Running: Does it Really Matter What’s Under Your Feet?

Written by admin on November 3, 2013 – 2:33 pm -

Where’s your favorite place to run? Ask ten people and their results probably vary as much as the different types of shoes they sport while doing so. As a recreational runner myself, I stick to my trail running like I stick to my Asics—invariably. Being an athletic trainer, though, has made me concerned about my joints and longevity of this activity. And so I began wondering, what surface is best? I searched high and low, looking through published research articles and running magazines alike, and here are the most well-founded and useful tidbits I came across:

• Overall, grass is king. It is soft, has a good amount of give, and thus provides the lowest impact forces of all the typical running surfaces. Unfortunately by its nature, grass has a tendency to hide obstacles like rocks or holes and is slippery when wet so consider the quality of the ground before lacing up.

• Next best are trails that are made of ground/natural materials (woodchips, dirt, or that stuff that looks like kitty-litter [think American Tobacco Trail]). Trails can be a great way to mix it up and get closer to nature. In the summer months, they are an especially valuable option because trails that run through wooded areas are often much cooler. However, variables such as roots and snakes are cause to be on the lookout. Also, I would be careful of running on trails the day or two after significant rainfall because it loosens the running surface and can often leave channels in the trails that are dangerous to unprepared runners.

• If you have to, pavement will do but try not to run on banked surfaces and make sure you have a supportive shoe that is in good condition.

• Sand is a unique option that has its benefits if you are fortunate enough to find yourself at the beach. Loose sand easily dissipates the energy of your foot strike and challenges your leg musculature in ways harder surfaces cannot. If you choose to run closer to the water where the sand is more compact, pay attention because that is often where the steepest banking is, which can put uneven pressure on your joints.

• Variety is also beneficial, but ease into new training mediums. The different surfaces stress various muscle groups which can help with overall performance. If afforded different options such as track, trail, and treadmill; take advantage of them.

• If you’re more competitive and/or aiming for a race, it would benefit you to have your training mimic the race. This includes the running surface. If you know ahead of time that you’re going to running on pavement, increase the proportion of your running on similar surfaces as you get closer to race day.

• At the end of the day, as long as it’s even, debris-free, and dry, you’re probably good to go. Your body adjusts to the surface automatically after the first few steps by changing how much you flex your knees while running to absorb the shock. If you are truly a distance runner and really rack up the miles, it’s better to be kind to your joints and go for a softer surface if you have the option to do so.

When it comes down to it, there is considerable research on the forces experienced by the joints when running on various surfaces, which can have an impact (pun kind-of intended) in the long run (nailed it). However, you’d be hard pressed to find a study that directly relates any one kind consistently to injury, and so there is still room for question and a lot we don’t know. Take the above tips with a grain of salt and ultimately rely on your body’s feedback to guide your running choices. If you find yourself in a performance rut or with constant aches in the confines of your running routine, maybe it’s time to branch out and blaze a new trail (sorry, I couldn’t help myself). Happy running!

Alex Vitek is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com


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Chronic Exertional Compartment Syndrome: A Review

