16. July 2016 11:38
The ankle, or the tibiotalar joint, connects the leg and foot. It comprises of various bones, muscles, blood vessels, tendons and ligaments. The joint bears maximum body weight, helps maintain body balance and absorbs external shocks while running, standing and walking. The bones are protected by a thick cartilage which prevents them from rubbing against each other. Ankle Arthritis is characterized by damage or gradual wearing out of this cartilage.
Listed below are the different types of Arthritis that may affect the ankle joint:
- Rheumatoid Arthritis- It is a chronic condition which may result in joint inflammation. In this, the body’s immune system starts attacking the synovial membrane which protects the joint
- Osteoarthritis- This is the most common form of Arthritis which is characterized by the damage caused to the cartilage within the joint. As a result, the bones tend to rub against each other and get damaged
- Juvenile Arthritis- It is commonly seen in young people less than the age of 16 years
- Gout- A type of Arthritis that occurs when level of uric acid in the blood increases and starts depositing within the joint spaces in the form of hard crystals
- Infectious Arthritis- Bacterial, fungal or viral infection in the blood may lead to this type of Arthritis. It is also known as Septic Arthritis.
- Psoriatic Arthritis- A type of arthritis which is accompanied or preceded by a skin disease, Psoriasis
- Degeneration of joint due to aging
- External injury or trauma to the joint may develop Arthritis over a period of time
- Genetic predisposition
- Inherent misalignments in bone or joint structure
- Bone dislocation/fracture
- Ligament and tendon tear
- Excruciating pain
- Loss of movement
- The joint may feel tender when touched
- Visible Deformity
- Difficulty in weight bearing
- Stiffness in the joint, particularly in the morning
- Feeling of warmth around the joint
- Pain tends to flare up after prolonged or vigorous physical activity
- Detailed clinical examination of the joint
- The orthopedic doctor may analyze the patient’s symptoms and medical history
- Evaluation of changes in gait
- X-ray may be conducted to assess bone damage
- Blood tests to identify the type of Arthritis
- MRI and CT scan may be done to reveal soft tissue damage
The non-surgical methods of treatment may include:
- Lifestyle modification to reduce activities that aggravate pain
- Incorporating light exercises to maintain joint and muscle strength
- Weight loss may be recommended to prevent putting pressure on the joint
- Ankle foot orthosis (AFO) may be used to improve joint stability
- Shoe inserts and walking cane may be helpful
- Physical therapy may also be recommended to increase ankle strength
- Prescription of anti-inflammatory medicines
Surgical methods may include:
- Arthroscopic Debridement- removal of damaged cartilage and other parts using arthroscopic techniques
- Bone fusion or Arthrodesis- The affected bones may be combined together using plates, wires or screws to cease their movement and prevent rubbing against each other. It helps to relieve pain and prevent the condition from worsening.
- Total ankle replacement or Arthroplasty may be recommended for patients with advanced stage of Ankle Arthritis
For diagnosis and treatment of Ankle Arthritis, visit OrthoTexas. To schedule an appointment with the foot and ankle specialists in Flower Mound, TX, you can call at (972) 899 – 4679.
2. July 2016 13:49
Distal humerus fracture refers to a break in the upper arm bone or the humerus. The three bones, humerus, radius and the ulna together, form the elbow joint and the base of the humerus is called the distal humerus. The bones are held together by ligaments, muscles and tendons. The distal humerus fits into the cup shaped part of the ulna and enables the elbow to move or bend. Fractures of the distal humerus are rare and generally occur in association with other arm injuries.
- Falling directly on an outstretched hand
- Vehicular accidents
- Sports injuries
- A direct hit to the elbow joint
- Bruising or skin discoloration
- Inability to move the elbow
- The joint may feel unstable
- The fractured bone may protrude out of the skin, in severe cases
- Severe pain
- The area around the joint may be tender to touch
- Swelling, numbness or joint disfigurement may be seen
- Clinical examination of the injured arm to check for the severity of injury
- Palpation may be done to assess the exact location of tenderness and pain
- The pulse rate may help to analyze disruption of blood flow to the limb
- X-ray may be conducted to point out the exact location and extent of damage
- MRI scan may be required if damage to soft tissues is suspected
The treatment of distal humerus fracture may depend upon the type of injury and damage caused to the bone as well as soft tissues. Non-surgical procedures may include:
- A splint may be used to keep the joint stable during the healing period
- Cryotherapy- application of ice packs at regular intervals
- Pain killers and anti-inflammatory medicines may be prescribed to relieve pain
- Antibiotics may be prescribed in case of infection of an open wound
- The patient should avoid lifting weights for a few weeks
Surgical procedures may be required in case of an open fracture. The following procedures may be recommended:
- Using minimally invasive techniques, metal pins, screws and wires may be inserted into the joint to stabilize the bone
- Bone Fillers- In case the bone is badly crushed, a piece of bone may be taken from another body part such as pelvis and inserted into the joint. Alternatively, artificial bone mass made up of calcium may be used
- Surgical replacement of the elbow may be suggested if the joint is damaged beyond repair
- Physical therapy may be helpful in regaining joint strength and mobility post-surgery
For effective treatment of distal humerus fracture, visit OrthoTexas. To schedule an appointment with the orthopedic surgeons in Flower Mound, TX, you can call at (972) 899 – 4679.
