November 17, 2016
Flat feet problems? Ankle, knee, or toe pain? Custom orthotics may help.
Custom orthotics are exactly that: one-of-a-kind shoe inserts or ankle braces molded just for you. They can relieve pain and discomfort in the foot and correct deformities. They can also provide stability and improve performance of the ankle and knee joints, especially during high injury-risk activities like sports. A custom orthotic is better quality than a standard off-the-shelf orthotic and usually lasts longer.
A board certified orthopedic doctor specializing in foot and ankle care is the best type of medical professional to diagnose and treat problems in that area. Why not just go straight to a physical therapist or podiatrist? Orthopedic doctors have earned a medical degree and trained extensively to evaluate the entire body from a medical perspective. That means, for example, they can properly diagnose a pain in the lower leg that turns out to stem from the hip, knee, or back. Other types of practitioners don't have the training to find the problem at its root like that.
While many of our patients have benefited from custom orthotics, many more have been helped with other solutions. A well-informed stretching or physical therapy regimen prescribed by an orthopedic doctor, ice, rest, anti-inflammation medications, or less commonly, surgery, may be just as effective or better in many cases. The only way to know is to see a doctor who can give the most comprehensive medical diagnosis.
April 26, 2016
"There's a bump on my big toe joint. Should I show my doctor?"
A bump on the foot that isn't going away or is painful can give you a good reason to see an orthopedic doctor. He or she can provide a diagnosis and set a up a treatment plan to help you recover. A bump on the toe may be a type of bunion. Bunions, bunionettes, and adolescent bunions are all painful conditions specifically affecting the second toe joint (metatarsophalangeal joint (MTP)). There are some differences between the three types of bunions:
Bunions are painful and develop over time. Typically only adults (mostly females) complain about these large bumps on the inside of the foot at the big toe joint. The big toe also becomes angled inward toward the rest of the toes. This is usually caused by frequently wearing pointed shoes that pinch the toes together. Eventually one or both big toes may even overlap or underlap the toe next to it, causing even more problems. While bunions can be hereditary, wearing shoes that squish the toes together is considered the primary cause. These can often be helped or prevented altogether by wearing roomier footwear.
The name "bunionette" sounds like a miniature bunion. It's actually a bunion located on the little toe MTP joint instead of the big toe. Bursitis, a callus, or a corn over this tiny joint may develop as the body responds to the pain and irritation.
Adolescent bunions afflict kids, usually ages 10-15. They're the same as regular bunions but they're caused by heredity, not footwear.
All three types of bunions can also be caused or exacerbated by inflammatory or neuromuscular conditions.
The most common symptoms of bunions:
• Painful or tender red bump on the MTP joint
• Outside toe angled inward
• Hard skin on the bottom of the foot under the affected joint
• Limited range of motion in affected toe
• Difficulty walking (severe cases)
In addition to the common symptoms, bunions or any other painful foot condition can negatively affect athletic performance or daily activities by causing a person to walk, run, or move differently to compensate for the pain. This can alter the correct body position, which may cause other musculoskeletal issues affecting balance, accuracy, and even endurance. Improper body position is also known to increase the chance of injury to joints, muscles, and tendons.
There are effective treatments available for bunions. Changing footwear, padding the bunion, getting custom orthotics (toe spacers, toe splints, inserts that reposition the foot), ice, and anti-inflammatory medications are the most common ways to relieve symptoms. Surgery is an option if these treatments don't help, although recovery is long. Surgery for adolescents is normally not recommended because the bunion can return after they are full-grown.
November 23, 2015
Cyclists: Keep Your Ankles Healthy!
The many miles and hills around the South Bay make cycling an exciting way to stay fit, not to mention the gorgeous views. It’s easy to make this a lifestyle, especially with such a large cycling community in the area. With habit, though, comes repetition, and with it must come good form in order to stay pain free.
The ankles can get stressed after long rides. This can be from improper foot position, having flat feet, having too high of a saddle, riding in soft-soled shoes, having a bent pedal or crank…the list goes on.
The most common ankle pain complaint from cyclists is pain in the back of the ankle, which often indicates Achilles tendonitis. Severe Achilles tendon problems may require surgery, but In early stages, they can often be remedied with ice, anti-inflammatory medication, and rest. Gently stretching the Achilles tendon is also important. One way to do this is to stand with the ball of the foot on a stair or curb for 20-30 seconds and let the heel hang down, taking care not to overstretch. If the symptoms don’t subside, or the pain has migrated or is getting worse, it’s time to see an orthopedic doctor.
A board certified orthopedic doctor specializing in ankle problems is usually the best choice for these types of issues. He or she can create a custom treatment program that helps you get back on your bike sooner and can advise you about the most ideal form for your particular body mechanics. If you need custom shoe orthotics, this person is also the most qualified resource. Having the right diagnosis and treatment for your pain, especially if you want to get back to logging miles quickly, takes a qualified medical expert who will listen carefully to your needs and goals, and be your partner as you heal and move into health again.
