Archive for category: Foot and Ankle

Denver ankle repair doctors diagnose and treat ankle pain

October 14, 2020/in Foot and Ankle, news /by administrator

There are numerous causes of ankle pain from arthritis to trauma, and ankle repair procedures vary widely according to the type of injury or illness. Learn when a sprain, strain or other injury is severe enough to require treatment or surgical solution. In Denver, ankle repair doctors treat the entire spectrum of injuries and illnesses that cause ankle pain.

Ankle sprains or tears

When the ligaments connecting your ankle bone to the rest of your foot and leg are stretched too far, the result is an ankle sprain. For most sprains, time, along with a regimen of rest, ice, compression and elevation (RICE) is enough to repair the damage. Some people also benefit from a wrap or brace to stabilize or immobilize the joint while the ligaments heal. Giving your ankle enough time to fully heal is essential. Repeat sprains can occur if the injury goes untreated or doesn’t heal properly, and more complex ankle repair may be needed.

If the ligaments are strained to the point of tearing, ankle repair may include longer immobilization or even surgery, as well as physical therapy. Surgery can be used to repair or replace the torn ligaments, depending on the severity of the tear.

Ankle fractures

A broken ankle can impact one or more of the three bones that make up the ankle, and ankle fractures often occur with ligament damage, especially when more than one of the ankle bones is broken. As with most fractured bones, the more severe the break, the more involved and time intensive the ankle repair.

Ankle fractures can occur from over rotating (“rolling”) or twisting the ankle, or from other trauma caused by sports collisions, falls, car accidents, etc. In addition to a physical exam, doctors use various imaging methods such as x-rays, MRIs and CT scans to determine the type and severity of an ankle fracture. If surgery is required to repair the ankle, a surgeon will reposition any bone fragments to realign your ankle bones. These pieces may then be held together with plates and/or screws so they can correctly heal.

Achilles tears or tendonitis

The Achilles is the largest of our tendons and connects the calf muscles to the heel bone. People who have repeatedly experienced tendonitis in the Achilles, which presents with inflammation and pain, can be more prone to tearing their Achilles tendon. Tendonitis can be treated with rest, ice, immobilization, physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs), like Advil.

An Achilles tear is typically accompanied by a “pop,” and the pain can range from severe to none at all. Some people experience a sudden pain in the calf, others, pain in the heel. Most feel very unstable when attempting to walk after the Achilles ruptures.

Ankle repair for an Achilles tear involves surgery to reattach the tendon to the bone or tendon to tendon. Your Denver ankle repair specialist may want to order an MRI in addition to a physical exam to confirm a tear or the severity of any tendonitis.

Arthritis

Both rheumatoid arthritis and osteoarthritis can cause ankle pain due to inflammation and eventual destruction of the tissue (cartilage) between the ankle bones. Although the nature of the damage is different in each type of arthritis, in both cases, some patients respond well to non-surgical ankle treatments like rest, ice, steroid injections and NSAIDs. However, end-stage arthritis of the ankle may require surgery to resolve chronic pain issues.

Chronic Ankle Instability

People who have had multiple ankle sprains can develop chronic ankle instability, where the ankle frequently gives way on the outside of the foot. This can happen to anyone regardless of age and occurs in athletes and non-athletes alike. Symptoms include frequent swelling and pain, and overall lack of stability that often results in a turned ankle while standing, walking, running or competing.

Many treatments for this type of ankle repair are non-surgical and include patients wearing an ankle brace for support and protection during day-to-day activities; and physical therapy to build balance, strength and stability. Surgical ankle repair is typically considered if more conservative treatments are not effective, and the instability is significantly impacting a patient’s lifestyle.

Whether chronic ankle pain is disrupting your life, or a traumatic event causes damage to your ankle, ensure you take time for proper healing and ankle repair. Our experienced foot and ankle doctors, and our comprehensive team of physicians’ assistants, physical and occupational therapists and more are here to help you get moving again!

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Are you at risk for a ruptured Achilles? How to reduce your risk.

February 25, 2020/in Foot and Ankle, news /by Alan Ng, DPM

A ruptured Achilles is a the most common tendon rupture that can occur in your legs. The Achilles tendon connects your calf muscles to your heel bone. While it is a strong tendon, it can partially or fully tear, or rupture, if over extended.

Certain demographic and lifestyle factors can increase your risk for a ruptured Achilles. While gender and age are two key risk factors that none of us can influence – the majority of ruptured Achilles tendon injuries happen to men between the ages of 30-50 – there are several other risk factors that may be managed or minimized by lifestyle choices:

Maintain a healthy body weight: Excess weight puts additional strain on the Achilles tendon, thus making ruptures more likely. By maintaining a health body weight, or BMI (Body Mass Index), people of all ages and genders can reduce their risk of a ruptured Achilles.