Written by admin on July 15, 2013 – 10:00 pm -

Active individuals, including athletes or people with highly active jobs, have a risk of sustaining an orthopedic condition. While a lot of the focus remains on the traumatic, or acute, injuries, a vast majority of conditions may result from overuse. The body can only take so much before these overuse injuries begin to create dysfunctions and inflammation in the body, thus causing chronic pain syndromes. One syndrome that results due to overuse is a condition to the lower legs called chronic exertional compartment syndrome.
Chronic exertional compartment syndrome (CECS) is the direct result of increased pressure within one or more of the four compartments of the lower leg. These compartments include the anterior, lateral, superficial posterior, and deep posterior. This increase in pressure causes compression of the muscular and neurovascular structures located in each compartment. The anterior compartment is the most common compartment for this syndrome to occur in, however, any or all compartments may be involved (Blackman, 2000). The condition is activity related as symptoms are generally felt only during activity. These symptoms may include a deep aching pain, tightness, and swelling of the involved compartments. These same symptoms will resolve fairly quickly with rest.
One such case involving CECS involved a 22 year old male soccer athlete who reported to clinic with insidious, yet sudden, onset of bilateral lower leg tightness. This pain was felt consistently about 50 minutes into soccer activities and would resolve within 15 minutes of rest. Examination of lower legs revealed firmness to the bilateral anterior and lateral compartments which is a common finding in this condition. To confirm that CECS is present, the best method is by measuring the compartment pressure. Compartment pressure measurements were taken in this patient. These measurements revealed resting compartment pressures well above average in bilateral anterior and lateral compartments. It was determined that this patient was suffering from CECS.
Once CECS is identified, treatment and management of the condition is the next barrier that needs to be addressed. This patient was given options for both non-operative and operative interventions. Upon consideration, the patient elected to receive bilateral anterior and lateral compartment release by fasciotomy.
Surgical intervention involving fasciotomy compartmental release remains the main form of management for this condition, particularly in younger, athletic individuals such as the soccer player described above. The American Journal of Sports Medicine recently published an article that investigated functional outcomes and patient satisfaction after fasciotomy for CECS. In this investigation, the authors identified patients between 1998 and 2008 that presented with CECS that had failed non-operative management and presented them with the option of either continuing to receive non-operative treatment or to receive referral to orthopedic surgeon for fasciotomy release. Patients with a minimum 2-year follow-up were provided a questionnaire describing their pre-treatment and post-treatment conditions. This questionnaire included quality and duration of symptoms, analog pain scale, symptomatic and functional responses to treatment, and satisfaction with treatment. All medical records and patient outcomes were then reviewed. After interventions were implemented, the operative group had a much higher rate of success and patient satisfaction rate at 81% in both categories compared to the non-operative group with success and satisfaction rates of 41% and 56%, respectively. Patients that received combined anterior and lateral compartment release had a much higher failure rate (31%) than those receiving an isolated anterior compartment release (0%). Also, the data analyzed revealed that those patients who were college-aged or younger had a higher satisfaction rating when compared to patients post-college. The authors concluded that patients 23 years old or younger with isolated anterior compartment syndrome are excellent candidates for fasciotomy release. Furthermore, they conclude that lateral compartment release should be avoided unless clearly indicated by symptoms and compartment pressure measurements (Packer, Day, Nguyen, Hobart, Hannafin & Metzl, 2013).
In the case of this 22 year old soccer player, he elected to receive bilateral anterior and lateral compartment fasciotomy for CECS. Despite the conclusions of Packer et. al., this particular patient responded favorably to both anterior and lateral compartment releases. Factors that likely attributed to the success of this individuals surgery were the fact that he was younger and fell into the group of people that respond more favorably. The athlete was able to return to soccer activities and has not had any recurrence of symptoms.
Additional studies supporting the use of compartment fasciotomy include one study published in 2010 that concluded compartment release is a cosmetic, safe, and effective means of treating CECS (Wittstein, Moorman & Levin 2010). Another study later concluded that, for athletes, a meticulous surgical intervention for CECS will yield good outcomes and return to play can be expected in as quickly as 8-12 weeks (Murray & Heckman, 2012).
Despite the overall support for the implementation of surgical intervention for patients suffering from CECS, many patients wish to avoid surgical interventions by means of more conservative management. For athletes, particularly those involved in intense aerobic activities such as soccer or track athletes, conservative management is a realistic option to pursue.
One key component that must be addressed is analyzing the athletes running mechanics to identify a possible cause for why the condition became a problem. In 2012, the American Journal of Sports Medicine published an article investigating the effects of forefoot running on pain and disability associated with CECS. The investigators identified 10 individuals that were clinically indicated for surgical compartment release. Once these individuals were identified, surgical intervention was postponed and conservative management was implemented in the form of a six week forefoot strike running intervention. Multiple variable were measured before and after the six week intervention including compartment pressures at rest and post-running, running distance, and reported pain. The results showed that after the six-week intervention, mean post-run anterior compartment pressures significantly decreased from 78.0 ± 32.0 mm Hg to 38.4 ± 11.5 mm Hg. Additionally, running distance significantly increased and reported pain while running decreased. No subject involved in the study needed surgical intervention (Diebal , Gregory, Alitz & Gerber, 2012).
Based on the results of this study, any high caliber athlete wishing to avoid surgical intervention should strongly consider a running gait analysis from a qualified professional to determine if forefoot running is a viable option to remain off the operating table.
While the surgical intervention of the 22-year old soccer athlete was a success, the question must be raised: would the athlete have been able to avoid a surgery by altering his running gait? Future research and clinical trials must be implemented in order to draw more support towards successful non-operative interventions for CECS. For some patients, this may be viable substitute to surgical intervention.

