Posts Tagged ‘ankle pain’
Monday, March 28th, 2011
As I spoke about is a previous blog, I was preparing to repair an ankle fracture that a local high school baseball player sustained while slipping on ice. I wrote about the etiology, or causes of ankle fractures and what could happen if it went untreated versus treating it conservatively and surgically.
Well, this patient and their parents elected to have the ankle repaired. In the orthopedic foot and ankle world, it is known as an open reduction and internal fixation of the ankle. After the patient elected to have it surgically repaired, they needed medical clearance and blood work. The blood work is important because it can give the physician pertinent information on the patient’s health such as infection, illness or bleeding disorders. This patient was a non-smoker and 280 lbs. The patient’s parents signed his consent after I went over the x-rays and reviewed his possible risks and complications. Oh yeah, there are risks and the patient and physician can potentially encounter complications. Some of the complications associated with this surgery can be infection, non-healing of the wound or bone, re-fracture, fixation failure (this is where the screws and plates fail), numbness, chronic swelling, increased pain, and complex regional pain syndrome, better know as RSD (reflex sympathetic dystrophy). Well, the patient was healthy!!!!
I met the patient at the hospital on a cold Wednesday morning and it was early. I love to do early surgeries because I am awake and full of Starbucks. The patient was anxious, but calm for a 17 year old. The mother and father were a little anxious, but I always try to have a conversation that is not related to the surgery and try to have a laugh before a case. To my many patients, I do have a good time and good laugh. Ha Ha!!!
The patient was brought into the operating room and was placed in the hands of our highly trained anesthesiologist and was put under general anesthesia. This type of anesthesia is the best choice, especially for relaxation of muscles and pain control.
We proceeded to place the patient in the proper position and this patient is tall and quite heavy, but proportionately built. Man, I was tired from just moving the patient! The patient tolerated the procedure and I reduced the ankle while they were under the general anesthesia. This is entails distracting the ankle fracture fragments and putting back into alignment. Once the fracture is put back into alignment, bone clamps are used to temporarily hold the fracture in place and we take intraoperative pictures to the position. His reduction looked GREAT! We used what we call a 5 hole, 1/3 neutralization plate and 5 screws. This will allow the fracture to stay in place without placing too much compression on the fracture. Prior to putting in the last screw, I examined the ankle joint and saw that there was some instability in the lower part of the ankle. The placement of the last screw was just above the ankle joint to provide stability and healing of the lower part of the ankle, and this is known as a transyndesmotic screw.
The patient was placed in a posterior splint and they were instructed not to walk on the ankle. The patient was seen after the procedure and he was doing very well…
Next month, we will see how the patient survived the first month!!! Please look for “Part 3” to this blog collection about ankle fractures.
If there are any ankle injuries, our physicians are highly trained to repair any ankle injuries or ailments. Please think of Affiliated Foot and Ankle Center, LLP for your foot and ankle conditions. We have locations in Howell, Edison and Monroe, NJ and have been providing top quality foot and ankle care for over 20 years….
By Dr. Jasen Langley
Tags: Affiliated Foot and Ankle Center, ankle, ankle pain, athlete, broken ankle, Dr. Jasen Langley, foot injuries, foot injury, fractures, howell
Posted in fractures | 4 Comments »
Monday, February 21st, 2011
Fall, slips and twisting of the foot and ankle can occur anywhere and at anytime and they hey are very painful. Many people let these injuries go untreated. However, what lurks beneath is a whole story of the injury that occurred.
Ankle Fractures have become more prevalent during these winter months. Many sidewalks and road surfaces go untreated. These slippery surfaces have become disabling and crippling for most patients who fall down.
When people or potential patients fall and injure their ankle, the ankle becomes very swollen, purple, red and painful. Sometimes the ankle can look “out of joint” or dislocated. Most people cannot walk, or have a difficult time walking. In severe cases, toes can become discolored and the affected lower extremity can become numb or the leg has a loss of feeling. This can potentially lead to a compartment syndrome, or the neurovascular structures have become affected. Those conditions can be discussed at a later date.
