Geovany Soto and His Os Trigonum

Geovany Soto and His Os Trigonum His Os Trigonum is gone thank goodness! He should be ready to rock and roll by opening day! What is this Os Trigonum latin-sounding thing anyway?? An Os Trigonum is a small extra bone that is connected to the back of one of the bones that make up the ankle. If we have one, it has been there since birth. This bone is meant to fuse to the back to this ankle bone (known as the talus) as we grow, but sometimes it does not and ends up sitting back there, usually well behaved. When a catcher with an Os Trigonum (like Geovany Soto) squats, this bone can get pinched and cause a great deal of pain and swelling in the back of the ankle! The pain can act like Achilles tendonitis and is commonly mistaken for this. When ice, rest and anti-inflammatories don’t help, the options are to put the foot in a big black surgical boot for a while (not an option when the Rangers need him ASAP!) or to take the bone out! The surgery itself involves an incision between the outside of the Achilles and the ankle bone. The bone is carefully shelled out and the skin is sewn up!

That is it pretty much! Recovery is much quicker that an Achilles tendon surgery and the relief is outstanding! He is no worse for the wear without this extra bone and the Rangers are all the better because of it (one can only hope)!

What Does an Achilles Tendon Tear Look Like?

You have probably read several articles and heard on the news multiple times about someone famous tearing their Achilles tendon.  This is no simple fete.  The Achilles tendon is the largest tendon in the leg and the force it takes to tear it has to be significant.  Often it is a force that causes the foot to come up towards the leg sharply, causing tremendous stretch of the tendon.  When this occurs, you feel a pop in the back of your leg and often describe it as being hit by a baseball bat or getting shot with a gun.

I have many curious patients who have these types of injuries and they always want to know what it looks like.  So in a recent surgery to fix this rupture, I took a couple of pictures.

In this picture, the stringy thing in the center of the incision is the ruptured Achilles tendon. You can see how large the tendon actually is and there is an obvious tear straight across the tendon.  Also note that there are multiple tears running longitudinally along the length of the tendon.  This gives it the "horse tail" appearance that we often use to describe the tendon after rupture.  

This picture shows how traumatic a rupture can be with significant bleeding and trauma to the tissues.  In this particular case there was also a large bone spur present prior to the injury which caused the tendon to be thicker than normal.  For this patient, the majority of his tendon was degenerative and there was minimal healthy tendon available for use.  So in this case, the tendon was replaced with a graft.  But in cases with healthier tendon, often repair can be done by just sewing the two ends back together if it is repaired quickly.

Recovery for this traumatic event is lengthy, but once healed this patient will return to digging holes, climbing trees, running or anything else they feel comfortable doing.

Beach Etiquette for Feet

As many of my patients know, I love to travel.  And beautiful beaches are my favorite.  During a recent trip to Grand Cayman I watched some appalling things happen to feet.  So I thought I would share my top tips for your feet at the beach.

1.  Shoes are a good thing and for numerous reasons.  But there is no need to wear cross trainers and socks all the time.  Flip flops or sandals are the way to go.  But leave the "fancy" flops for dinner out.

2.  Planning on running on the beach?  Don't do it barefoot unless you are used to running barefoot.  The sand is much softer than your treadmill and will cause things like achilles tendonitis and posterior tibial tendonitis to occur and quite possibly ruin your trip activities.  Take your running shoes for this one.

3.  Heading out in the water and not sure what type of shoreline you are dealing with?  Water shoes are great.  I've been to several beaches that looked like there was a soft sandy entrance, only to find out that  it was a rocky, spiny ledge in disguise.  But if it is soft like baby powder...let those toes free!

4.  I try to get in at least one spa day while on vacation and there is always a question of spa etiquette in different countries.  But the one thing that is never a question...wear the provided slippers everywhere!  It may be the top spa in the world but that doesn't mean the spa goers have the healthiest habits.

5.  Don't forget your feet when applying sunscreen.  One of the worst burns I ever got was on the tops of my feet.  I could wear shoes for 4 days!  Melanoma on the feet is rare, but can be the most deadly when it occurs.  And don't think that beach time is the only time your feet are getting sun.  Those walks out shopping with flips or sandals on allow plenty of sun time for those tootsies.

6.  Feel a sting or a burn while walking?  You may have stepped on glass hidden by the sand or a broken seashell.  You can also step on broken coral at the waters edge that can really hurt.  Best thing to do is immediately wash your foot with soap and water and check for anything that may be stuck in your foot.  If necessary, seek medial attention.

7.  If you are diabetic or have any problems with your sensation or circulation, always think "protect my feet"!  Check the bottom of your feet often for cuts, scrapes or burns you didn't know you had.  Again, seek medical treatment if you see any cut or burn on your feet.  The organisms that grow in the ocean can cause serious infections very quickly.

Not sure what shoes are right for your beach vacation?  Visit our certified pedorthist at Healthy Steps.

I love the beach and the water.  And I am often barefoot on the beach when I can be, I'm just careful.  But I must touch on one other topic.  If you are snorkeling and come across a beautiful coral reef, please don't touch it or stand on it.  This is not a resting area for humans.  It is a home to millions of living organisms and fish and it is our job to protect them!