August 25, 2015
"But it was just a little twist and fall!”
The foot can get injured with very little impact or drama. Even tripping over the top of something and falling can cause problems that need medical attention. Although at first it may feel like a sprain, there's more to the foot than just ligaments that get overstretched. The mid-foot area is packed with several bones and ligaments that stabilize the foot and transfer weight properly to the leg. This area is called the Lisfranc Joint Complex. When these structures are misaligned or broken in any way, it can negatively affect the entire mechanics of body motion.
Common symptoms of a Lisfranc injury are:
• Pain and swelling on the top of the foot
• Bruising on both the top and bottom of the foot
• Pain, sometimes severe, when trying to walk
• Pain in the mid-foot when standing one-legged on the injured foot and trying to raise up to a "tiptoe" position
An orthopedic doctor, preferably one specializing in the foot, needs to perform an examination if any of these symptoms are present. If the doctor suspects a Lisfranc injury, he or she will likely take x-rays, since they show both fractures and misalignment. MRI and/or CT scans may be taken to see further details prior to a surgery but are usually not necessary to diagnose the injury.
Treatment for a Lisfranc injury requires many weeks of non-weight bearing, even in less severe cases. A cast and crutches are still needed for partial ligament tears and no fractures. Surgery is recommended if any bones are fractured or if any ligaments are completely torn. Hardware is used to fix the structures back into position or to fuse bones that cannot be repositioned.
Lisfranc injuries are unfortunately known for limiting a return to sports. A successful recovery can still result in arthritis to the injured area. An orthopedic doctor who is highly trained and who specializes in the foot is the most qualified doctor to diagnose and treat this complex problem with the most desired results.
July 21, 2015
A Case for Ankle Replacement
Most talk about joint replacement focuses on the knees and hips. We don't hear as much about the smaller joints, especially something as complex as the ankle. But because ankle replacement hardware and surgical techniques have improved so much in the past ten years, more people are considering ankle replacement instead of ankle fusion surgery.
Ankle pain and range of motion problems alone don't make someone a good candidate for ankle replacement. In most cases, keeping the natural joint is best, as long as pain and restricted movement symptoms can be managed conservatively. This includes physical therapy to strengthen the ankle area, which can relieve pressure on the joint. Bracing, weight loss, activity modification, medications, injections, and even a regimen of elevating and icing and/or heating the ankle may also be effective.
Many people become concerned about changing their activities, but it may only be temporary. Often just reducing inflammation for a while can allow a person to then get back to doing their favorite things. If conservative therapies have been exhausted and the doctor determines that the person is a good surgical candidate, ankle joint replacement surgery, called total ankle arthroplasty, may be recommended.
The surgery takes about two and a half hours and the hospital stay can be 2-3 days under typical circumstances. The ankle must be elevated for much of the time in the hospital. Weight bearing is off limits for 3-6 weeks after the surgery, but doctor-prescribed range of motion exercises can start much sooner. Getting back to normal activities takes about six months, but it can be longer in some cases.
June 24, 2015
"I'm training for a long race and the ball of my foot hurts!"
Runners, cyclists, and any athlete who suddenly increases their training regimen may put themselves at risk for sesamoiditis of the foot. Ballet dancers are particularly susceptible. Sesamoid bones are attached only to tendons and are found around some joints throughout the body. The largest sesamoid is the kneecap. Sesamoids act like a pulley that slides over the joint, protecting and strengthening it. There are also two sesamoid bones just under the big toe where it meets the foot, allowing us to put more force on the area without causing pain and instability.
Common symptoms of sesamoid issues are:
• Pain and swelling in the ball of the foot
• Pain when moving the big toe in different directions
• Trouble bending the big toe
• Pain in big toe when pressed down toward floor
Sesamoid problems most often stem from the inflammation of the tendons attached to the bone. When they swell, it puts pressure on the surrounding nerves and causes pain. It's rare to have a broken sesamoid, and even rarer to have a sesamoid bone with reduced blood supply.
An orthopedic doctor specializing in the foot is the best practitioner to diagnose and treat sesamoid problems. He or she can rule out more serious conditions as well. Your doctor will talk to you about your medical and incident history, perform a physical exam, and likely take x-ray and MRI images of your foot to in order to correctly diagnose the problem.
Surgery is usually not required to fix sesamoid problems. Temporary activity modification, shoe modification, taping, bracing, anti-inflammatory medication, injections, rest, ice, and some physical therapy modalities have all been shown to help effectively. If none of these treatments work, your orthopedic doctor may recommend surgical removal of the sesamoid bone.
May 26, 2015
"An ankle doctor can help with knee problems?"