When those presentations are noticed, patients need to be treated immediately!!!! These dislocations or fractures that are left untreated can seriously affected the healing of the fracture and potentially affect the neurovascular health of the lower extremity.
Recently, a senior from a high school local to Howell, NJ who plays baseball slipped on ice and injured his ankle. He noticed the ankle becoming extremely swollen and went to the local emergency room and they told him that he had an ankle fracture and he needs to follow-up with the podiatrist.
This patient was seen in our office in Howell approximately 5 days later and another set of x-rays were taken. He had an above the ankle joint fibular fracture with a separation of the two bones of the ankle-tibia and fibula known as a syndesmosis tear. His fibula showed slight displacement. These types of ankle fractures with displacement require surgery. Without surgical repair of the ankle, he would have long-term problems. Currently, he is scheduled to have a procedure and I will keep you updated.
Ankle injuries should always be treated as well as the patient following up with a doctor to make sure that no other problems exist such as displacement of bone or dislocations. Conservatively, ankle injuries can be braced, immobilized and patients can be sent to therapy. If the injury requires surgery, the patient needs rest and no weight bearing activites for up to eight weeks.
If you have any questions or might be having foot or ankle issues, please feel free to contact one of our 3 offices which are located in Howell, Edison and Monroe, NJ.
By Dr. Jasen Langley
Tags: ankle pain, Dr. Jasen Langley, foot injuries, foot injury, fractures, howell, sports injuries
Posted in fractures | No Comments »
Sunday, October 3rd, 2010
It does take some coordination to use crutches and being an athlete I have mastered the use of crutches in 2 weeks. It is ironic that I am a Physical Therapist for Affiliated Foot and Ankle Center in Howell, NJ and I am a currently one of their patient’s. I have instructed patients for over 5 years on the proper technique of ambulating with the use of crutches. I am now filling the shoes of my patient’s.
I have suffered from an injury that has me using crutches for quite some time now. I fractured my heel while I was hiking. Immediately when I fractured my heel I was unable to weight bear because of the excruciating pain. I have been using crutches for 2 weeks and I have great sympathy for the individuals that I treat and others who have had the privilege to use crutches. Crutches will put a damper on your activities and tasks. Now that I have had the experience with crutches I have created some helpful tips for my patients or any individual who may need to ambulate with crutches in the future.
#1.) Ask yourself ….Do you have the coordination to use crutches? If not, get a knee walker. (See below)
#2.) Make sure your crutches are properly fitted for you. (See below)
#3.) Go SLOW. Think before you step. You cannot rush with crutches.
#4.) Wear a tool belt or fanny pack. This will come in handy when you need to carry things. My favorite one is a fitness fanny pack with an attached water bottle.
#5.) Prepare your clothes the day before. This will save time and energy when you are getting ready in the morning.
#6.) Set up everything you need on one level so you are not trekking up and down the stairs more than once a day.
#7.) The safest and easiest way to ascend and descend steps is on your butt!
#8.) Take rest breaks. Crutches are not made for long distances. But if you must, make sure there are chairs or benches where you intend to walk.
#9.) Crutches are not meant for leaning on them. Your underarms will thank you.
#10.) Do not use your crutches in a crowded area. A slight push or shove can easily knock you off balance.
I am planning on traveling and using crutches are tiring and not the best for sight seeing. I have researched other forms of medical equipment. I have found that a knee walker is the fastest form of transportation when you are planning to walk long distances. Insurance does not cover this device and most local surgical supply shops do carry knee walkers. You can rent them for approximately $30 a week. I had a difficult time finding a knee walker because all the knee walkers were on hold for other lucky individuals, so I purchased one online for $290.00. If I were to rent one for 8 weeks I would pay $240 so I justified $50 more to have my very own knee walker. This device is great! It is faster than being on two feet and you can travel distances in no time. I have taken my walker to the mall and shopping. The basket on the walker comes in handy when I need to shop. The walker folds up conveniently to place in your car. This is my recommendation when you need to go the distance, and you do not have access to a wheelchair.
