YOU MAY BE DAMAGING YOUR ANKLE WITH EACH STEP

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.

- DR TIMM

Walking on Anchors

The Tampa Bay Rays superstar Evan Longoria is one who can vouch for the trouble that heel pain can cause. In essence, the heel is anchoring him from doing what he is usually able to do on the field. IF he were to read this, as you all do, he would be coming in as well for an immediate consultation and high energy shock wave treatment. This has been shown in many cases to effectively remove heel pain and pressure within 6 weeks post treatment. We would augment this with a platelet rich plasma injection under ultra sound guidance to enhance the healing of the distraught fascia. This is going to otherwise hold him at bay for months to come during the season, and frankly the Rays cannot afford this length of reduced productivity from him.  Get into our office as soon as possible to reduce the length this anchor has it's grips on your feet, causing you to reduce your exercise frequency and increase your weight. It is a spiral that most people can do without.

DR TIMM

An Arizona mother has found herself under fire after posting a video online showing her daughter breaking her feet while jumping off a roof on a dare in a bid to raise money for the injured teen.

Carrie Yunker, of Peoria, created a page on the popular crowdfunding site gofundme.com, asking the online community to help her raise $4,200 that will be used to cover her daughter Nicole Easton's everyday expenses for the next several of months while she recovers from her injuries. 

In a post on the fundraising site, Yunker explained that her daughter just graduated from high school, had a good job and had recently moved into her first home 'as an adult' when disaster struck.

In her online plea for help, Yunker explained that while her daughter did not have health insurance, her father was able to add her to his plan.

The accident landed the girl in a wheelchair, and she is expected to be disabled for the next six weeks, according to her mother. 

Yunker then went on to explain that her daughter not being able to work for a while means that she would be unable to cover her share of the rent and bills, which could result in her losing her home. 

The mother gave a breakdown of her daughter's expenses, writing that she will need $1,800 for rent for half a year and $2,400 for expenses like food, toiletries, phone and utilities.

This is a foolish stunt which could leave this poor unfortunate teen with chronic pain and debilitating arthritis with potentially the need for a triple arthrodesis in the future for both sides. This likely resulted in a calcaneal fracture to both feet, which is perhaps one of the more debilitating injuries sustained from a fall from a height. She was most fortunate to not sustain a spinal injury as well, which could have left he in a wheelchair for much longer than 6 weeks. Any time you are dared to attempt any stunt that could significantly injure yourself, keep in mind you may only get to make a foolish mistake once, with lengthy and difficult longstanding consequences, so you should think before you act.  

We deal primarily in foot and ankle problems, and this sort of pain and arthritic sequelae are commonplace for us to manage. We have a detailed protocol for varying pathology, and are able to manage this post traumatic OA with a variety of modalities until surgery is absolutely required. 

At FFLC we are regularly seeing patients who fall from a height, and most of these individuals are roofers, construction workers, and others with on the job injury. However, if you fall like this Arizona teen, you may be left with significant medical expenses and difficulties walking the remainder of your life.  She may benefit from arthrodesis procedures in her early 20's if the damage is significant, otherwise she may be unable to run, which may or may not impact her for years to come. Life lesson here: Be safe and think before you act. 

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Bootchellas

Twitter feed: Ankle boots are trending in India! #Bootchella

Women are always looking for the next trendy shoes. Actually, these particular shoes are excellent, as they provide ankle support and still appear stylish. Their main downfall is the narrow toe box and 2 inch lift in the heel region, which are a recipe for NEUROMAS and METATARSALGIA to form. These are very common foot complaints that undoubtedly are sequelae of this type of shoe style. At FFLC, we aim to reduce or eliminate pains in the foot and ankle, but sometimes the shoes are directly to blame. Ask a FFLC doctor today about cutting edge neuroma treatments, and you will likely be pleasantly surprised to hear that surgery is only used as a LAST RESORT. 

DR TIMM