Limited ankle range of motion and a host of other ankle problems can cause a chain reaction up the body, causing knee pain, hip pain, and even back pain. It's especially important for those who have had an ankle injury to dedicate themselves to getting their ankle health back. If possible, any swelling, stiffness, or range of motion issues need to be worked out during the initial post-injury physical therapy your doctor prescribes.
After the therapy is done, patients can also benefit greatly by:
• Staying active
• Stretching their calf muscles (Achilles tendon) once a day or more
• Making "ankle circles" part of their before and after exercise routine
• Writing the alphabet with each foot:
Sit on a high, sturdy platform and put one leg on a stool or chair. Dangle the other leg, and write each letter of the alphabet in the air using that foot. Keep the hips and knees still while using only the ankle joint to complete the motions. Switch legs and repeat.
• Doing calf raises 2-3 times a week
An orthopedic doctor specializing in the ankle area is the best resource for properly diagnosing and treating ankle problems. He or she can answer your questions and will work with you to find the best treatment program for you.
April 1, 2015
Why Some People Can Walk on a Broken Ankle
A broken ankle is one or more fractures of one or both of the lower portion of the lower leg bones, the fibula and the tibia. A trip or fall, car accident, or an ankle rotation or roll are the most common causes of ankle fractures.
Broken ankles can happen at any age but are often more severe in older people due to issues with lower bone density. Along with the fractures, tendons and ligaments are usually damaged, which causes instability until healing is complete.
Someone who breaks an ankle and can still walk on it likely has a hairline fracture with very little to no damage to the surrounding tendons and ligaments; however, even this type of break needs medical attention.
Symptoms of a broken ankle may include:
• immediate sharp, severe pain at the ankle joint or just above
• swelling and bruising
• tenderness when touched
• inability to put weight on the foot
• visible bumps or protrusions in the ankle area
Medical attention is advised if a person has these symptoms. Failure to treat a broken ankle can result in deformity, instability, loss of strength and agility, reduced range of motion, arthritis, chronic pain, and more.
Treatments for a broken ankle do not always require surgery, but it's recommended in many cases. Fractures without displacement may only need a cast. Physical therapy is essential during recovery to restore stability, strength, and range of motion.
February 20, 2015
"I have a heel spur—does it have to be removed?"
As a general rule, an experienced orthopedic doctor doesn't treat conditions. He or she treats symptoms. If you're having foot pain and x-rays or examination reveal that you have a heel spur, it's likely not the cause of the problem and won't have to be removed. Plantar fasciitis is often the culprit of foot pain on the bottom of the foot in the heel area.
Plantar fasciitis is the inflammation of the tendons running along the bottom of the foot. Damage or tears to the tendons are caused by stress. There are many reasons why this could happen:
• Tight calf muscles
• High arches
• Running frequently or running long distances
• Sudden increase in athletic activity
• New exercise routine
The pain from plantar fasciitis can be quite intense, and it's important to get treatment when that happens. An orthopedic doctor and surgeon specializing in the foot area is the most knowledgeable and experienced resource. He or she can correctly diagnose foot pain conditions and recommend many sound and proven treatment options.
The most common form of treatment for plantar fasciitis is stretching the calf and foot muscles. Other less invasive treatments include medication, physical therapy, shockwave treatment, and custom shoe orthotics. Surgery is rare and is only considered if these treatments don't work.
January 16, 2015
"My ankle doesn't bend all the way up!"
A condition called equinus is often diagnosed when a patient's ankle doesn't bend far enough (less than 10 degrees) in the upward direction toward the leg. It can happen in both ankles but is usually worse in one. Some people with the condition walk on their toes to compensate, so equinus is names after horses (equines), who are toe-walkers.
Equinus can be caused by:
• Tight calf muscles that develop over time or circumstance
• A congenital condition (tight or short calf muscles present at birth)
• Wearing a cast or being on crutches
• Wearing high-heeled shoes
• A "floating" bone fragment from an injury that inhibits ankle motion
• Diabetes (Can cause Achilles' tendon to tighten)
• Neurological disorders involving calf muscle spasms
Equinus can cause all kinds of secondary problems, depending on how a patient compensates for the limited range of motion:
• Plantar fasciitis
• Arch pain
• Arthritis in the middle of the foot
• Pressure sores, pain, or calluses on the ball of the foot
• Ankle pain
• Calf cramps
• Shin splints
Most patients see a doctor for the above symptoms without realizing they have equinus. An orthopedic doctor specializing in the foot and ankle area is best qualified to diagnose and treat the condition. The doctor will perform a thorough examination and take images to look for bone fragments.
Physical therapy is recommended in most cases because it's very effective at stretching the calf muscles. Other treatments may include custom orthotics, arch supports or heel lifts, splinting, anti-inflammatory medications, and activity modification. Most patients do not need surgery to get relief from equinus, but those with a "floating" bone fragment or tight tendon are most likely to need it.
