't have a gym membership? Easy...just walk. All you need is a good pair of tennis shoes. Want to know which shoe is right for your? The doctors at FAANT are experts in knowing what is best for your feet.
3. Your reward for losing weight is a treat of your favorite food.
Don't reward yourself with food. That will make it that much harder to lose those inches. Better yet, how about a new pair of jeans or a night at the movies (but skip the buttered popcorn!). Download the newest album from your favorite artist.
4. You keep cheating!
Before you start your week, write down excuses you have used in the past to cheat on your healthy eating. Then write down responses and ways to counteract this when the urge arrives.
5. You tried exercising everyday, but just got bored.
If you don't like walking on a treadmill, you don't have to. If you find biking to be more boring than watching paint dry, then don't do it. Do what you like. Are you a dancer? Have you tried Zoomba? How about just turning on your stereo for 40 minutes and shaking your thang! Are you a fish in the summertime? Then join a local Y with an indoor pool and swim all year long. The important thing is just to move!
Hopefully these 5 things will help in your journey for better living. Along the way, your feet are going to hurt. That's why FAANT is here! If your foot or ankle is preventing you from meeting your goals for a healthier lifestyle, call us right away!
Let's look at a few reasons to why this happens and how you can turn it around:
1. Your goal was to exercise 1 hour everyday of the week.
If you have not exercised in a while, this is really unrealistic. And attempting it will cause you to fail 99.9% of the time. Start with something you CAN do...20 minutes 3-4 times a week. Progress 5 minutes each week adding another day after every 3 weeks. This is gradual increase in exercise and will reduce your chances for heel pain and Achilles tendonitis.
2. You decided to lose 30 lbs in the first month.
For healthy weight loss, 1-2 lbs per week is the best. So how do you do this if you don't have a gym membership? Easy...just walk. All you need is a good pair of tennis shoes. Want to know which shoe is right for your? The doctors at FAANT are experts in knowing what is best for your feet.
3. Your reward for losing weight is a treat of your favorite food.
Don't reward yourself with food. That will make it that much harder to lose those inches. Better yet, how about a new pair of jeans or a night at the movies (but skip the buttered popcorn!). Download the newest album from your favorite artist.
4. You keep cheating!
Before you start your week, write down excuses you have used in the past to cheat on your healthy eating. Then write down responses and ways to counteract this when the urge arrives.
5. You tried exercising everyday, but just got bored.
If you don't like walking on a treadmill, you don't have to. If you find biking to be more boring than watching paint dry, then don't do it. Do what you like. Are you a dancer? Have you tried Zoomba? How about just turning on your stereo for 40 minutes and shaking your thang! Are you a fish in the summertime? Then join a local Y with an indoor pool and swim all year long. The important thing is just to move!
Hopefully these 5 things will help in your journey for better living. Along the way, your feet are going to hurt. That's why FAANT is here! If your foot or ankle is preventing you from meeting your goals for a healthier lifestyle, call us right away!
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