Sizing your crutches:
Even if you have already been fitted for crutches, make sure your crutch pads and handgrips are set at the proper distance, as follows:
Crutch pad distance from armpits: The crutch pads should be 2 finger widths distance from your armpits. Make sure you are standing up straight and shoulders are relaxed.
Handgrip: Place it so your elbow is flexed 20 degrees, so you can fully extend your elbow when you take a step. Remember, your weight will be shifted into your wrists and palms (not your armpits) when you take a step. There is no need to wrap your crutch pads with towels because you do not lean on your crutch pads with your armpits.
Crutch length: The total crutch length should equal the distance from your armpit to 10 inches in front of a shoe.
By Valerie Gregory, CPT, CKTP
Tags: ankle, ankle pain, ankle sprain, Ankle Sprains, foot injuries, foot injury, fractures, howell, sports injuries, sports injury, valerie gregory
Posted in General | 4 Comments »
Tuesday, July 6th, 2010
Many patients will come into our office at Affiliated Foot and Ankle Center located in Howell, NJ asking the question, “Why are my ankles so swollen?” Usually this time of the year, it is caused by the increase in salt intake from too many barbequed hot dogs and the increase in humidity during the summer months. There are many possible causes for swollen feet and ankles, ranging from the common and harmless to the rare and dangerous.
Occasionally, the ankles and feet swell as the result of something localized to that part of the body. If you recently suffered a traumatic injury to one or both of your legs, for instance, it’s expected for the onset of swelling and bruising to occur. The ankles and feet can also swell as the result of an infection. For instance, a severe ingrown toenail or an insect bite that you’re having a reaction to may cause unexpected swelling. Burns, including sunburns, can also cause swelling.
Sometimes a more systemic problem can lead to edema in the ankles and feet. Problems of the heart, liver, and kidneys can eventually cause swelling in the lower legs, ankles and/or feet. Pregnancy and obesity can both cause obstructions of the circulatory system leading to swelling of the feet and ankles. Arthritis and other joint diseases can lead to pain and swelling in the feet and ankles, although this swelling will be focused in the joints themselves and you shouldn’t expect a generalized puffiness.
A certain amount of swelling in the ankles and feet is not uncommon in the summer months, especially if you’ve been standing or walking for long periods. It’s also common to get swollen ankles or feet if you’ve had to do a lot of prolonged sitting, such as during an airplane flight. I regularly visit the spa while on vacation to treat myself to a relaxing massage because of the swelling. A massage assists your body to rid of excess fluid. Some women get swollen ankles and feet during menstruation.
Medications such as antidepressants, steroids, blood pressure medications and hormone supplements are a common cause of swelling in the ankles and feet. Diet can also play a role. If you’ve been taking in too much salt, it can lead to swelling.
Finally, gaining weight and being more sedentary can often cause an increase in the size of your feet and ankles.
If you are unsure of the cause of your swollen feet or ankles it is imperative to make an appointment with one of our physicians at our office in Howell, our office in Edison, our office in Monroe or our office in Carteret. BETTER SAFE THAN SORRY.
Possible Causes of Swollen Feet/Ankles
- Foot or Ankle Injury
- Diet
- Insect Bite
- Allergic Reaction
- Pregnancy
- Water Retention
- Nephritis
- Side Effect from Medication
- Poor Fitting Shoes
- Cellulitis
- Lymphedema
- Varicose Veins
- Poor Circulation
- Deep Vein Thrombosis
- Heart Failure
- Anemia
- Kidney Disease
- Diabetes
- Gout
- Rheumatoid Arthritis
By Valerie Gregory, MSPT, CKTP
Tags: ankle, ankle pain, Diabetes, Diabetic, feet pain, foot, foot injuries, foot injury, foot pain, howell, pregnancy, swollen foot
Posted in General | 4 Comments »
Tuesday, May 25th, 2010
Being a podiatrist in Howell, NJ by the Jersey Shore, a large number of patients that present to the office with pain in their feet have underlying deformities but still want to wear sandals for the summer. While sneakers with orthotics are the most supportive, it is not always ideal for the summer and going to the beach or being by the pool.