22. February 2016 12:16
De Quervain’s Tendinosis is a condition that causes irritation and constraint in the tendons around the base of the thumb. Inflammation in the tendons and the tendon sheath can lead to pain and tenderness along the whole thumb. The pain increases while performing simple activities such as forming a fist or grasping something.
- Overuse of the thumb
- Direct blow to the thumb
- Repetitive grasping
- Inflammatory conditions such as Rheumatoid Arthritis
- Racquet sports
- Activities such as gardening
- Pain and swelling at the back of the thumb
- Pain that travels into the thumb or upwards to the forearm
- Pain increases when pinching or grasping things
- Swelling and pain on the side of the wrist at the base of the thumb
- Pain gets worse while moving thumb or wrist
- A catching or snapping sensation can be felt during thumb movement
The orthopedic doctor may perform the Finkelstein test to diagnose the condition. The patient may be asked to make a fist with the thumb placed in the palm. The wrist may be bent towards the outside causing the swollen tendons to stretch. If this movement is painful, the patient may be suffering from De Quervain's Tendinosis.
- Medication: Non-steroidal anti-inflammatory medication may be recommended by the doctor to provide relief from inflammation and pain. The medication may be injected directly into the thumb to provide immediate relief.
- Corticosteroids: Corticosteroid injections may be administered into the tendon sheath to reduce pain and inflammation.
- Splints: Splints may be used to provide support to the thumb and wrist. It is important to completely stop all activities that worsen the pain.
- Ice packs: Application of ice packs may also be useful in reducing the swelling and discomfort.
- Exercise: The doctor can suggest certain strengthening exercises to regain the normal range of thumb movement.
Surgical intervention may be required in case conservative treatment methods fail to provide any relief. The procedure involves opening the thumb covering to make space for the swollen tendons. The patient may resume his routine work once the thumb regains full range of movement.
The orthopedic surgeons at OrthoTexas provide effective treatment for De Quervain's Tendinosis. For appointment, you can call at (972) 899 – 4679 or visit 4951 Long Prairie Rd, Suite 100, Flower Mound, TX 75028.
27. January 2016 08:20
Iliotibial Band Syndrome is an injury caused due to overuse of the knee or thigh muscles. The Iliotibial band is a bunch of fibers which begin near the pelvis and joins the tibia after running along the outer side of the thighs. This band is also linked to the muscles of the buttock as well as hip joint and plays a major role in facilitating the movement of the knee. Inflammation of the Iliotibial band causes pain in the knee which may worsen if not treated immediately. The injury is commonly experienced by runners, tennis players, weight lifters and cyclists. Generally, a patient is able to restore normal range of motion using conservative methods of treatment.
- Excessive running
- Improper stretching before and after a running session
- Muscle imbalance
- Abnormality in limb length
- Supination or outward rolling of the foot during physical activity
- Presence of bowlegs (genu varum)
- Weak hip muscles
- Sitting cross legged or squatting for too long
- Abnormal tilting of the pelvic bones
- Pain in the knee which may radiate towards the thighs and hip joint
- Pain is felt when the foot touches the ground
- Difficulty in climbing stairs
- Swelling or tenderness may be observed
- Tenderness and stinging sensation
- Popping sound in the knee
- Detailed analysis of the symptoms reported by the patient as well as his/her medical history
- Physical examination to check limb length discrepancy, muscle weakness or tightening or swelling and tenderness in any part of the lower body
- Checking the functioning of the hips, lower back, legs and thighs
- Analysis of the patient’s gait and range of motion
- MRI scan may be required to assess the severity of inflammation in the Iliotibial band
- Cryotherapy – application of ice packs at regular intervals to reduce pain
- Prescription of anti-inflammatory drugs by the doctor
- Physical therapy and specific stretching exercises may help to strengthen the supporting muscles and retain normal range of motion
- Electrotherapy may be used to reduce pain and inflammation
- Keeping the affected leg elevated
- Wearing specific shoe inserts or shoes
- Surgical lengthening of the Iliotibial band to prevent stretching
We, at OrthoTexas, provide complete treatment for Iliotibial Band Syndrome. To schedule an appointment with the orthopedic surgeons in Flower Mound, TX, you can call at (972) 899 – 4679.
