LeVert Possible Repeat Stress Fracture Injury

LeVert Possible Repeat Stress Fracture Injury

Michigan’s shooting guard Caris LeVert will be sitting it out for the rest of the season due to a foot injury. LeVert was limping after a victorious game against the Northwesterns Wildcats and later that night he was seen on crutches. He is scheduled for surgery this week, following a 12-week and rehabilitation period.

LeVert injured the same foot he had surgery on last May due to a stress fracture, and most likely, he may have the same injury since the recurrence of stress fractures are very high.  

What is a stress fracture?

Stress fractures are small but painful cracks on the bone, usually affecting the foot. This occurs because of muscle fatigue, the over used muscle can no longer absorb shock, thus transferring all the stress to the bone, leading to tiny cracks. Stress fracture is one the most common injuries in sports.   I always refer this to thinking about an egg shell with cracks but not fully broken so that the content does not spill out.    MRI's are excellent at diagnosis this condition, but the advent of ultrasound provides a quick and more cost effective alternative. 

Some patients may have pathological fractures: eg bone tumors or osteoporosis, this needs to be checked thoroughly by a physician. 

Treatment

Rest is the best treatment for stress fractures. Allow the injured bone to heal for 6 to 8 weeks, the patient should not engage in with the activity that caused the fracture during this period. Recurrence of stress fracture is common, which causes larger cracks  or a full fracture that can move out of place and that takes longer to heal and lead to possible surgery.

Another treatment available is injection of stem cells or amniotic stem cells to the fracture site to aid the body in healing of this condition.  This is not covered by insurance but has been proven to cut the healing time in half in fusion cases whereby the surgeon creates a fracture on purpose to allow two bones to mend together.  Fusions are done for generative joint disease and severe deformities such as a collapsed foot or multiple fractures that require stabilization. 

If you have a nonhealing stress fracture or repeat stress fractures see your doctor. 

Courtney Love have Plantar Fascitis?

Plantar fascitis remains one of the most common problems seen in our practice. in the picture below is   Courtney Love wearing a posterior night splint that is usually one at night to help stretch out the Achilles tendon and the plantar fascia.  This is part of the treatment protocol for plantar fasciitis at our office. Most of the time people will complain about pain upon first steps in the morning that is because the plantar fascia , a ligament on the bottom of the foot that attaches to the heel, is inflamed as well as contracted during the night of sleep. This is why the plantar fascial night splint is very important to use at night when you have an attack of plantar fasciitis. We do not recommend walking on your plantar fascial night splint however for it is not meant to be a weight bearing apparatus  The most common treatment for plantar fasciitis is an injection of corticosteroid, or injection of PRP, or the newest injection is amniotic stem cell injection into the  plantar fascia to allow for healing.  I cannot over emphasize the need for stretching at physical therapy as well as arch supports to help aid in the healing and prevention of future attacks of plantar fasciitis. This is a very painful and preventable problem. I am sure Courtney Love's podiatrist  would not have approved her walking on the beach with her night splint.

Victoria Beckham wearing corrective orthotics and reasonable shoes for her bunions.

Victoria Beckham and her Bunions

A bunion is a bony bump at the joint of the big toe. Over time, the bunions can progress and become more and more painful. It is estimated that around one in four people between the ages of 18 and 65 have bunions. Furthermore, the prevalence of bunions increases with age.

Victoria Beckham, for instance, has suffered from bunions for the longest time. She was probably predisposed to bunions from birth. Her misshapen feet have brought her years of agony. Constantly wearing those pointy high heeled shoes has contributed to its progression.

Because she did not want to ruin her stylish look, she puts up with the pain. She has previously voiced her dislike for flat shoes, saying “I beyond hate ballerina flats. I just don’t get it. I love heels.” She was so into heels that she even wore wedge sneakers when she was invited to pitch and open a Dodgers baseball game.

Thus, she has resorted to wearing corrective insoles in the hopes of avoiding bunion surgery. However, she has been advised to undergo bunion treatment soon, otherwise, it could lead to more serious foot problems.