Flip-flops have become increasingly popular over the last couple years but can also cause injuries to the foot due to the lack of support. I actually broke my fifth metatarsal wearing a pair when it caught on the saddle of a door. There instability is in the thin sole with only two thin straps. The important thing to remember is that they are not designed for activity but for style. There are some sandals that are designed with more support and can actually have an orthotic built in or can have an orthotic put in them. The things to look for in a pair of sandals for the summer are supportive soles that you cannot bend in half. Leather works very well and reduced skin irritation. The sandal should also be larger than the foot so the foot does not hang over. Avoid ankle straps and gladiator style sandals as they may cause irritation and blistering. Birkenstocks have larger more supportive straps on the top and similar styles provide more support and stability. Wedges also will give increasing instability and may cause ankle sprains if the heel slips off. Look for sandals that provides cushion and arch support built into to it. You should also not be wearing the same ones that you have worn for years. Like regular sneakers and shoes that should be replaced as they wear down, so should your sandals. A good rule is every 6 months for regular activity and more often for increased activity. If the shoes or sandals have worn in such a way that they are rolled in or out it is time to replace them. If you are planning to do a lot of walking, sneakers and orthotics are still going to be the most supportive and provide the most benefit. APMA has listed sandals that they recommend. Check with your local podiatrist to see if they have them in their office or where you can find these more supportive sandals.
By Dr. Alison DeWaters
http://www.footdoctorsnj.com/adewaters.html
Tags: alison, ankle, ankle pain, ankle sprain, Ankle Sprains, arch support, Dr. Alison Dewaters, Dr. Dewaters, Exercising, feet pain, foot, foot injuries, foot injury, foot pain, fractures, heel pain, howell, orthotics, Plantar fascial band, plantar fasciitis, proper footwear, sandal, sandals, shoes, toe pain
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Monday, May 3rd, 2010
This weekend was the New Jersey Marathon at Pier Village in Long Branch. I saw a lot of athletes all shapes and sizes were running to compete their best. Running is a sport for many ages and anyone can run. Plus it is cheap; you don’t need equipment or a gym, all you need is a good pair of running shoes. Because of the weather being warmer and days longer, I have seen more and more people running outside. Being a Physical Therapist at Affiliated Foot and Ankle Center in Howell, NJ many patients ask me, “Which running shoes are best for my feet?”
First you have to figure out the type of feet you have: flat feet, high arched feet, or neutral or normal feet. If you’re looking at your foot in a standing position, you’ll know you have flat feet if you don’t see any arch. The bottom of your foot, from your toes to your heel, is completely flat. If you do the footprint test, you won’t see an inward curve from your big toe to your heel. If you’re flat-footed, you’re most likely an overpronator, which means that your feet roll inward when you run. You will probably need a running shoe that maintains your stability. Look for the words “motion control” and “stability” on the box of running shoes you are considering. In addition to motion-control shoes, some flat-footed runners also need to wear orthotics. Orthotics or custom-made shoe inserts that correct foot issues can be made at our offices in Howell, NJ, Edison, NJ, Carteret, NJ or Monroe, NJ. We will make a custom mold of your feet and design an orthotic that best suits your needs.
If you have high arches, you’ll notice a high arch on your foot. If you do the footprint test, your print will curve inward, making the middle part of your foot look very thin. If you have high arches, you probably supinate or underpronate, which means your feet roll outwards as you run. You need to look for flexible shoes with a soft midsole that absorbs shock. When buying running shoes, look for options with the words “flexible” or “cushioned” included in their descriptions.