December 8, 2014
Foot Pain: How does a previous orthopedic injury lead to arthritis?
Foot pain can be caused by a number of problems, but osteoarthritis, brought on by general wear and tear and aging, is the most common cause. That's because as we get older, our bodies don't repair cartilage as fast. Obesity and family history are also factors in the onset of osteoarthritis. Pain, tenderness, swelling, stiffness, reduced range of motion, and trouble walking as a result are the most noted symptoms.
Because the foot and ankle are such complex areas—28 bones and 30 joints in a very small space—they can be vulnerable to injury throughout our lives. Once a joint is injured, the body can actually secrete hormones into it that cause the cartilage to deteriorate several times faster than the normal rate, bringing on arthritis symptoms. This is called post-traumatic arthritis. It can happen to people earlier in life than osteoarthritis, especially if their injury happened when they were young.
Treatment for arthritis of the foot and ankle varies. Conservative therapies such as anti-inflammatory medications, custom foot orthotics (shoe inserts), custom shoes, injections like cortisone or joint lubricants, activity modification, and physical therapy are effective for most patients. An orthopedic foot doctor and can correctly diagnose and create a tailored treatment program appropriate for a patient's particular symptoms. Earlier treatment may prevent or prolong the onset of more severe symptoms, which may warrant surgery. There are different surgical options, depending on how the arthritis has affected the area.
November 7, 2014
Heel Pain That Won't Go Away
Our heels bear many tons of weight for every mile we use them. They're well-suited to this: protected with fat pads, thick skin, and shored up by the Achilles' tendon, one of the toughest tendons in the body. When the heel is injured, it needs special attention because we depend on it so much.
Depending on whether the pain is under or behind the heel, an orthopedic doctor can tell what the most likely course of treatment should be. The key is paying attention. If your heel pain isn't going away, it's time to see the doctor. The right diagnosis and treatment greatly increases the chances of the pain subsiding and not turning into a more serious chronic condition.
Your doctor will thoroughly examine your heel and may ask you to stand or walk in certain ways in order to properly diagnose your injury. Common treatments are rest, activity modification, stretches, shoe inserts, ice, and anti-inflammatory medications, depending on the specific problem you have. Surgery is rarely necessary.
September 26, 2014
POP QUIZ: Which toe gets broken the most?
Nearly a quarter of all the bones in the body are in the feet. These small bones bear body and impact weight with every step and jump. They can fracture after too much direct and repeated stress. The pinky-toe metatarsal/phalanges (forefoot/toe) bones are most commonly fractured. (Did you guess correctly?!)
Symptoms include sharp pain, swelling, and tenderness over the metatarsal bone. There's a catch, though—many X-ray images do not detect a stress fracture unless it's displaced. More sensitive types of imaging are required for detecting these small fractures. If you have any symptoms of a toe fracture, see an orthopedic doctor right away for the most accurate diagnosis. Because they're so experienced at knowing what to look for and what imaging tests to conduct, they're mush more likely to find a fracture if it's there.
Letting a toe fracture go untreated can result in pain for a longer period, improper healing, and make you vulnerable to a more serious fracture.
Treatment for most toe fractures includes wearing non-weight bearing boots, immobilization, or surgery. Surgery is only necessary for displaced fractures. Prognosis is good to excellent in most cases.
August 22, 2014
Injured Ankles Need Physical Therapy
Because ankles bear so much weight, they need serious help after an injury. Do not ignore lasting pain, swelling, bruising, or the inability to keep weight on your ankle. Get a diagnosis from your orthopedic doctor if you're not healing! Failure to do so can leave you with an ankle that doesn't work right, which can be painful and affect your gait, and in turn cause problems throughout your whole body.
One common ankle injury, a talus fracture, happens at the talus bone at the lower part of the ankle joint. The joint is very important for gait, especially when walking on uneven surfaces. Talus fractures result from high impact forces such as those sustained from a car accident, or a high-velocity fall from skating, snowboarding, or falls from high elevation.
Injury to the talus often results in a major loss of motion and function. Many talus fractures require surgery to align the bone, allowing it to heal properly. A fracture that is not displaced may only require casting for 6-8 weeks, but most patients will undergo surgery because of the forceful nature of the injury.
Post-surgical recovery from a talus fracture involves staying off the affected ankle in order to protect it. An assistive device like a pair crutches, a walker, or even a wheelchair will be necessary.
Physical therapy is crucial to restoring range of motion and function of the ankle joint because by this point the joint has been immobilized for several weeks. There are two stages to physical therapy for this injury. The first is to teach proper use of the the cane or walker or wheelchair and give exercises that keep the leg muscles strong for future walking. The second stage is to rehabilitate the ankle itself with range of motion and strengthening exercises. Throughout both stages the therapist may use heat, ice, electrical stimulation, or massage to help reduce problems with pain, swelling, immobility, and scar tissue.
