Wednesday, July 31, 2013

Ankle Sprains

Ankle sprains are a common injury after a fall, sudden twist or blow to the ankle joint. Approximately 40 percent of those who suffer an ankle sprain will experience chronic ankle pain, even after being treated for their initial injury.

A review article published in the May 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) explains that tendon injuries to the ankle can be a possible cause for this chronic pain. In some cases, the condition is untreated or overlooked which prolongs the pain and the problem. "When patients injure their ankles, the injury may not seem serious at first," explains Terrence Philbin, DO, lead author of the article and Fellowship Director of the Orthopedic Foot and Ankle Center in Columbus, Ohio.

"People may not seek medical attention and they can think it will just get better on its own. I think that is why this condition often goes undiagnosed." The authors of the article describe how in some cases chronic ankle pain may actually be the result of injuries to the peroneal tendons. The peroneal tendons are located behind the outside portion of the anklebone (called the fibula). The tendons help to stabilize the foot and ankle. Tendon injuries can include tendonitis or swelling around the tendons. In more severe cases, the peroneal tendons can actually tear or there can be a swelling of the tendons behind the fibula bone. This can cause the ligament that holds the tendons together to stretch out and tear, or even rupture. Symptoms associated with peroneal tendon injuries can include: Ankle pain that is not responding to treatment Swelling and tenderness around the outside of the ankle Pain behind the anklebone Pain that transmits from the ankle down into the foot.

The use of magnetic resonance imaging (MRI) or ultrasound can be helpful when identifying and diagnosing peroneal tendon injuries and disorders. "These imaging techniques offer a more complete look at the peroneal tendons," noted Philbin. "One might consider getting an MRI or ultrasound especially if you have chronic ankle pain." If the condition is caught early, non-operative treatment options can include: Rest, ice and elevation Anti-inflammatory medication Immobilization in a cast or brace Physical therapy More serious injuries of the peroneal tendons, including tears or ruptures, will very likely require surgery. 

Peroneal tendon injuries can happen suddenly or can develop over time. The injury is most common among athletes involved in sports that require repetitive ankle motion and in individuals who have high arches of the foot. A proper diagnosis is essential in order to treat peroneal tendon injuries correctly and to help alleviate chronic pain. Philbin reminds patients, "If you have ankle pain and it is not getting better, do not ignore it. Get it evaluated by a physician who has experience treating foot and ankle injuries."

We can try a variety of measures to reduce pain and swelling and disability from this condition. PRP injections, low profile bracing, and physical therapy are excellent nonsurgical options. Ultimately surgery would be considered pending the nature and severity of the problem, and how you respond or fail to respond with nonsurgical management. 
New data gleaned from five years of studies have shown that artificial sweeteners can lead to weight gain as the body forgets how to process real sugar.

Sweet taste without the guilt — this has long been the promise of diet sodas.

But researchers at Purdue University have found by reviewing studies done over the past five years that diet soda and other artificially sweetened products could cause the same health problems as regular soda. In review, Susan E. Swithers, a Purdue professor of behavioral neuroscience, discovered that with consuming artificial sweeteners like sucralose, aspartame and saccharin, the body loses its ability to process real sugar, which could result in weight gain.

With real sugar, messages are released to the brain and the gullet via hormones that regulate digestion and intake of food, blood sugar levels, and even perception of fullness and satisfaction from the food consumed. However, with no actual calories to process with artificial sweeteners, the body doesn't know how to react.
"You've messed up the whole system, so when you consume real sugar, your body doesn't know if it should try to process it because it's been tricked by the fake sugar so many times," says Swithers to CNN.

The end result, says Swithers, is that the body's metabolic system stops reacting to real sugars and doesn’t release the hormones that say, “That was delicious, I’m full.” This can cause an endless cycle of feeling hungry and wanting more sugar.  It has also been shown that people who regularly drink diet soda have a higher risk of weight gain, obesity and type 2 diabetes and heart disease.

However, representatives of the American Beverage Association disagree and argue that low-calorie products can be effective tools for weight control, calling the study “an opinion piece,” in a released statement, according to CNN.

