Tony Parker Blows Out His Ankle

Did you see the video of Tony Parker’s ankle injury in the game against the Miami Heat? Nasty! It made my ankle hurt! Looks like the San Antonio Spurs will be without him for a while. Ankle sprains can take 4 to 8 weeks to heal; and that’s assuming he doesn’t need his ligaments repaired and didn’t break anything. Preliminary reports say bad sprain, but that could mean anything. Watch the video and you will wonder if 4 weeks is enough to recover from that!

Ankle sprains are actually one of the most common sports injuries, especially in basketball. Many players actually suffer from chronic instability due to multiple ankle sprains over a period of years and little or no true rehab. Many younger athletes return to sport as soon as the swelling goes down and they can get their shoes back on and laced up. This is way too early! An ankle sprain actually messes up the proprioception in your ankle so your brain has trouble understanding where your ankle is in space. This makes you more unstable and prone to reinjury.

If you have an ankle sprain, you should be evaluated by a sports medicine podiatric foot and ankle surgeon if you have localized pain, swelling and bruising, as well as inability to walk more than 5-7 steps comfortably. Many a foot fracture has been missed in the emergency room when x-rays were taken only of the ankle and not the foot. The fifth metatarsal is often broken with the same mechanism of injury of an ankle sprain, so the foot should be evaluated as well. If severe ligament injury is suspected, an MRI can evaluate the grade of injury. This is really what decides whether surgery is needed for full recovery.

Treatment for ankle sprains really depends on the degree of severity, which can only be determined by your doctor. Initial treatment always includes “R-I-C-E” therapy – Rest, Ice, Compression, and Elevation. Pain and edema is usually controlled with NSAID’s (non-steroidal anti-inflammatories) like ibuprofen. Bracing or casting coupled with non-weightbearing on crutches may be needed in more severe injuries to rest and stabilize the ankle while it heals. Return to pain-free ROM and stability is the goal. Surgery is only recommended in Grade 3 severe injuries in athlete’s or in those patient’s who have had multiple ankle sprains and suffer from chronic ankle instability. Long-term ankle instability can often be avoided with an aggressive physical therapy program. Bracing should only be used in the short-term during rehabilitation because long-term bracing actually causes atrophy and decreased ROM.

Physical therapy is needed for all ankle sprains. The goals of physical therapy should be to regain full ROM, strength and yes, your friend and mine: proprioception. Regaining strength as well as overall balance training are the keys to successful rehabilitation of an ankle sprain. A maintenance program of ankle strengthening, stretching, and proprioception exercises helps to decrease the risk of future ankle sprains, particularly in individuals with a history of multiple ankle sprains or of chronic instability.

Bottom line: if you happen to try to imitate Tony Parker and fall down and go “Boom” playing basketball or any other sport, have your ankle sprain evaluated by a podiatric foot and ankle surgeon. Delaying treatment and rehabilitation can lead to life-long instability and a really bad jump shot!

Crazy Bony Growths Under the Toenails

Osteochondromas

Have you noticed your big toenail growing funky? Have you noticed a pain or bump at the end of your big toe? Is your nail changing but you don't think its fungus? There could be a really easy answer and solution for these symptoms!!

A lot of times people will walk around their entire life with big toenails that look and feel different than the rest of the toenails on their feet. If your big toenail has always been thickened or is painful when you touch it you could be suffering from what is called a subungal exostosis.

What is a subungal exostosis??

A subungal exostosis is a growth that most commonly occurs on the distal phalanx of your big toe, or at the end of your big toe directly under the nail. This type of lesion is a combination of both bone and cartilage and usually can easily be seen on X-rays.

How do I know if I have a subungal exostosis?

Many times these lesions are asymptomatic, but if you are having pain in your toenail, or your toenail grows weird then you need to have it looked at.

Most of the time these lesions are completly benign but because they cause discomfort the treatment for them is most often excision.

If they are disturbing the nail bed and causing your nail to grow funny then a podiatrist can easily remove the growth in an out patient surgery setting. The recovery from a surgery like this is quick and easy. Afterwards your nail will usually grow much more normal than before and be pain free!! So dont wait, if you are sick of your funny looking toenails have them checked out. You could be walking around with painful ugly toenails when there is an easy fix!

LaDainian Tomlinson Slowed By Turf Toe

The San Diego Chargers star running back, LaDainian Tomlinson, has been hampered all season by an early turf toe injury. This injury can be devastating and has ended many NFL careers. What is turf toe really? How can we avoid this pain in the toe?

What is turf toe?

Turf toe is a condition of pain in the base of the big toe. This usually caused from either traumatically jamming the toe, or pushing off repeatedly when running or jumping. The most common complaints are pain, stiffness and swelling. The pain can be so severe that pushing off in football is virtually impossible.

This injury is especially common among athletes who play on artificial turf, hence the name “turf toe”. The hard surface combined with running, jumping and cutting in football and soccer, make turf toe a frequent injury. Some also blame the choice of athletic footwear. The more flexible shoes, especially used in competition, provide less support to the forefoot joints, possibly contributing to the incidence of turf toe.

How does turf toe occur?

When a player sustains a turf toe injury they are actually tearing the capsule that surrounds the joint at the base of the big toe. Tearing this joint capsule can be extremely painful. Furthermore, tear of the joint capsule can lead to significant instability and even dislocation of the joint at the base of the toe. This may lead to accelerated cartilage wear and arthritis of the big toe known as Hallux limitis or rigidus. This wear-and-tear arthritis can end a promising career prematurely.