Sources:

Blackman, P. (2000). A review of chronic exertional compartment syndrome in the lower leg. Medicine and Science in Sports and Exercise, 32(3 Suppl), S4-10. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10730989
Diebal , A., Gregory, R., Alitz, C., & Gerber, J. (2012). Forefoot running improves pain and disability associated with chronic exertional compartment syndrome. The American Journal of Sports Medicine, 40(5), 1060-1067. Retrieved from http://ajs.sagepub.com/content/40/5/1060.short
Murray, M., & Heckman , M. (2012). Chronic exertional compartment syndrome: Diagnostic techniques and management. Techniques in Orthopaedics, 27(1), 75-78. Retrieved from http://journals.lww.com/techortho/Abstract/2012/03000/Chronic_Exertional_Compartment_Syndrome__.15.aspx
Packer, J., Day, M., Nguyen, J., Hobart, S., Hannafin, J., & Metzl, J. (2013). Functional outcomes and patient satisfaction after fasciotomy for chronic exertional compartment syndrome. The American Journal of Sports Medicine, 41(2), 430-436. Retrieved from http://ajs.sagepub.com/content/41/2/430.short
Wittstein, J., Moorman, C., & Levin, L. (2010). Endoscopic compartment release for chronic exertional compartment syndrome: surgical technique and results. The American Journal of Sports Medicine, 38(8), 1661-1666. Retrieved from http://ajs.sagepub.com/content/38/8/1661.short

Matt Rongstad is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com.


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What you eat and how you exercise can prevent foot and joint pain

Written by admin on June 18, 2013 – 5:44 pm -

Joint pain is the most common complaint for the patients visiting an orthopedic surgeon. Many common causes of pain can be managed with a few easy and inexpensive strategies. Here is some simple advice to help you maintain a healthy, pain-free lifestyle.

Do
•change your shoes when showing signs of wear
•obtain custom shoe inserts to correct flat-footedness or collapsed arches
•regularly engage in a low-impact, cardiovascular fitness regimen
•allow sufficient time to recover following a period of intense exercise

Don’t
•engage in excessive, high-impact exercise when you are in pain
•forget to stretch
•exercise at a higher intensity than you are used to
•eat too many highly-processed foods or beverages

Do

Do change your shoes when showing signs of wear:
A great deal of technology and research goes into the construction of today’s athletic footwear, and this has led to improved comfort and stability for active people. For best results, opt for a professional fitting to find the right shoe for your foot and for the activity in which you will engage. When your shoes show signs of wear, your feet and arches will not receive the cushioning and support that are necessary to prevent joint pain. Change your shoes frequently, especially when they are showing signs of wear.

Do obtain custom shoe inserts to correct flat-footedness or collapsed arches:
Shoe inserts redistribute weight and relieve pressure on sensitive areas of the feet, and can reduce the stress on the lower body, correct an improper gait, and compensate for structural abnormalities, which may also prevent or alleviate knee, hip, and lower back pain. Pick up some shoe inserts at your local store or speak with your physician about getting custom shoe inserts to help you correct flat-footedness or collapsed arches.