Theresa Hedrick, nutrition and scientific affairs specialist for the Calorie Control Council lobbying group, told WebMD, "I think it's important to remember that low-calorie sweeteners are one aspect of a multifaceted approach to health or obesity prevention. ...They aren't magic bullets."

Weight gain is a major contributor to all foot and ankle problems, and our patients need to understand that weight loss therefore will directly impact the reduction of most foot and ankle pain. Ask us about your weight loss options today, or at your next appointment.

Friday, July 19, 2013

What you should know about Gout in the foot and ankle

Have you ever suffered from a painful and swollen joint in your foot or ankle?  Has this pain persisted despite taking antibiotics and anti-inflammatory medications?  Have you had multiple episodes of this pain?  If so, then you may be one of 8.5 million Americans who suffer from gout each year (1).

Prevalence of Gout has been increasing in recent years and it is currently one of the most common causes of inflammatory arthritis in industrialized countries.  Factors that contribute to this condition include increased lifespan, dietary habits, renal and cardiovascular disease, alcohol consumption, and prescribed drugs that may raise serum uric acid levels (2).

Gout results from the deposition of uric acid crystals in a joint, resulting in acute inflammatory response.  If left untreated, chronic gouty arthropathy can develop and progress into deposition of uric acid crystals and tophi in soft tissues.  In the foot and ankle, Gout is most commonly manifested in the great toe joint.

Current treatment guidelines:
  • Non-Steroidal Anti-inflammatory medications (NSAIDS) or corticosteriods in the acute phase
  • Uric acid Lowering Treatments (ULT), i.e. Allopurinol, for maintenance
  • Shoe gear modification – wider, supportive shoes with insoles
  • Custom Orthotics – accommodations to restrict motion of the affected joints
  • Ankle Foot Orthoses (AFO) – restrict motion of the ankle joint (if affected) to limit inflammatory response
  • Vitamin supplementation
  • Surgical reconstruction – reserved for failed conservative and pharmaceutical therapies

If you suffer from gout or symptoms resembling gout, then consult with your foot and ankle specialist for work-up and management.

Foot sprains - Are they more than just sprains?

Have you ever been diagnosed by your doctor with a “foot sprain” after an accident, fall, or foot-twist?  Were you immobilized with a boot for a short period of time without much relief?  The reality of the situation is that you may have incurred a more debilitating injury in your foot ligaments. 

Some might ask what do the National Football League athletes Santonio Holmes, Ryan Kalil, Matt Schaub, and Dwight Freeney have in common?  They all suffered from a frustrating foot injury commonly referred to as Lisfranc’s injury.

The injury is named after Jacques Lisfranc, a French surgeon in Napoleon’s army.  It refers to a ligament and/or osseous (bone) injury of the metatarsal-tarsal joints and can present with severe dislocations and fractures (1).  The mechanism of the injury involves either a direct force of trauma on a planted foot or indirectly through a complex sequence of twisting motion.

Diastasis noted in the joint complex consistent with Lisfranc ligament injury
Approximately 20% of Lisfranc injuries are misdiagnosed in the emergency room because of their vague presentation and subtle x-ray findings (2).  They are often mislabeled as "foot sprains” and thus, treatment is often delayed which results in:
  • Post-traumatic arthritis
  • Chronic midfoot instability
  • Chronic pain
Lisfranc injuries occur in 1 person per 55,000 yearly.  67% of which are results of motor vehicle accidents, crushing injuries, and falls from heights (2).  Although those injuries are not common in the general population, certain athletes suffer a higher rate of this injury.  It is seen in 4% of football players per year, with offensive linemen incurring 29.2% (3). 

Foot and ankle specialists are trained to recognize the pathology using specific clinical examination and with the help of imaging modalities such as stress x-rays, CT scans, and even MR images.  If recognized early, prompt treatment can limit complications and potentially salvage an athlete’s season/career.

If you have sustained or suspect a foot sprain, then consult with your foot and ankle specialist.