July 31, 2014
"It hurts to climb stairs!"
Any pain that is persistent or keeps you from doing what you like to do is worth getting checked out. If your lower leg just below the knee hurts when you climb stairs, you may want to see an orthopedic doctor. Among other things, an irritated bursa can cause you pain and can be treated by your doctor.
A bursa is a jelly-like sac that cushions and decreases friction between soft tissues like tendons, bones, and muscles. When it gets irritated, the condition is called bursitis. Pes anserine bursitis affects the bursa on the shin bone (tibia) 2-3 inches below the knee.
Pain comes on gradually. It's typical to have swelling and tenderness when the area is pressed. Continued physical activity and climbing stairs also causes pain.
Athletes, especially runners, and people with osteoarthritis are most commonly affected. Activities that can cause or make pes anserine bursitis worse are:
• Not stretching before a running-type workout
• Too much running on hills
• Increasing exercise/mileage suddenly
• Osteoarthritis of the knee
• Tight hamstring muscles
• Having the knee or lower leg turn out while in motion
• A torn meniscus on the inner side of the knee
Treatments include physical therapy, activity modification, stretching tight hamstrings, weight loss to alleviate joint and muscle pains, anti-inflammatory medications, and icing. Your orthopedic doctor can inject the bursa with a steroid and anesthetic solution if the pain is more severe. Surgery is rare, but your doctor can remove the bursa during an outpatient procedure if necessary.
July 23, 2014
Treat Your Bent Toes
There are many ways to treat deformed, bent toes, a condition called hammer toe. In this condition the one or more of the middle toes can become bent at the second joint, resembling a hammer. This often causes calluses or corns on the top of that joint or at the tip of the toe.
What causes hammer toe?
--Shoes with a narrow toe box and/or high-heeled shoes can force the toes into a bent position
--Muscle imbalance between the top and bottom muscles of the toes
Conservative treatment starts with shoe modification. Your orthopedic foot specialist can recommend a shoe that is roomy, has cushioning and padding, and is wider at the toes. A simple prescription for toe straps, cushions, and corn removers can be given. Physical therapy can help with gaining range of motion by stretching and strengthening tight toe muscles.
Will I need surgery?
When conservative methods fail, your doctor may recommend surgery. The procedure is typically done on an outpatient basis with local anesthetic. The recovery period usually allows walking but not strenuous hikes or similar activities. Post-op physical therapy may be needed.
June 13, 2014
Taking your ankles for a hike with Dad this weekend?
The beautiful weather and many opportunities for outdoor activities around the South Bay make it a great time to talk about these often neglected body parts: your ankles. Keeping them strong with stretching, and also balance and strengthening exercises helps a lot. It also helps to have good proprioception, the awareness of where your body is in space. If you know where you are in relation to other objects and more importantly, where and how your feet will land if you are up in the air or on unstable ground (like on a canyon hike with Dad), your chances of landing safely increase.
Here are some suggested exercises that combine ankle strengthing and balance:
1. Stand on one leg, hold for 45 seconds, switch.
2. Stand on one leg, have someone throw a ball back and forth with you 15 times, switch legs. Repeat 2 more times. (Be sure to throw the ball to each side and high and low.)
3. Squat with balance shifted to one leg, or half-squat with one leg out front, switch. Make sure your hips are pushed backward (like you're sitting back into a chair) so that your knee is directly on top of your ankle on the weight-bearing leg.
Stay safe this weekend, and enjoy the weather and family! If you have an ankle or other orthopedic problem, we're here if you need us at 310-316-6190 on Saturdays (walk-in or appointment) 9-1 or any weekday (appointments only) 8:30 am - 5:30 pm. Any of our doctors can treat you for ankle problems. Our foot and ankle specialist is Kenneth K. Park, MD: www.tosmg.com/park
May 16, 2014
Numbness, tingling, or shooting pain in your foot? Don't ignore symptoms of nerve damage, which can be irreversible...
There is a tunnel in the foot going from the inside of the ankle bone through the ligaments stretching across the foot. It's called the tarsal tunnel, and the nerves inside it can become compressed, resulting in tarsal tunnel syndrome (TTS).
This can happen from various forms of swelling: varicose veins, swollen tendons, inflammation from diabetes or arthritis, or the swelling that occurs after an ankle or foot injury. It can also be caused by scar tissue, flat feet, fallen arches, and any variety of lumps and bumps in the foot, such as bone spurs or cysts, that could put pressure on the nerves.
• Tenderness and aching
• Sharp pain around the inner part of the foot and ankle
• Radiating pain along the inner or outer part of the foot
• Tingling or burning
Conservative treatment options for TTS include a change of footwear, anti-inflammatory medications, rest, ice, or a local cortisone injection. More treatments done in physical therapy can also be very beneficial. If after conservative treatment symptoms continue for several months, tarsal tunnel release surgery may be necessary.