Do regularly engage in a low-impact, cardiovascular fitness regimen:
Joint stiffness and pain are often caused or exacerbated by inactivity. By keeping the muscles and joints active, you can lessen the incidence of pain. Regular exercise also strengthens the muscle groups surrounding the joints, providing support that can reduce the likelihood of injury.

Do allow sufficient time to recover following a period of intense exercise:
Rest is important following activity to enable the tissues comprising the muscles and joints to regenerate, and to allow any minor swelling to dissipate. Not resting properly between workouts may intensify any pain you may experience and contribute to further injury.

Don’t

Do not engage in excessive, high-impact exercise when you are in pain:
The basis of a conservative approach to pain treatment is rest. When pain occurs, suspend activity for a couple of days and consider over-the-counter, anti-inflammatory medication. Resume activity gradually and stop as soon as any pain returns.

Do not forget to stretch:
Muscles that have not been properly warmed up and stretched are much more prone to injury and pain from exertion. To be sure that you prevent injury, even if you are just going for a walk, make sure that you stretch and warm-up sufficiently before and after your activities.

Do not exercise at a higher intensity than you are used to:
It is not wise to begin from a state of relative inactivity to participating in an event such as a 5K run or an hours-long bike ride. The inflammation and pain that can result from such an immoderate activity can last several days and can lead to injury. It is important to train properly for such events.

Do not eat too many highly-processed foods or beverages:
A growing body of evidence suggests that processed wheat flours and sugars contribute to the incidence of musculoskeletal pain. The best diet for preventing joint pain is one that is balanced and includes sufficient protein, and fresh fruits and vegetables.

Summary

Always consult your physician if you have questions about preventing joint pain. Sore joints can have a significant negative effect on your life and prevent you from doing the things you love. Maintaining healthy joints is a tough task, but your physician can provide you with helpful advice that will keep your joints in great shape.


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The Broström Procedure: Restoring Stability To Loose Ankles

Written by admin on April 12, 2013 – 10:42 am -

The arrival of spring’s warmer weather brings with it the desire to get more active. We are spending more time on the tennis courts, the golf course, the ball field, etc., providing opportunities to burn some energy and have fun … but unfortunately, being active also carries with it a risk of accidents and injury.

The ankle sprain is one of the most common injuries sustained by athletes and non-athletes alike. Simply stated, the “sprain” is a stretching or tearing of the lateral (outside) ligaments of the ankle: anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). One or all of these ligaments may be damaged in a sprained ankle, and though uncommon, other ankle ligaments may also be damaged. The classic mechanism of such an injury is “rolling,” or inverting, the ankle after landing on another player’s foot or stepping on an uneven playing surface. This inversion mechanism of injury causes the ligaments to stretch, partially tear, or completely rupture. Very severe injury or repeated injury may ultimately result in chronic ankle instability. This results in decreased function of the ankle joint and becomes quite a nuisance for competitive athletes.

The primary treatment in both acute and chronic cases begins with external stabilization using ankle braces. This is combined with a rigorous rehabilitation program guided by a physical therapist. When conservative treatment measures fail and instability of the ankle becomes a daily issue, surgical intervention may be considered. The Broström procedure is primarily used to repair the ATFL; however, the CFL (and even more rarely, the PTFL) may be repaired during the procedure as well. By repairing these damaged ligaments, proper ankle mechanics and function are restored. The ultimate goal is to restore the ankle to its pre-injury state. The procedure has a 90% success rate, and athletes usually return to play within three-four months.

Recovery time after the surgery may vary depending on each patient’s response. Typically, there is a six-week period of time when the ligaments are allowed to heal. During these six weeks, the patient will be non-weight bearing or limited weight bearing status (in a boot) and only allowed to do light range of motion activities. After the initial six-week healing time, physical therapy is introduced to help regain proper ankle strength, range of motion, proprioception, and restoring a normal gait (walking without a limp). Returning to high level activities may take up to six months; however, it may be sooner depending on each individual.