8. January 2016 11:10
Posterior Tibial Tendon Dysfunction is a condition that affects the ankle and the foot as a result of the tearing or inflammation of the posterior tibial tendon, which connects the calf muscles in the leg to the bones on the inner side of the foot. The tendon helps to keep the foot arch intact and provides stability while walking or movement. An injury to the tendon results in loss of stability and gradual development of a Flatfoot. This ailment is found to be more prevalent in women particularly after the age of 40.
- Injury to the leg or foot resulting in tearing or damage to the tendon
- Sudden fall
- Stress, hypertension, Diabetes and Obesity increase the chances of developing this problem
- Sports or high impact activities such as basketball, soccer or tennis may result in repetitive use and consequent tearing of the tendon
- Pain which can get worse with movement or any activity involving walking, running or even standing for long duration
- The patient may develop swelling near the arch of the foot
- Gradual collapse of foot arch
- The outer ankle bone will develop pain with the shifting of the heel bone
- Too many toes will be visible from the rear of the foot due to inward rolling of the ankle
- Change in foot shape
- Analysis of the patient’s medical history
- Assessment and investigation of the time and process of injury
- Conducting a flexibility test to check the range of motion
- Several imaging techniques may be applied such as X-rays, CT scan, MRI or Ultrasound to analyze the bone and tissue damage
- The orthopedic doctor may recommend the patient to rest the injured foot or leg and strict avoidance of activities that pressurize the foot
- Application of ice packs at regular intervals 3-4 times in a day helps reduce swelling
- Prescription of anti-inflammatory drugs or pain killers
- Use of a cast or a special boot to immobilize the leg or to provide additional support to the tendon
- Orthotic devices such as a brace or a shoe insert may help alleviate symptoms of Flatfoot and provides adequate support to the patient
Surgical methods of treatment depend on the severity of the damage and location of the tendon. The following methods may be adopted:
- Damaged posterior tibial tendon may be removed and replaced by another tendon in the foot to restore function and stability
- Surgical removal of the inflamed tissues around the tendon
- Flatfoot can be treated by lengthening the calf muscles
- Osteotomy, i.e. surgical cutting of one or two bones to repair the Flatfoot and create a normal arch shape
For comprehensive treatment of Posterior Tibial Tendon Dysfunction, visit OrthoTexas. To schedule an appointment with the foot and ankle specialists in Flower Mound, TX, call at (972) 899 – 4679.
25. November 2015 08:54
Acquired Adult Flatfoot Deformity (AAFD), or Pes Planus, refers to a condition characterized by a progressive flattening or collapse of the arch of the foot. It generally occurs when the posterior tibial tendon, a muscle that attaches the ankle and the midfoot, becomes dysfunctional. This tendon is largely responsible for maintaining the foot’s alignment, arch and a proper gait. AAFD is termed progressive because the process of flattening occurs over a period of time and starts affecting the other soft tissues in the ankle as well as foot. The condition may start with pain in the ankle and lead to permanent deformity or development of Arthritis if not treated.
- Sudden injury to the posterior tibial tendon/ Posterior Tibial Tendon Dysfunction (PTTD)
- Existing Flatfoot that further stresses the ligaments and tendons
- Wear and tear of the soft tissues in the foot or ankle
- Inflammatory Arthritis not only affects the joints but also the ligaments leading to a fallen arch and painful Flatfoot.
- Injury to the foot ligament, fracture/dislocation of the midfoot bone
- Change in alignment of the foot/flattened arch
- Pain while walking, running or standing for long duration
- Most of the toes are visible from the back of the foot
- Limp walk
- Swelling and tenderness over the inner ankle
- Longstanding history of pain in the inner or outer ankle
- Improper alignment of heel and leg
- Deformity of the forefoot
The orthopedic doctor will be able to assess the problem by looking at the feet when the patient stands. People with AAFD have feet that appear splayed out wherein most of the toes are visible from the back of the foot and the arch is noticeably flattened. Diagnostic tests may include:
Single leg-heel rise test- This test requires the patient to stand on one leg and raise the heel above the ground a couple of times. Ability to do so indicates that the posterior tibial is still intact.
X-ray of the foot while bearing the complete body weight helps to establish the extent of deformity.