How is turf toe diagnosed?

Turf toe is diagnosed based primarily on the physical examination of the patient. X-rays may be taken to ensure there is no fracture or evidence of arthritis. Occasionally an MRI is needed to evaluate the surrounding tendons or to rule out an occult stress fracture.

What is the treatment of turf toe?
Treatment of turf toe consists of trying to control the inflammation of the joint capsule. Treatment protocol can include:
1. Rest
2. Ice
3. Elevation
4. Taping or padding to off-weight the toe joint
5. Anti-inflammatories
6. And in chronic cases steroid injections to the joint may be helpful
7. Long term use of a functional foot orthotic to balance the forefoot in the cleats is quite helpful.

Athletes diagnosed with turf toe should avoid stress to the joint for about three weeks to allow the joint capsule to heal. Once returning to activities, functional orthotics can be used to limit the motion of the big toe and prevent further damage to the joint capsule.

Will turf toe return?
Unfortunately, turf toe can return, often more severe than the initial injury, and rehabilitation may be very slow. LaDainian Tomlinson has been slowed by his injury all season and most likely will not be 100% until he can rest at the end of the season. Most athletes have trouble when they try to come back to sports too soon after sustaining a turf toe injury. Surgery is rarely needed for treatment of turf toe unless this has been a chronic injury and spurs are present in the joint limiting motion. If a bone spur has formed, and severely limits the motion of the toe joint, surgery to remove the spur may be helpful.

Prevention and early treatment is really the key! If you are experiencing pain in the joint after running in practice, your shoes should be evaluated for a functional orthotic to balance your biomechanics and hopefully avoid significant turf toe.

Lumps in Your Feet? May Be A Plantar Fibroma

So, I saw this patient the other day with large lumps on the bottom of her foot. She complained of pain when walking on the lumps and denied any trauma. She said they just “popped up”. After examining the lumps, I diagnosed her with plantar fibromas.

These are thickenings of the plantar fascia or the ligament on the bottom of the foot. They can be genetic, occur from trauma or just appear with no reason. She had tried changing shoes, but this did not change anything.

Conservative care for plantar fibromas includes:
· padding or custom orthotics to offload the lumps
· deep tissue massage
· physical therapy
· injection therapy
· topical verapimil

I explained the surgical treatment was removal of the lump along with a large section of the plantar fascia to reduce recurrence. But this condition has a 20% recurrence rate even with removal of the fascia. So all attempts at conservative care should be made.

If you are experiencing "lumps" in your feet or pain when walking, see a podiatrist today! Not all lumps are fibromas, a small amount are cancer. Early detection is the key! For more information, visit our website! Lots of great foot information!

Don't Mess around with Ingrown Toenails!

Ouch!! An ingrown toenail hurts! Ingrown toenails hurt because the nail is curving into the skin. This causes a red, swollen, irritated and painful toe. Dont wait till the toenail is dripping pus, you dont need to live with the discomfort or pain.

Before you start performing foot surgery in your bathroom STOP. Remember that most of the time the toenail is ingrown in a place to deep for you to reach. By digging at your toenail you increase the risk of infection and cause yourself more pain.

Here are some tips to determine if your toenail is ingrown:

1. Push on your nail, does it hurt???

2. Is your toe red in color?

3. Is your toe swollen and painful

4. Do you have liquid or pustular drainage present?

Instead of digging at it, have it checked out by a podiatrist who is trained to remove the nail without pain. It may only need to be cut differently or you might need a portion of the nail removed. Even in the worst cases, most people are back to full activity after a couple of hours or at the latest the next day. You might also need an antibiotic to help get rid of the infection. If you think you have an ingrown get it checked out.

Don't mess around with ingrowns! For more information you can go to our website.

Funky Toenails

Have you noticed those toenails changing color? Are they yellow, black or brown? Getting thicker or really flaky? And quite possibly a little musty odor in those socks? This all sounds like nail fungus or medically described as onychomycosis.

Anyone can develop nail fungus. It is a common organism found in the environment that once finds a warm, dark, moist place to grow (under your toenails!) it florishes. Those 5 year old tennis shoes don't help either. You can easily transfer the fungus living in those shoes to your toenails. Do you enjoy frequent pedicures? Do you allow your nails to catch a breather? Continual polish on nails increases the suspectibility of getting a fungal infection.

The diagnosis is made with a clinical exam where clippings of the toenail are sent to a labratory where the fungal elements can be seen under a microscope. Once this has been detected, there are 3 options for treatment. There are a couple of topical medications that can resolve a mild fungal nail infection is used properly meaning every day for at least 6-9 months. Some cases may be so severe that an oral medication may be used in combination with the topicals to work from inside out to cure the infection. When one nail is involved and topicals have not worked, then removing the nail and allowing it to regrow without fungus is also another option.

No matter what treatment option you and your doctor decided, it will take at least 6-9 months to notice improvement or resolution. Nail fungus does not have an overnight cure! Oh, and don't forget to change those tennis shoes every 8-10 months!!

Who Needs Orthotics and Why

Dr Crane discusses in this video the benefits of functional foot orthotics.
Who needs orthotics? Why?
Watch and learn...if you have a question for any of the doctors at Foot & Ankle Associates of North Texas, contact us and we will add it to the series of Q & A on the blog.




Healthy Steps...For Your Feet...For Your Life!