Unfortunately, ankle injuries are a common result of today’s active lifestyles. If you happen to fall victim to an ankle injury and traditional treatments just don’t seem to help, remember that there are other alternatives available, and the Broström procedure may be the answer for you.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at 919-562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com, or on Twitter @drmarkgalland.

Matt Rongstad, ATC/LAT is a post-graduate fellow of the GOSM program at OSNC.

The above article was published in Circa Magazine (April-May-June 2013).


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The Injured Ankle: When Is An Ankle Injury More Than Just A Sprain?

Written by admin on April 11, 2013 – 10:24 pm -

You stepped in a hole, landed on another person’s foot, tripped on a root, or simply took an awkward step. We’ve all done it – that is, “tweaked” our ankle and assumed it must be just a simple ankle sprain. You push through the pain limping for awhile, waiting, expecting your ankle to return to normal. The swelling slowly reduces, but the bruising worsens until you cannot take a step without intense pain. Unfortunately, a more significant injury is present. How do you know when an injury isn’t just an ankle sprain, but rather an injury that could prove an impediment to your active lifestyle?

Many conditions can, initially at least, be confused with a simple ankle sprain. Fractures are the most common, and can involve bones of the ankle or nearby portions of the foot. Most frequently injured are the malleoli – the ankle bones that protrude the most, each resembling a small golf ball on each side of the ankle. Another common fracture site is the talus, which lies between the malleoli. Last, and technically not an actual bone of the ankle, is the fifth metatarsal that connects to your pinky toe; it is a part of the midfoot, but is often injured by a similar mechanism as other ankle injuries. Perhaps the most serious soft tissue injury of the ankle is the now-infamous high ankle sprain. This is an injury to the ligaments that connect the two lower leg bones, the tibia and fibula, together at the ankle. This often requires surgical correction, or at the very least, immobilization and restricted weight-bearing for several weeks.

Clinicians have a variety of tools available to make the correct diagnosis. The Ottawa Ankle Rules is one such tool that is particularly important in the athletic setting – on the court and on the field, and is routinely used to determine when an x-ray is necessary. The rules are somewhat technical in nature, but can be easily summarized as any direct tenderness of an ankle or foot bone, combined with the inability to walk four steps, indicate the need for medical attention. As in all cases, the rules are generalized and one should seek medical attention for any injury that one deems serious. The true inability to bear weight is a red flag that should dictate the need to seek professional medical attention.

The initial treatment for all of these injuries is immediate use of R.I.C.E. (Rest – Ice – Compression – Elevation) and should be continued for at least three days to decrease pain, swelling, and bruising. A physician skilled and experienced in treating sports injuries should be consulted as soon as possible. Sports medicine specialists are usually orthopaedic surgeons with additional training or certification in sports medicine. These physicians frequently care for a number of athletic programs and teams, and are well versed in the diagnosis and treatment of a variety of athletic injuries.

Preventing these injuries is always preferred to treating them, but is not always possible. Select footwear appropriate for the sport or activity. It must fit well, providing support and stability to the foot and ankle. If a history of multiple ankle sprains is present – a sign of underlying ankle instability – it is good practice to employ ankle taping or to wear lace-up ankle braces during activity. Perhaps most important is maximizing strength, endurance, and balance, which are best obtained with sport-specific drills performed as a part of a supervised rehabilitation program.

Ruby Floyd is a senior athletic training student at Western Carolina University, studying this semester at the GOSM program.

Dr. Mark Galland is a Board Certified orthopaedic surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. He can be reached at 919-562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com, or on Twitter @drmarkgalland.

Above article published in Circa Magazine (January-February-March 2013, p. 46)


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What is Plantar Fasciitis?