Take a smart approach high-impact exercise: Especially with certain activities or when increasing intensity suddenly. Any sport that emphasizes running, jumping, quick pivots or change in direction tends to see a higher-than-average occurrence of Achilles tendon ruptures. Common examples include tennis, high-intensity cross training, soccer, and basketball. Similarly, any dramatic increase in your level of intensity can put you a higher risk for a tear.

Warm up well, weekend warriors: If you don’t get much activity during the week, but like to go “all-out” on weekends, be sure to really emphasize a good warmup, ease into your activity, and always remember to stretch. Keeping your body limber and staying warm throughout your activities can help to minimize the risk of a ruptured Achilles or other injury.

Know the potential risks of some antibiotics: Certain antibiotics, known as fluoroquinolones, may increase the risk of a ruptured Achilles tendon by causing damage to the tendon. While this type of antibiotic may also damage other tendons, the majority of cases are associated with weight-bearing tendons, and the Achilles, in particular. Doctors typically only prescribe such drugs under specific circumstances when the benefit of the antibiotic outweighs the risk of an Achilles tear. However, patients should be sure to review and understand the risks and benefits before taking any medication.

Understand that steroid injections also have a cost-benefit trade off: Steroids can reduce inflammation and joint pain but can also weaken tendons, including the Achilles when injected nearby.

Ruptured Achilles Prevention

In addition to knowing the risks there are a few things you can do to minimize your chances of an Achilles tendon rupture, including:

Keep your workouts diverse: Especially if you already have any of the other risk factors, be mindful of how frequently you participate in activities that demand a lot of running and jumping. This could include alternating between running and biking or swimming and taking rest days between court or field time.

Don’t go from zero to 60: If you’re starting a new routine or are thinking about rounding up the team for some glory-days court time, be smart and conservative. Don’t go from couch potato to working out 5 days a week; and try to resist getting overly competitive in a pickup game if you haven’t touched a ball in years. A good rule of thumb for increasing your effort is to do so no more than 10 percent per week. When you do exercise or compete, always warm up slowly and stretch before you really get going. Gently stretch key muscle groups, in particular your calves. Never bounce while stretching – instead make slow gradual motions.

Listen to your body: If you’re feeling sore or feel like an exercise or a move is too much, don’t ignore the warning your body might be giving you. Back off your intensity when you need to. This could mean alternating walking with running or replacing a hopping motion with a stepping motion in an intense exercise class.

How to tell if you’ve ruptured your Achilles and what to do next

Many people report feeling sudden, intense pain and hearing a snap or popping sound when their Achilles tears. Most also notice an immediate limit in their ability to walk normally. If you think you’ve ruptured your Achilles, you should seek prompt medical attention from an orthopedic specialist. They will be able to confirm the nature and severity of the tear and recommend the best treatment plan to get you back on your feet and active.

Whether you’ve partially or fully torn the Achilles, surgery is often the best solution to repair the damaged tendon. A foot and ankle specialist will reattach a fully ruptured Achilles or repair a partial tear. Patients must typically be off their foot or the foot and ankle may be immobilized for at least several weeks to allow the tendon to begin to heal. In some cases, immobilization without surgery is an option.

Full recovery from ruptured Achilles surgery takes time – around 6 months to get back to normal activities, if you’re following a good physical therapy plan.

Advanced Orthopedics & Sports Medicine Specialists has several foot and ankle surgeons who use the latest surgical and open repair techniques that minimize the incision size and provide the best patient outcomes. Get in touch for more information or to schedule an appointment with one of our foot and ankle specialists.

Best Foot & Ankle Surgeons

Dr. Keith Jacobson

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Dr. Alan Ng

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Dr. Scott Resig

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Flip Flop Running equals Plantar Fasciitis

Are your summer activities causing plantar fasciitis?

July 9, 2019/in Condition, Foot and Ankle, news /by administrator

It’s sandal season! And while that might make you (and your toes) jump for joy, the rest of your foot might not feel the same. In fact, many people experience pain on the bottom of their heel as warmer weather allows us to trade in shoes and boots for flip flops and bare feet. A condition – called plantar fasciitis – is the most common cause of pain on the bottom of the heel according to the American Academy of Orthopaedic Surgeons (AAOS), which reports approximately 2 million patients are treated for this condition every year.

But why now? The plantar fascia, a ligament that runs along the bottom of your feet, is designed to act as a support mechanism for your foot. Plantar fasciitis is typically caused by too much pressure or repeated strain, and this time of year, a seasonal or lifestyle change could be the cause.

Scrapping supportive shoes in favor of flip flops

Winter boots, tennis shoes and other supportive footwear do a great deal to protect the heel and foot. When you ditch sturdy shoes for a flimsy pair of flip flops (or no shoes at all!) and then hit the street, your feet take notice. Think about a time where a quick trip to the store turned into a full day in flip flops. Repeated days of coming down on hard pavement with very little cushion or support to protect your foot can lead to plantar fasciitis.