April 3, 2014
Prevent Ankle Sprains The most common ankle sprain is of the lateral kind, with damage occurring when one “rolls” the ankle--the foot rolls under while the leg moves outward. Symptoms include tenderness, swelling, bruising, and pain on the outer portion of the ankle.
Increase your chances of preventing an ankle sprain by:
• warming up before exercising
• gently stretching the area
• training gradually, increasing the amount of activity in your sport rather than suddenly performing at a high level
• wear properly fitted footwear that is in good condition
• use extra caution on uneven surfaces, uphills, and downhills
• for those who have had previous sprains, use tape or a brace under proper medical instruction
The RICE method is recommended after a sprain occurs:
Rest--do not put your weight on the ankle as long as it is painful to do so; crutches may be necessary
Ice--for the first three days following the sprain, ice the area for 10-20 minutes every 1-2 hours
Compression--apply an elastic bandage; it should feel like pressure is applied but should not restrict circulation; a doctor or physical therapist can also help with bracing
Elevate--to reduce swelling, keep the ankle above the heart for 2-3 hours a day
Early weight bearing and balance training is recommended. A physical therapist can teach these. Taping and bracing helps stabilize the ankle. Most people recover fully, but 20% of people who experience a lateral ankle sprain develop instability and have recurrent sprains.
March 4, 2014
TURF TOE: Toe Pain that Lasts
Turf toe is a term used to describe an injury to the joint capsule of the big toe. It's called turf toe because the injury is common among athletes who play turf sports like soccer and football.
Turf toe occurs when the big toe is hyperextended with the heel raised, during direct impact, while changing direction, or accelerating or decelerating. (Imagine the big toe being stepped on and pinned down, or caught on the ground or something else while the rest of the body is still in motion.)
• Toe stiffness
• Redness over the bottom of the big toe
Treatment options can vary from orthotics to anti-inflammatory medications, proper body mechanics, stretching, and cortisone injections. Even though symptoms may persist for a long time, the prognosis is good to excellent.
January 3, 2014
Rigid big toe for no reason? Let a TOSMG orthopedic doctor help!
Hallux refers to the big toe. Rigidus describes the stiffness of the joint, in this case, the "knuckle of the big toe."
Big toe rigidity is common among adults without any preceding trauma. The cause is unknown, though a genetic predisposition is suspected.
Symptoms are often found on both big toes and include stiffness with bending or straightening of the big toe, local swelling, and tenderness.
Conservative treatment may include stretching, orthotics, anti-inflammatory medication, and cortisone injections. Surgery is sometimes performed in order to increase mobility, but outcomes can be unpredictable.
September 23, 2013
Do orthopedic surgeons always want to operate?
An orthopedic surgeon is first and foremost a medical doctor who helps patients get better. Most of the time that doesn't mean actually having surgery. The doctors at TOSMG estimate that for every patient who comes to them with orthopedic problems, less than 1 in 10* will actually have surgery. So what happens to the rest?
Physical therapy, rest, ice, anti-inflammatory medications, changing habits, injection therapy, and stretching are among the most common prescriptions for our patients. It's only when a combination of these more conservative treatments fail that surgery may be suggested. But the simple fact is that most people get better without it.
*Estimate only. Does not include patients who are referred for a surgical consultation, meaning that another doctor has already determined, and that the TOSMG doctor agrees, that the patient needs a highly trained, expert orthopedic surgeon in order to get the best outcome.
September 9, 2013
"My Achilles' tendon hurts!"
Achilles' tendon pain and problems often arise from having muscles that are too tight. More specifically, the gastrocnemius muscle (calf muscle) is one of the main causes of Achilles' tendon ailments as well as many other problems seen in the foot and ankle. Researchers believe the tight calf muscle is an atavistic trait (passed down over time) and/or due to lack of stretching and some types of shoe wear. Some symptoms may include:
• pain in the back of heel (Achilles area)
• pain in the arch
• intermittent cramping in the calf
In children this can manifest as a condition called idiopathic toe walking where the child looks like he/she is tip-toeing around when walking. This often resolves on its own by age 2-3. A tight calf muscle can also cause a foot that is flat to become more flat over time.
While most symptoms are fleeting, those that cause limitations to daily activities or last for more than a few weeks should be evaluated by an orthopedic doctor. Most of these conditions can be treated nonsurgically with physical therapy, bracing, and/or activity modification. A minor surgical procedure called a gastrocnemius recession can stretch the calf allowing more flexibility. This should be reserved as an option only if nonsurgical treatment has failed.
August 12, 2013
Morton's neuroma is a painful condition that can affect the bottom of your foot, more specifically the "ball" of your foot. This burning, sharp pain is usually caused when there is a thickening of the tissues around the nerves that lead to the toes.
