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.

Yankees Derek Jeter Out For the Season With an Ankle Fracture

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.

Snap, Crackle, Pop....My Ankle Hurts!

Snap, Crackle, Pop. Ankles are not supposed to make that noise.

It softball season and you just attempted to slide into second base and you managed to twist your ankle. You have done this before but this time it was followed by an audible snap you have not heard before. Oh yeah, and don’t mention that strange lump at the ankle you did not have this morning. You treat it like you have treated your previous ankle sprains, icing, elevation and trying to walk a little more gingerly, but it has not gotten better after several days, and any pressure to your foot is excruciating and unstable.

You may have an ankle fracture. Ankle fractures can typically occur during a violent injury like a car accident, fall from a height, or twisting motion of the ankle. The ankle consists of three bones that are bound to each other tightly by ligaments and allow motion of the foot up and down to allow for normal running in walking. When a fracture occurs the normal alignment of the bones of the ankle is lost as well as ligament integrity and instability, and pain ensues.

Ankle fractures need to be diagnosed and treated as soon as possible in order to provide the most appropriate treatment. Minor fractures can sometimes be treated with a period of immobilization while more major unstable fractures require surgery. If an ankle fracture is left untreated it can lead to chronic instability of the foot and ankle as well as chronic pain from arthritis.

Typical recovery from fracture to a normal shoe is around three months, so if you don’t want to miss next year’s softball season or possibly every softball season in the future, see a podiatrist immediately after any ankle injury.