Couch to 5K… or None to Run

These popular workout concepts can kickstart your exercise plan, but “making too big a change too fast is also an invitation for injury,” says Dr. Keith Jacobson, podiatric surgeon at Advanced Orthopedic and Sports Medicine Specialists. True beginners need to build lower body strength and flexibility as they get started to avoid injury, and plantar fasciitis is very common among those who overdo it. In this case, the old saying “walk before you run” is great advice.

Skipping the stretch

Especially if you are a beginner, don’t skip the stretch before or after working out. Tight calf muscles in particular put increased stress on the plantar fascia. Regular stretching improves your mobility and reduces the chance for injury.

Getting your (outdoor) run on

Even if you’ve been hitting the gym year-round, running on a treadmill or cushioned indoor track is more forgiving on your joints and your feet. “A sudden switch to outdoor running often means pounding away the miles on city streets, says Dr. Scott Resig. “Asphalt or concrete is really rough on your feet and joints and can also lead to plantar fasciitis.”

Started barefoot running?

No matter what surface you’re usually on, you’ve probably heard of barefoot running. But is it good for your feet and joints? Can it prevent, or does it cause, plantar fasciitis? The short answer is that more research must be done, and at the very least, it depends on how you started running.

Harvard researchers have extensively studied the mechanics of running and humans’ history as runners and found – among many other things – that most people who grew up and are accustomed to running barefoot strike the ground with the forefoot or midfoot first, rather than heel first, which is how most shod runners (aka most average Americans) strike the ground. But heel striking is not necessarily bad, and many shoe-wearing runners do it without discomfort or injury. Researchers even emphasize that “no study has shown that heel striking contributes more to injury than forefoot striking,” even though it is generally viewed as a higher-impact stride.

Does that mean you should lose the shoes and start barefoot running? Again, it depends, but know that merely removing your shoes does not immediately change your running gait and it’s wise to pursue any major adjustment with caution.

“If you already have heel pain or suspect plantar fasciitis, see an podiatric specialist before making any changes, and consider give yourself a break from running entirely while you determine the cause of your pain,” says Dr. Alan Ng, podiatric surgeon and foot and ankle specialist at Advanced Orthopedic and Sports Medicine Specialists. If you’re healthy and want to explore barefoot running, consider using a different shoe once per week, or start with a neutral or a minimalist shoe, which are lightweight and have a flat sole (vs the standard heel rise) but provide more protection and support than no shoes at all.

Listen to your body, get a professional diagnosis, implement treatment

If your heels are hurting and you’ve recently changed your activities (or your footwear), you might be suffering from plantar fasciitis and it’s time to see an orthopedic specialist. He or she will examine your foot, look for areas of tenderness at and in front of the heel bone.

Conservative treatment for plantar fasciitis helps 90 percent or more of those suffering and includes rest, ice, NSAIDs, cortisone shots and movement – including stretching and physical therapy. In more extreme cases, and only after failure of non-surgical treatment, surgical solutions may be recommended.

Need more information or an appointment? Get in touch!

Best Foot Surgeons

Dr. Keith Jacobson

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Dr. Alan Ng

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Dr. Scott Resig

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Painful bump on the side of your big toe? Why you shouldn’t ignore a bunion.

July 10, 2018/in Deformity, Foot and Ankle, news /by Keith Jacobson, DPM

That painful bony bump on the side of your big toe? It’s probably a bunion. Nearly a quarter of people age 18-65 have bunions, making them one of the most common foot issues among adults. They also run in families and are more prevalent among women (thanks, cute heels), and among those over 65. In fact, more than a third of people over age 65 (36 percent) have bunions.

Whether it runs in your family or you’ve been choosing fashion over function, there are five key things you should know to deal with your bunion and move past the pain.

What causes bunion pain?

We know what predisposes people to getting bunions, but what’s happening with our feet to cause so much pain? It starts when your big toe begins to turn in toward your second toe. As that happens, the joint at base of the big toe bone pushes out to the side, where it meets your footbone (called the first metatarsal) and that pressure causes pain. This area carries a great deal of weight when you are standing or walking, and that pressure causes pain. The area may become red and callused over time. The pain can become so severe that it’s difficult to wear shoes.

Bunions range from mild to severe and should be treated differently

Depending on how prominent and painful your bunion is, your orthopedic or podiatric surgeonmay recommend a variety of treatments that can slow the progression of your bunion, or minimize the pain, but surgery is the only way to truly correct the situation. Beware of ‘treatments’ claiming non-surgical bunion removal.

Popular methods to manage bunion pain and slow progression are wearing supportive well-fitting shoes that align your foot properly for walking, using orthotics or a gel pad to cushion the area when wearing shoes and wearing a splint at night.