• Typically there is NO deformity that is visible through the skin
• Tingling and/or numbness in the toes
• Feeling of standing on a pebble or folded sock
• Burning pain beginning in the ball of the foot that may radiate into the toes
• Irritation, pressure, or injury to one of the nerves that leads to the toes
• Wearing high heels or tight-fitting shoes
• Certain sports that involve high-impact activities, such as running
• Those with foot deformities, such as bunions, hammertoes, and abnormal arches are at higher risk for developing Morton's neuroma.
• Any foot pain that last longer than a few days should be examined by a medical professional
• Physical exam of the foot
• Imaging tests, such as x-rays, MRI, and ultrasounds, to rule out any other sources of foot pain
• Changing footwear
• Proper shoe orthotics
• Surgery to remove the affected nerve
Please feel free to contact us with any questions about Morton's neuroma or other orthopedic needs. Torrance Orthopaedic & Sports Medicine Group is committed to pursuing the health of each and every patient.
July 22, 2013
Achilles Tendon Rupture
An Achilles tendon rupture is a very common soft tissue injury where the tendon that attaches the calf muscles to the heel tears, either partially or completely.
An Achilles tendon rupture can occur with sudden acceleration or abrupt deceleration like jumping or running up hill. The injury occurs most often in people in their 20s and 30s, and it affects men more often than women. Common causes are decreased calf strength and flexibility, excessive weight and corticosteroid injections to the tendon.
Conservative treatments include rest and physical therapy. Large tears may require surgical repair.
Should you have any questions regarding Achilles tendon injuries or other orthopedic concerns, please contact us here at Torrance Orthopaedic & Sports Medicine Group. We're open Monday through Friday 8:30 a.m. - 5:30 p.m. for appointments and we welcome walk-ins on Saturdays 9 a.m. - 1 p.m.
June 24, 2013
Peroneal Tendonitis (ankle tendon inflammation)
Peroneal tendonitis is the inflammation or irritation of the tendons that run behind the outside bony prominence of the ankle (lateral malleolus).
• Excessive repetitive forces during standing and/or dynamic activities (example: marathon running)
• High arches
• Recently tried a new exercise
• Significant and sudden increase in exercise activity
• Poor footwear
• Pain around the back of the ankle
A board certified orthopedic surgeon can properly diagnose this condition and create an effective treatment program. This is commonly the safest and fastest route back to health.
• Anti-inflammatory medications
• Physical therapy
• Muscle strengthening
• Activity modification
• Specific shoe inserts or orthotics
• Surgical repair of peroneal tendon tears can clean up the tendon and bony spurs
Please contact Torrance Orthopaedic & Sports Medicine Group for any of your orthopedic concerns, where caring for families in the South Bay is our privilege.
April 22, 2013
Ganglion cysts are small cystic swellings around the tendons or joints, most often found in hand, foot, or knee. They are also known as "bible cysts" because the treatment in the past was to hit the cyst with a bible or large book to cause it to rupture.
Ganglion cysts are most common in the hand, more notably the wrist or fingers. They are often on the back of the hand. It is also common to have swelling at the metacarpophalangeal joint (where the finger meets the hand) and interphalangeal joint (the next joint out from there).
There are various causes of ganglion cysts, but the most common reason is a protruding area due to a weakened portion of a tendon sheath or joint capsule.
The most common treatment for ganglion cysts is surgery. A surgeon will aspirate (drain) the cyst and inject the area with corticosteroid. Stiffness and scar formation can occur from the surgery.
Please contact Torrance Orthopaedic & Sports Medicine Group for any of your orthopedic needs, where caring for families in the South Bay is our privilege.
April 9, 2013
Restless leg syndrome:
Restless leg syndrome (RLS) is a disorder that stems from the nervous system. Symptoms of RLS include tingling, throbbing and the urge to move the legs. RLS can also affect a patient's sleep habits because it can interfere with sleep patterns.
Patients who suffer from RLS can take medication such as ropinirole and pramipexole. Many patients reports short-term relief but can also have negative long-term effects.
Studies show that exercise and stretches can help reduce RLS symptoms by 50%. Exercising and completing stretches in small amounts throughout the day are most effective. Make sure to gear the total amount of exercise by your individual endurance and tolerance. Studies show that lower body resistance in coordination with aerobic activity is most beneficial. For example, try easy lunges during a walk. Pumping your ankle (similar to pressing a gas pedal) can help circulation as well. Because tight leg muscles are a common symptom, try stretching your calf, hamstring and quadriceps. Avoid exercise within 2 hours before bedtime to keep your sleep cycle consistent. Most importantly, do no overdo it. For some patients with RLS, too much exercise can increase symptoms. Listen to your body.