Written by admin on January 16, 2013 – 7:02 am -

Plantar fasciitis is the progressive degeneration of the plantar fascia of the foot and is a common Orthopaedic complaint. . Plantar fascia is the medical term for the fibrous connective tissue that comprises and creates the arch of the foot by connecting the calcaneus (heel bone) to each of the phalanges (toes). The plantar fascia is located along the bottom side (plantar surface) of the foot, and is amongst the densest fascia in the body. Originally presumed to be an inflammatory disorder of this tissue, we now know that inflammation is only rarely the culprit. Numerous men, women, and even world-class athletes suffer from plantar fasciitis. Marcus Camby of the New York Knicks and Derrick Favors of the Utah Jazz are two NBA players currently battling the condition.

Plantar fasciitis is most prevalent in men between the ages of forty and seventy but is also frequently seen in women. The most common complaint of plantar fasciitis is a sharp pain in the heel or arch of the foot. Others include a ‘pulling’ sensation, a sharp or dull ache, or a burning sensation. Someone suffering from plantar fasciitis may complain of pain during or after intense exercise, or after standing for long periods of time; however, the classic report is pain in the morning when getting out of bed but subsiding throughout the day, or a gradual onset of dull pain which then turns into sharp pain as the day progresses. Individuals with pes planus (flat feet/no arch) or pes cavus (very high arch) are more prone to plantar fasciitis (albeit for different reasons) than individuals with normal arches. Other causes or risk factors for plantar fasciitis are sudden weight gain or obesity, long distance running, and poor arch support in shoes.

Initial treatment begins with rest, ice massage (freezing a water bottle and rolling the bottle back and forth under the foot), OTC anti-inflammatories, and stretching the foot and heel throughout the day–especially before getting out of bed– by rolling over a tennis ball, wearing shoes with the appropriate amount of support, shoe inserts, and wearing night splints while sleeping to keep the foot and fascia stretched throughout the night, preventing contraction (tightening) of the fascia tissue. If conservative treatment fails, PRP or steroid injections and/or surgery may be considered. We have had excellent results with the emerging technique of Platelet Rich Plasma (PRP) injections.

Plantar fasciitis symptoms may take anywhere from days to years to subside. Prevention of plantar fasciitis is best ensured by optimizing the flexibility of the ankle joint, Achilles tendon, and calf muscles (gastrocnemius and soleus)

References

A.D.A.M. Medical Encyclopedia. (2012, March 1). Plantar fasciitis. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004438/

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com.

Caitlin Davis, LAT, ATC is a post graduate fellow at GOSM. For more information, visit us at www.atcfellowship.com


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“The Right Shoes Can Ease Knee Pain”

Written by admin on January 3, 2013 – 8:45 am -

“Boots, sandals, pumps, sneakers, loafers … When it comes to shoes, the options are dizzying. What you wear on your feet can affect your knees, so it pays to know which footwear may lessen pain and protect your knee joints. These tips can help you choose the right shoes.”

To read the entire article, please click here.

Medical Reviewer: Williams, Robert, MD
Copyright: © Copyright 2011 Health Grades, Inc


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Dr. Mark Galland Releases Podcast On The Lisfranc Injury

Written by admin on November 15, 2012 – 10:29 pm -

Dr. Mark Galland, a physician at Orthopaedic Specialists of North Carolina, has announced the release of a podcast discussing the lisfranc injury, a common midfoot injury involving the tarsal and metatarsal joints. In the podcast, Galland discusses what the lisfranc injury is, causes, symptoms and treatment of the injury, and the recovery process after treating the injury.

To listen the podcast, click here: Lisfranc Injury


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Who is Lisfranc? Better question is what…

Written by admin on October 17, 2012 – 3:20 am -

The NFL Injured Reserve has been awash with foot injuries the past two weeks. Cedric Benson, Ryan Kalil and Santonio Holmes all have sustained midfoot injuries, also known as a Lisfranc injury–much more serious than a simple sprain and sometimes requiring surgery.