Acquired Adult Flatfoot Deformity can generally be treated through non-surgical methods by supporting and strengthening the tendons or ligament. Surgical intervention is required only when these non-operative measures fail to restore the foot arch and balance. Depending on the degree and functional requirement of the patient, a specific or combination of procedures can be used for treatment. These may include:
- Rest and avoidance of strenuous activities
- Immobilization of the foot with a cast for a specific time period
- Orthotic inserts can be prescribed to support the hind foot
- Wearing an ankle brace
- Weight loss to prevent pressure on the soft tissues and ligaments
- Surgical intervention to lengthen the ligament or muscle
- Surgical replacement of the affected tendon with another tendon
- Surgical realignment of bones
For diagnosis and treatment of Acquired Adult Flatfoot, visit OrthoTexas. To schedule an appointment with the orthopedic doctors in Flower Mound, TX, call at (972) 899-4679 or visit 4951 Long Prairie Rd, Suite 100, Flower Mound, TX 75028.
11. March 2014 13:33
A Bunion is a localized area of enlargement of the inner portion of the big toe joint (known as metatarsal phalangeal joint). Sometimes Bunion may also affect the outside portion of the foot at the base of the little toe. This kind of Bunion is sometimes referred as a tailor’s Bunion or Bunionette.
- Hereditary: Some hereditary (genetic) tendency to have this joint weakness can be taken as one of the causes of Bunion.
- Arthritis: According to foot and ankle specialists, patients of Osteoarthritis or rheumatoid arthritis are more prone to Bunion.
- Trauma: Sprain, nerve injuries and fractures may sometimes lead to the condition.
- Tight-fit and high-heeled shoes: It has been found that tight-fitting, high-heeled and narrow –toed shoes may increase the risk of developing Bunion.
- Repetitive Stress: Ballet dancers are more likely to suffer from the disease as these kind of activities causes repetitive stresses to the foot resulting into Bunion.
- Inflammation: The enlarged joint at the base of the big toe can become inflamed with redness.
- Pain: Tenderness and pain can be felt and sometimes pain could be so severe that it can get difficult to walk.
- Swelling: Swelling can be seen and felt at the base of the toe. The foot may become so wide that may cause difficulty in fitting into a shoe.
- Deformation: Along with the deformation in the big toe, the second toe might get deformed too.
- Severe Condition: In case of severe conditions, the big toe can push the smaller toe up out of place, making the condition worse.
- Footwear Recommendation: High-heeled, pointed and tight fitted shoes should be avoided. Trainers, Slippers or shoes with laces and straps are highly recommended by foot doctors.
- Icing: Ice packs’ padding over the Bunion may help relieving the pain and swelling.
- Medication: Anti-inflammatory medicines can be taken for the first-aid.
- A course of antibiotics may be included in the prescription if the skin and tissues over the deformity are affected.
- Medication may differ if the Bunion had developed as a part of arthritis.
- Surgery: An operation may be advised in severe cases:
- Choice of the operation depends upon the severity, shape of the foot and some other factors.
3. December 2013 10:55
Lisfranc injuries refer to injuries affecting the midfoot bones or ligaments. These injuries are often mistaken for sprains, but are actually a lot more severe, and might take months to heal. In some cases, surgery might be required for the treatment of a Lisfranc injury. The common symptoms of such an injury are swelling on top of the foot, severe foot and ankle pain, and bruising on or below the foot. Bruising below the foot is usually a sure-shot sign of a Lisfranc injury. If you experience any of the above symptoms, you should immediately visit an orthopedic doctor, to get yourself diagnosed and treated.
Your doctor will perform several physical tests such as tenderness to pressure, single limb heel rise, “piano key” test for pain, and a stress examination. This could be followed by imaging tests like X-rays, MRI scan, and a CT scan to confirm the diagnosis. Depending on the severity of your injury, a treatment plan will be devised for you. If no fractures or dislocations are detected in the joint, and the ligaments are not completely torn, non-surgical treatment is usually sufficient. This involves wearing a non-weight-bearing cast for 6 weeks, and ensuring that no weight is applied upon the affected foot.
The next step in the treatment involves progress to weight-bearing with an orthotic or a removable cast boot. It is important to attend follow-up visits with your doctor during this period, for them to be able to monitor the progress of your foot through imaging tests. In some cases, these findings can indicate that the bones have been displaced, in which case you might have to undergo surgery. The surgical treatment for Lisfranc injury is recommended for injuries involving a fracture or abnormal positioning of the joints of the midfoot. This surgery aims at realigning the joints and returning the fractured bone fragments to their original positions.
The surgical options include internal fixation, in which the bones are repositioned with the help of plates or screws; and fusion, in which the damaged bones are fused together, to promote their healing as a single, solid piece. The latter is opted for incase of severe injury in which the damage cannot be repaired. Surgery must be followed by rehabilitation, in which weight-bearing is gradually reintroduced after a 6-8 week period of non-weight bearing.