If you’ve examined your feet or your footprint and it doesn’t look flat-footed or high-arched, you most likely have a neutral or normal foot. Your footprint will have a noticeable curve inward, but not by more than 3/4 of an inch. This is the most common type of foot, and it’s also the least susceptible to injury provided it’s equipped with proper shoe gear. If you have normal feet, you can choose from a wide variety of running shoes, including ones made for neutral runners.
After you have examined your foot and you still cannot determine the type of feet you have, it will benefit you to be evaluated by a foot and ankle specialist. We can help you determine what type of feet you have and suggest shoes that are best suited for your needs.
By Valerie Gregory, MSPT, CKTP
http://www.footdoctorsnj.com/physical.html
Tags: ankle, ankle pain, arch support, Exercise, Exercising, feet pain, foot, foot injuries, foot injury, foot pain, heel pain, howell, nj, orthotics, plantar fasciitis, runner, runners, running, shin splints, shoes, sports, sports injuries, sports injury
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Tuesday, April 20th, 2010
Ankle sprains are one of the most frequent injuries that occur in athletes. The inversion ankle sprain is where the foot goes inward and is the classic rolling of the ankle. Prevention of this type of injury in athletes that have a tendency to roll their ankle has been a large debate. To tape or not to tape has been the question. Taping vs. prefabricated bracing has been researched on both the efficacy and the cost of each. It has been shown that both can reduce the risk of recurrent ankle sprains. It also has been shown that taping and bracing does help to strengthen the ankle and also improve the proprioception. Proprioception is the body’s ability to detect where it is in space, which is often damaged with a sprain, which leads to recurrent sprains.
Taping has been shown to reduce the risk of ankle sprains in the athlete that is prone to the inversion ankle injury. There are several issues with taping though. Some athletes develop irritation from the taping. There are variations in the person taping. The tape has also been shown to loose its efficacy in as soon as 10 – 30 minutes. Taping can also be more costly as you add up the cost of the tape on a regular basis and the time of the person taping. The cost of one roll of tape is on average $1.40, which is needed for one ankle plus the cost of pretape, lubricant and the person taping, it can cost over a thousand dollars per athlete per season. Taping does work very well but the cost and loss of strength has been points to advocate the use of a prefabricated brace. Taping can also not be adjusted by the athlete.
Bracing has also been shown to decrease the risk of ankle sprains. Ankle braces are prefabricated and not being custom to each athlete may cause some irritation to certain patients. The ankle brace can be adjusted by the individual athlete during the course of the game or practice, which cannot be done with the tape. The cost of the brace is anywhere from $35-$100 which is significantly less than the cost of the tape.
Overall both taping and bracing are both effective ways of reducing ankle sprains. Bracing is a more cost effective way of reducing the ankle sprain and since there is no learning curve, it is always applied properly and can be adjusted by the athlete his or herself.
By Dr. Alison DeWaters
www.footdoctorsnj.com
Tags: Alison DeWaters, ankle, ankle pain, ankle sprain, Ankle Sprains, athlete, athletes, Dr. Dewaters, feet pain, foot, foot injuries, foot injury, foot pain, runner, runners, sports, sports injuries, swollen foot
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Wednesday, April 7th, 2010
Hello My Affiliated Foot & Ankle Family,
I am sitting here on vacation while writing this blog. I notice everyone walking barefoot on debris ridden concrete and on sand where there is debris also. You have to be aware of injuries to the foot and ankle.
Please be aware of puncture wounds. Puncture wounds are injuries that penetrate the skin. These particular injuries need to be addressed immediately. Debris and infection of the foot and ankle are the main conditions. If this condition is not addressed, it can get very painful, red, hot and swollen.
In some instances, the person may need to be hospitalized. Diabetics should also be extremely cautious with punctures because they may not even know they have an injury.
Plantar warts thrive in pools and other wet water conditions. These are viruses of the foot that invade the skin and cause painful lesions. These thickened calloused areas may have blackened dots and a “cauliflower-like” appearance. These lesions can be painful. Many parents will mistaken these spots as just callouses. These should be treated because they spread throughout the foot.