A Lisfranc injury is an injury to the ligaments and/or bones of the midfoot. This injury can affect one or multiple joints of the midfoot and may include a fracture. Lisfranc injuries are named after Napoleon’s personal surgeon who first described the injury, then common in cavalry officers. The injury was typically sustained when the foot caught in the stirrup and twisted when the cavalryman was thrown from the saddle. Today, football and soccer players are more prone to these injuries because of the twisting and falling mechanisms that occur so frequently in competition.

Symptoms of a Lisfranc fracture include swelling over the top of the foot, bruising on the top and/or bottom of the foot, and pain with weight bearing. Athletes should seek medical attention from an Orthopaedic physician. An x-ray and sometimes an MRI or CT scan will be necessary to determine the alignment of the small bones and joints of the affected foot as well as the integrity of the ligaments.

Non-operative treatment of a Lisfranc injury includes non-weight bearing for 6 weeks in a cast, and progressing to a walking boot for an additional 2-6 weeks. An athlete would not be able to return to athletic competition until he is able to complete sport specific drills without pain.

If an operation is necessary, as it is for Kalil and Holmes, it can take up to six months for full recovery. With this corrective surgery, the bones are put back into place (reduced) and held by plates and screws, which may require removal at a later date.

Prevention of a Lisfranc injury is difficult especially in physically demanding sports like soccer and football, but it is helpful to wear well-fitting, properly designed and constructed footwear (avoid the Clearance bin). Cleats that are too flimsy and flexible may not be able to properly support the foot, increasing susceptibility to injury.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com or you can follow him on twitter: @drmarkgalland.

Kate Anderson, ATC/LAT is a post-graduate fellow at GOSM, Galland Orthopaedic and Sports Medicine. Follow her on twitter @kattethegreatt.


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TURF TOE: SMALL BODY PART-BIG INJURY

Written by admin on October 16, 2012 – 12:59 pm -

Beanie Wells' big toe injury

Arizona Cardinals football fans are perplexed. Why has something as seemingly insignificant as a toe injury sidelined their starting running back, Beanie Wells. Despite their small stature, toe injuries can be very painful and become chronic problems. One of the most common, particularly in football players is turf toe. So named, as in 85% of cases, the athletes play on artificial surfaces, which are typically harder and have less give.
Turf toe is a painful condition usually of the great toe. It occurs when the toe is bent backwards beyond its normal limits—called hyperextension. This forced movement stretches the tissues, particularly the ligaments, at the bottom of the toe. It can occur either from a single trauma or over time with repetitive overuse. .
The most common symptom is pain, particularly at the bottom of the joint, which is exacerbated with movement. In traumatic cases, the pain begins immediately, while with overuse, the pain gradually increases over time. Pain occurs in the “push-off” phase of running or walking, and it is particularly debilitating during acceleration, lateral movement, or jumping. Other symptoms may include swelling, redness, bruising, and decreased range of motion of the toe.
In less severe cases, athletes may continue to play using supportive taping or a stiff-soled shoe that will help prevent the excessive hyperextension of the great toe. Ice and anti-inflammatory medications may help control the pain. Unfortunately, the best treatment for turf toe is complete rest. In severe cases, the use of crutches and complete avoidance of weight bearing may be required. It is imperative that the condition be addressed early to avoid a chronic condition which will have adverse effects on performance.
As in the case of Cardinals running back Beanie Wells, this condition may take several weeks, or even months, to fully resolve. While traumatic injuries are difficult to prevent, overuse injuries can be averted by choosing footwear that provides the proper support at the toes. This includes a rigid soled shoe or special orthotic that prevents excessive motion.
For answers on turf toe injuries, visit www.orthonc.com
Matt Rongstad is an ATC/LAT currently training in the GOSM Fellowship.
Dr. Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine practicing in Raleigh, NC. He serves as the team physician and orthopaedic consultant to the Carolina Mudcats, Cleveland Indians Single-A affiliate as well as many other local high schools and colleges. twitter@drmarkgalland.com.

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