There are a variety of available orthotics (or orthoses) including over-the-counter or off-the-shelf commercial products and, as necessary, custom-molded orthotics that are generally prescribed medical devices.

Bunion surgery may be needed

Moderate or severe bunions and can involve cutting the joint at the big toe and then aligning it properly. In more severe cases, the entire joint may be replaced with metal plates and screws. See a video animation of how surgery corrects the bunion.

Don’t ignore bunion pain

If you let a bunion become too severe, you are likely to run out of non-surgical options for pain relief and may even need to consider a more involved surgical procedure such as replacing a joint in your toe or fusing bones together. This equates to a longer and more complex recovery time, not to mention prolonging your pain unnecessarily by not seeing a doctor and making a treatment plan. If you’ve had pain for a year or more, it’s definitely time to see a doctor to review your options.

Recovery takes time
The most common kind of bunion surgery is on an out-patient basis and takes around two months to recover. Your doctor will work with you to create a recovery plan which may include a special boot, rest, stretching and/or physical therapy. Active adults who want to return to load bearing exercise like running and jumping may need longer to get back in the action – but that’s time well spent if they can return to their activities bunion and pain free.

Learn more about your bunion treatment options with one of our podiatric surgeons:

Best Foot and Ankle Surgeons

Dr. Keith Jacobson

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Dr. Alan Ng

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Dr. Scott Resig

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Snowboarders vs Ski Ankle Injuries

December 19, 2017/in Foot and Ankle, news /by Alan Ng, DPM

Colorado: If it ever snows enough to ski or board again, avoid these common ankle injuries and stay on the mountain longer!

In Colorado, we’re having one of the slowest starts to the ski and snowboard season in a while, with even less snow than last year at this time. But late December brought plenty of snow to the Rockies last year, so get ready skiers and riders – and keep these four tips in mind to avoid an ankle injury and stay in mountain-ready condition!

Snowboarders beware: your risk of ankle injuries is higher than skiers.

It’s so common, it’s known as “snowboarder’s ankle” – which is actually a serious injury in the form of a fracture. This often occurs because snowboard boots are softer and less able to protect a rider from hard landings or awkward angles. The fracture is caused when the foot is pushed up and in-ward with sudden impact, and while it’s pretty easy to do – fractures account for as much as 50 percent of all rider ankle injuries – it’s harder to diagnose. It’s often hard to see or missed on x-rays and may require other tests to diagnose. If you have pain and swelling on the outside of your foot and ankle, see a foot and ankle specialist to confirm or rule out a fracture. Delaying treatment or a misdiagnosis can result in more serious long-term ankle pain and problems.

Even though the slopes aren’t totally ready, be sure you are.

It’s never too late to include some pre-skiing or riding exercises in your normal routine. Building strength, stability and flexibility before you hit the slopes lessens your chance of ankle injuries and other injuries too! Many gyms offer ski-conditioning programs and there are simple exercises you can do on your own to strengthen your core, legs and upper body. Riders, can practice with a wobble board, for example, to improve balance and ankle stability. Skiers and riders can benefit from a medicine ball squat which builds muscles and endurance in the lower back, glutes, and quads.

Skiers aren’t exempt from ankle injury – but it’s more likely to be a sprain

While firm ski boots are better at protecting the ankle than snowboard boots, sprains do still happen. When a skier comes down hard on the outside of their foot (which can happen while making a hard turn or stop, or by catching an edge), it forces the ligaments on the outside of the ankle to over-stretch or even tear. Most sprains heal on their own, but not before you manage through swelling, some pain and a sometimes pretty unsightly bruise. Severe sprains can require treatment including surgery. To minimize your risk of ankle sprain, ensure your boots fit snugly and your equipment is correctly sized and adjusted.

Be extra cautious in bad (seriously, really bad) conditions

The Denver Post reports – and you may have experienced – very limited open terrain so far, and what is open is dotted with patches of grass, rock and ice. Uneven and slick spots can be extremely challenging, even for advanced skiers or riders – anyone can catch an edge or lose their balance in spotty terrain. And let’s not forget the crowds. An ankle injury can easily occur when large crowds are forced into increasingly narrowing runs as skiers and riders come to abrupt stops. Think of these early days as a warm up to many months of enjoyable mountain time and take it easy on your speeds and aggressive moves this early in the season.

Foot & Ankle Specialists

Dr. Keith Jacobson

• Reconstructive Foot & Ankle Surgery
• Foot & Ankle Trauma
• Arthroscopy of the Foot & Ankle
• Arthroscopic Cartilage Repair
• Total Ankle Replacement

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Dr. Alan Ng

• Reconstructive Foot & Ankle Surgery
• Foot & Ankle Trauma
• