We are hoping David Pastrnak, forward for the Boston Bruins will return to the ice soon after suffering from a non-displaced fracture in his foot almost 8 weeks ago. The injury occurred back in October when he stopped a puck with his foot. The impact of the puck caused a small fracture in one of his bones. The initial x-rays did not reveal a fracture, however swelling and pain persisted. It is not uncommon for a fracture not to appear on x-ray until 14 days after the injury. A CT scan revealed a non-displaced fracture in an awkward area. Luckily the fracture was not severe enough to undergo surgery and a more conservative approach was taken. Bone takes 6 to 8 weeks to heal. Course of treatment includes icing and elevating for the first week. Ibuprofen and other NSAIDs should be avoided as they can delay bone healing. Tylenol can be taken to help with the pain. A walking boot or short leg cast can be used for 4 weeks at which point physical therapy can commence. At this point, the bone should be healed if Pastrnak has been compliant to his course of treatment.
If you have sustained an injury to your foot and continue to have pain come and see us for a comprehensive assessment at Foot& Ankle Doctors, Inc.
Brooklyn Nets forward Rondae Hollis-Jefferson is out indefinitely after fracturing the posterior aspect of his right talus. He recently underwent successful surgery with two screws to repair the fracture. He is expected to be out for the next 8 to 10 weeks.
The talus articulates with the tibia and fibula and plays an important role in ankle function and stability. The back of the talus is composed of a medial and lateral tubercle. The lateral tubercle is more commonly injured when the ankle is plantarflexed beyond a normal range or with forced inversion. Tenderness over the posterolateral talus or plantarflexion of the ankle may reproduce pain. The medial tubercle of the posterior talar process can fracture with excessive dorsiflexion with pronation. Tenderness between the medial malleolus and the Achilles tendon will produce pain.
Originally doctors thought Rondae Hollis-Jefferson was suffering from a mild ankle sprain since x-rays showed no signs of fractures. CT scans revealed a more serious injury.
Minimally displaced fractures can be managed with a non-weight bearing short leg cast for 4 to 6 weeks. Rondae Hollis-Jefferson must have had a significant displacement of the posterior process of the talus to have undergone surgery.
Our staff at Foot& Ankle Doctors, Inc. wish Rondae Hollis-Jefferson a full recovery.
Hammertoes are a painful and progressive deformity that commonly results from a muscle or tendon imbalance. There are tendons that run on top of toes known as extensors, which are responsible for pulling the toes up. There are also tendons that run on the bottom of toes known as flexor tendons that pull the toes down. When the flexor tendons become stronger than the extensor tendons the toes contract creating a hammertoe.
Patients often complain of pain when wearing shoes, contracture of toes, corns and calluses that form on top of the toes where the contracture is occurring and in between toes.
Flexor tenotomy is a quick, minimally invasive procedure with few complications or risks. There are no sutures needed or dressings that need to be changed. Patients will have a reduction in pain and do not need to take time off work. Flexor tenotomies give instant results, however it is not meant to be a cosmetic fix.
Local anesthetic will be administered to the toe before the procedure begins. Once the toe is numb a small stab incision will be made on the bottom of the toe with a needle. The needle is moved back and forth in a sweeping motion to cut the fibers of the flexor tendon. The toe will aggressively be moved up and down to ensure the fibers have been cut. Once the tendon has been cut the toes will immediately straighten and have increased flexibility. Patients will be shown how to splint their toe with adhesive strapping and educated on stretching the toe upwards.
If you are suffering from painful toes come see us at Foot & Ankle Doctors, Inc
Stay warm this winter and protect your feet from prolonged exposure to the cold and wet snow. Frostbite occurs with exposure to subfreezing temperatures below 32°F. There are four phases of frostbite injury:
- Prefreeze phase: The arteries in the foot vasoconstrict, while the veins dilate causing leaking of fluid from the cells
- Freeze-Thaw Phase: crystals start to form within the cell membrane and can result in rupture of cell membranes. Damage at this phase is still reversible
- Vascular Stasis Phase: Tissue is deprived of oxygen
- Ischemic Late Phase: The injured tissue is dead and damage to nerves occurs at this point
If frostbite is caught at an early stage rapid rewarming with circulating water at 104-108°F for 20 minutes can reverse the process. Rewarming is a painful procedure and it is recommended that you seek medical attention for appropriate pain medication. It is important to avoid smoking and caffeine as they can cause vasoconstriction of the arteries. Blood thinners such as Aspirin or Heparin can be administered to increase delivery of blood flow to distal parts of the foot, such as the toes.
Frostbites in later stages cannot undergo rapid rewarming. Instead, these injuries will be left to demarcate until a debridement or amputation will be performed. In the meantime, local wound care with Betadine, Dakin’s, or Silver Sulfadiazine may be applied to the wound depending on its severity.
Frostbite is a serious injury that can lead to amputation if left untreated. For more information come see us at Foot& Ankle Doctors, Inc.
We are sad to hear that Kevin Durant is suffering from a Jones fracture. A Jones fracture is a common fracture of the 5th metatarsal (a long bone on the outside of the foot that connects to the little toe) commonly caused by an inward twisting injury of the foot. Durant most likely experienced pain, swelling and tenderness along the outside of his foot, had difficulty walking and may have had some bruising. It was crucial that Durant was diagnosed and treated immediately because the 5th metatarsal has a poor blood supply that impedes the healing process.
Nonsurgical treatments for Durant includes resting and icing, immobilizing his foot with a cast and avoiding placing any weight on his foot. Jones fractures can take 6 weeks to heal and another 2-3 weeks of rehabilitation to build up muscle strength and range of motion.
Most professional athletes opt to treat a Jones fracture operatively with a screw or plate placed across the fracture site to avoid the possibility of delayed healing or non-unions, which are frequent with Jones fractures. It could be 8-12 weeks before Durant returns to the court if he decides to have surgery.
All of us at Foot& Ankle Doctors, Inc are wishing Durant a speedy recovery.
Bone biopsy and culture is the gold standard for diagnosis of osteomyelitis. Bone biopsy is indicated when clinical examination, laboratory findings and radiographic changes are suspicious for osteomyelitis. Chronic osteomyelitis can lead to longstanding wounds that can undergo malignant transformation into squamous cell carcinoma, and are termed Marjolin’s ulcer. Non-healing chronic wounds should also undergo a bone biopsy as well.
Bone biopsies can be obtained either from surgical debridement or percutaneously. At Foot& Ankle Doctors, Inc percutanous biopsies are performed in clinic in the following steps:
- Local anesthetic is injected in the area of skin to be biopsied
- A small incision is made over the desired area of biopsy site
- Blunt dissection is performed to the level of the bone
- A trephine biopsy needle is inserted into the area of desired bone
- Specimen sent for culture and pathology
If bone biopsy comes back positive for osteomyelitis, IV antibiotics can be started for 6 to 8 weeks. In some cases bone surgery to remove the infected bone is needed.
Peroneal tendon subluxation is a common injury in athletes especially skiers. It occurs when the ankle is rapidly dorsiflexed or the ankle is everted with intense contraction of the peroneal tendons. Pivoting motions of the foot and ankle in activities such as golfing, ballet, and gymnastics can also lead to subluxation of the tendons.
Our physicians at Foot & Ankle Doctors, Inc. will perform a thorough history and exam to differentiate peroneal subluxation from other lateral ankle disorders. Patients often report a popping or snapping sensation at the time of injury, which is indicative of a peroneal subluxation. On physical exam, it is common to find swelling posterior the lateral malleolus and a palpable bump over the peroneal tendons. Provocative tests can be performed to visually watch the subluxation of the peroneal tendons confirming diagnosis.
Radiographs may reveal an avulsion of the distal tip of the lateral malleolus along the course of the tendons. An MRI may be ordered for more severe injuries.
Conservative treatment options include immobilization in a short leg cast or splint in addition to RICE for 6 weeks. Surgical treatment is indicated in acute tendon dislocations in serious athletes who are eager to return to sports quickly. Surgical options include groove-deepening procedure or repair of the superior peroneal retinaculum.
Complications following surgical intervention include recurrence of the peroneal tendon subluxation as well as nerve injury. The sural nerve may be damaged and patients may experience numbness or a burning sensation to the outside of their foot.