Fungal infections flourish in moist, damp areas and if you are in these moist dark conditions, this can cause Athlete’s feet. Athlete’s Feet or Tinea Pedis can be contagious and caught by direct contact.
Lastly, traumatic injuries such as sprains and fractures of the foot and ankle can occur on slippery surfaces. If the person develops a sprain, this can be easily treated with ice, anti-inflammatories and bracing. If the injury is more severe such as a fracture, this should be treat with urgency. Many times patients will delay treatment to come and see me but I tell them they should have had the injury, such as a fracture, surgically repaired at the time it occurred depending on the swelling timing.
Wow, this is amazing that I am observing this while on vacation. If there is anyone who injured his or her foot, or caught a skin infection, remember to see your podiatrist. As you know, we are located in Howell and we are always available for our patients after their vacations.
Come check me out in Howell if you have any questions or check our website for any educational information at www.footdoctorsnj.com.
By Dr. Jasen Langley
Tags: ankle, ankle pain, Athlete's foot, foot, foot pain, fractures, fungal infections, fungus, injury, plantar warts, red hot foot, redness, sprains, swollen foot, wound, wounds
Posted in General | No Comments »
Saturday, March 27th, 2010
During the spring, many professional sports teams are at the highest levels of competition. The NBA playoffs, the NHL playoffs and the inauguration of the baseball season are all happening at the same time. This is not only a very exciting time for me, but also for many fans all around the country.
While competing at these high level sporting activities, an injury can be devastating not only to the player, but also to the team involved. The ankle sprain can be one such event that can debilitate a player, anywhere from a minimum of 4 weeks, to a maximum of 6 months to a year depending on the severity of injury. In the worse case, it is even possible that the player might not be able to return to the sport.
It is essential to promptly evaluate an ankle sprain for effective management. The initial studies should include a comprehensive physical exam to assess a fracture, dislocation, and ligament or tendon damage. Many professional sports team will immediately go to an MRI to aid in diagnostic evaluation. Alas, in real life it is not practical to get an MRI every time someone sprains an ankle. At our office, we use other diagnostic tools such as digital x-ray’s and diagnostic ultrasound to evaluate for ligament or tendon damage.
The treatment rendered will depend on the severity of the ankle sprain. The American College of Foot & Ankle Surgeons grades ankle sprains on a Grade I-IV. At our office, I see ankle sprains quite often, ranging at different grades. Amazingly, greater than 90% of our patients are treated conservatively without surgical intervention. Again, I feel the key to proper management is early diagnosis and treatment. The longer the treatment is delayed the more chances for long term instability.
By Dr. Varun (Ben) Gujral
Tags: ankle pain, ankle sprain, Ankle Sprains, athlete, athletes, foot injuries, foot pain, fractures, sports, sports injuries, sports injury, torn ligaments
Posted in General | No Comments »
Friday, February 26th, 2010
Pain is very subjective. Patients will often ask, “How much pain will I have after surgery?” This is a very difficult question to answer because everyone experiences pain differently. This also makes testing someone for pain difficult. Everyone experiences pain at different levels and have different thresholds for tolerating pain. Pain is often difficult to locate. When our bodies experience a pain, it sends the signal through our brain through nerve fibers. Small nerve fibers called delta fibers send 90% of the pain signals to the brain to specific locations in the cortex of the brain. Testing these fibers shows us where the pain is coming from. Small nerve fiber testing is a painless test that can show where the pain is coming from in about 20 minutes. An EMG tests for nerve damage. Pain occurs before the nerve is damaged. By testing the small nerve fibers, it locates accurately with 95% sensitivity where the pain is before there is permanent damage. This leads to earlier and more effective treatment. If you are experiencing pain that is not responding to traditional treatment, consult with your physician to see if you are a candidate for small nerve fiber testing.
By Dr. Alison DeWaters
Tags: ankle pain, EMG, feet hurt, feet pain, foot pain, nerve damage, nerve testing, pain, small nerve fiber testing, surgery
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