Victoria Beckham faced bunion surgery to correct the painful condition. On one occasion, she was seen wearing a pain or manly brogues. This was quite a leap from the usual towering stilettos that Posh Spice often wore.

Bunion surgery does not have to be a painful experience. Newer techniques along with scarless bunionsurgery methods have allowed patients to start walking in a surgical boot much sooner. Bunionectomies have come a long way. Choose by reputation of the surgeon as their skills vary by their experience and training. 

Call for an appointment with Dr. Kevin Lam 239 430 3668 with the Family Foot and Leg Center, PA in Naples, FL.   

How to lose your feet to diabetes

Your feet and Diabetes

Diabetes mellitus or commonly referred to as diabetes is a lifelong condition that affects the body’s ability to absorbs sugars from food. Normally, the body breaks down carbohydrates from food and converts it to glucose, a simple sugar our cells use for energy. In order for our cells to absorb glucose, insulin is needed. Insulin is a hormone produced by the pancreases to control blood sugar levels in our body.

There are two types of diabetes mellitus. Type 1 is the loss of insulin producing cells in the pancreas and Type 2 is the lack of insulin production by the pancreas, which may be combined with the lack of response or resistance the cells and tissues to insulin.

Due to the lack glucose absorption in the body, there is an increase in blood sugar levels. High blood sugar levels can damage or obstruct small blood vessels all over the body resulting to renal problems, high blood pressure, heart disease, blindness and nerve damage.

Risk of Diabetic Foot

Since diabetes can cause obstruction to the small blood vessels, this can drastically decrease the blood flow and damage the nerve ending of the extremities especially the foot. The risk of having foot problems with diabetes are as follows:

1. The patient has diabetes for a long time.
2. The patient does not comply with the prescribed medications, leading to increased blood sugar levels.
3. Lives a sedentary lifestyle
4. The patient is smoker.

Lack of blood supply

Uncontrolled blood sugar levels can reduce blood circulation to the feet; making the patient prone to infections after any injury to the foot. Below are signs of poor blood supply to the feet.

1. Cold feet.
2. Wounds are slow to heal.
3. Feet look pale or bluish in color.
4. Frequent leg cramps after walking a short distance.

Nerve damage

Chronic diabetes can cause nerve damage due poor blood circulation. Symptoms of nerve damage are numbness or pins and needles sensation to the feet, while some patients feel a burning sensation in the legs during rest.

What to do?

1. Take your diabetes medications regularly. Controlling your blood sugar levels is the key to preventing complications from diabetes.
2. Stop smoking.
3. Exercise. Regular activity will help improve blood circulation to your feet.
4. Visit your podiatrist if you notice decrease sensation on your feet, if you have ulcers or cuts.
5. Infections can quickly get out of control to blood infection and stays in the intensive care unit.

Diabetics are at high risk to impaired sensations, lack of blood flow, impaired nutritional status as well as impaired immune systems in most cases.   

See a podiatrist to save you limb and your life as 5 year survival rate after an amputation is grim. Diabetic complications have killed more people than cancer in the US. 

This it is a small problem still? 

Dr. Kevin Lam

www.NaplesPodiatrist.com

Adult flat foot repair with implant

There are many ways to fix a flat foot.   This patient is an older patient and lives alone, a 12 wks nonweightbearing in a cast after a triple arthrodesis procedure is not a good option for this patient due to social conditions.   Discussed using the hyprocure implant as an option to allow for quicker recovery.   The results for this patient was amazing.   She is ready to do the opposite foot, the trick of this surgery is to make sure the ligaments in the subtalar joint are released properly and proper sizing of the implant itself. 

right foot after implant / stent notice the arch

Notice left foot flattening

Lump on back of the heel: Haglund's deformity, Achilles tendonitis, Tendonosis

Lump on back of the heel is the complaint most people put as the reason for their office visit. Diagnosis for this case is:  Haglund's deformity (aka pump bump), Achilles tendonitis / Tendonosis

Symptoms:

Burning in the achilles, unable to run, jump or wear shoes due to the rubbing of the achilles. 

Throbs

Tightness in the Achilles

Conservative treatments:

See 1) NSAIDS such as motrin, etc if tolerated

2) Physical therapy

3) Home stretching excercises

4) Ice

5) Avoid shoes that rub on that area. 

6) High Energy Shockwave therapy

7) Platelet Injections / Stem Cell therapy

Diagnostic tests:

• MRI will likely show degeneration, partial tears or chronic inflammation, value of such is questionable. 
• Xrays are great for seeing the bony deformity that is causing this condition and surgical planning. 

Surgical treatment:

• Removing of the Bump 
• Removing of any spurs as indicated. 
• Removing inflammed or damaged achilles tendon
• Repair of the Achilles back into the insertion.

Below is an actual FFLC patient preop Xrays and clinical photos. 

Notice the bump right above the achilles insertion

Another view of the swelling

Side view of the painful bump

What is looks like on Xray, Multiple issues to be addressed.
1) Haglund's Deformity (top Arrow)
2) Insertional spur growing into the achilles tendon (bottom arrow)
3) bone cyst / erosion from chronic inflammatory condition. 

Patient is an active runner, pain immediately subsided after surgery. 

"Bump" no longer visible or irritated. 

4 wks in a cast, then another 2 wks in a boot that he can remove to start range of motion excercises. 

Physical therapy and boot to be used for walking at 6 weeks. 

Tens unit can be used to help with the cast disease that develops from not using the limb for some time. 

Overall, this is a very simple surgery to correct the condition.  Technique chosen by your surgeon varies.    I personally prefers to keep the achilles attachment and remove the spurs from varying angles to avoid prolonged recovery.  This also allows for anatomical repair without a question as to where mother nature intended. 

FFLC taking new patients

239 430 3668 option 2 for scheduling or you can request online through our PATIENT PORTAL. 

Bump on bottom foot aka plantar fibroma

Plantar Fibroma treated with conservative care at first at our center without avail.   Initial treatment consists of topical gel of Verapamil 15% gel and other topical compounds to help relieve the pressure and pain in an attempt to reduce the size but was to no avail. Typical protocol is 3 x a day application up to  9 months even.   She was not able to continue conservative care due to pain with every step. 

How are they formed? 

No true answer to this. Theories have involved: microtrauma, genetic predisposition, that causes the body to form extra fibrous tissue. 

Where are the fibroma commonly located in the foot? 

Typically the medial to central band of the plantar fascia. 

Medial being the side towards your big toe and central being around the 2nd and 3rd to region.  The photos below is a classic example of the fibroma in the medial and central bands. 

What are the chance of regrowth and is surgery successful? 

Fibromas have a high recurrence rate, up to 80% in some papers.    

Recommendation is usually to only remove such only if symptomatic. 

Symptoms can occur with even very small fibromas, some patients with even huge fibromas do not hurt. From experience the patients that complain about pain are those that have the fibroma growing right over a nerve, often an inflammed nerve is found under this fibroma.   The best case scenario is no regrowth or recurrence but next best out come is that if the fibroma regrows it forms in a different area that does not compress on the nerve. 

What steps can my doctor take to improve success? 

Papers have stated up to a 1.5 cm margin of regular tissue to be taken out in addition to the fibroma itself to reduce the chances of recurrence. 

I have them on my hands and my feet is that normal? 

Some people do have it in both areas but not always.  A hand surgeon or plastic surgeon will help address the hand lesions.  You have the same band of tissue called the aponeurosis in the hand as well as the foot. 

If you or loved ones have this condition call us at 239 430 3668 option 2 to schedule an appt!

Preop from the side of the Fibroma

Bottom look at the fibroma, see the dark area
 due to rubbing of the fibroma in her shoes. 

z incision made for adequate exposure for removal

Note the lesion with viable margins also removed
 to help  prevent regrowth