March 4, 2013
"Proper Use of a Cane"
Using a cane or other assistive devices can help in relieving/decreasing pain, adding stability and easing the pull of certain muscles.
Here are a few helpful tips on how to use a cane:
A) Walking: The assistive device should be used on the opposite side of the affected limb. If used for balance, pick a side that's most comfortable.
Move the cane and affected limb at the same time. Stand tall with good posture and look ahead, not down at your feet.
B) Proper fit: The length of the cane should be adjusted so that the top of the cane should line up with the wrist joint when standing straight with the arm completely relaxed at your side.
C) Going up Stairs: Up with the "GOOD". Step with the unaffected limb first.
Then move the cane and affected limb up to the step together.
D) Going down Stairs: Down with the "BAD". Step down with the affected limb and the cane together.
Bring unaffected limb down to the same step. When negotiating stairs, it's always safer to use a railing with the free hand whenever possible.
January 25, 2013
A bunion is characterized as an enlargement at the base of the big toe. Symptoms generally include inflammation, redness, tenderness and pain. They occur nearly 10 times more frequently in women compared to men due to tight fitting, narrow shoes. In some cases genetic factors may predispose one to developing bunions at an early age. Non- surgical treatment options include resting the foot, avoiding walking, wearing wider shoes or sandals, stretching and the use of cold packs/ice. If these methods fail, speak to your doctor about cortisone injections or taking an anti-inflammatory. If all fails, a bunionectomy may be the surgical route.
January 11, 2013
Drop foot or foot drop is often thought of as a neurological disability. Drop foot is not a stand-alone condition, but usually a condition of another underlying health issue. While the condition is caused by neurological problems, Drop Foot can be cured or minimized depending on the cause and possible treatments. Knowing the symptoms and the pre-existing conditions can help determine proper identification and treatment of the condition.
Usually this is caused by a nerve injury below the knee, but sometimes can occur at a higher level. The main symptom of drop foot is the limited ability to lift the front portion of the foot. This causes the foot to drag or "slap" the ground with each step. Raising your thighs when walking, as if stepping over a large object, is another symptom of drop foot.
Treatment for drop foot depends on the cause of the condition. This can range from wearing braces or splints for a period of time to surgery. Braces help hold the foot in place. Physical therapy exercises can also help with normalizing gait/walking. If the condition is caused by nerve damage from physical injury such as strokes, nerve stimulation can help with the use of a battery-operated electrical stimulator. Some cases require surgically repairing the nerve damage.
October 26, 2012
Rheumatoid Arthritis: Are you one of the 1.3 million in the United States that have rheumatoid arthritis? Rheumatoid arthritis (RA) is a chronic autoimmune disease that can damage the joints of the body. This systemic disease affects the internal organs of the body which in turns, causes inflammation to the joint lining tissue. Pain, stiffness, swelling and loss of functional mobility are all symptoms of RA. The inflammation can affect the body's organs such as the heart and lungs. Smaller joints are more likely to be affected by RA such as joints in the hands, feet and elbows. Many times, the inflammation can cause disuse of the joint and therefore, the muscles surrounding the joint become weak. Although there is no current cure for RA, the disease can be controlled especially if you seek medical help early. If you believe you are having symptoms of rhematoid arthritis, please contact one of our orthopedic specialists at Torrance Orthopaedic & Sports Medicine Group. We are here to help you with your wellness journey.
October 15, 2012
Shin splints, or tibial stress syndrome, refer to pain along the shinbone. Shin splints occur with physical activity and are a result of excessive forces being placed on the bone or the surrounding tissues that connect muscle to the bone. Shin splints can be caused by either irritated or swollen muscles from overuse, tiny stress fractures in the bone, or overpronation which will cause excessive stretching of the muscles in the lower leg. Depending on the exact cause, pain may be felt on either side of the shinbone or in the muscles. The dull aching pain may be experienced during exercise or shortly after finishing exercise or in some cases constant. Despite the different causes treatment for shin splits will be the same – icing/rest, NSAIDS, a more supportive shoe or arch support, or physical therapy here at TOSMG that will focus on improving flexibility and strength in the lower leg.
August 17, 2012
One common foot problem is plantar fasciitis, which is a thickening of the tissue at the bottom of the foot. Plantar fasciitis occurs when the thick band on the bottom of the foot is overstretched or overused. Foot arch problems, long distance running, poor fitting shoes, and sudden weight gain can predispose individuals to a higher occurrence of plantar fasciitis. The most common complaint is a pain and/or stiffness in the heel, which can be dull or sharp, burn or ache. The pain is usually worse in the morning within first few steps, excessive standing or walking, or after intense activities. A health care provider may recommend the use of an anti-inflammatory, foot and ankle stretches, use of supportive shoes, resting and icing. Treatment may also require the use of a night splint, a boot, cast, or orthotics. If you are currently experiencing foot pain consider seeing us at TOSMG.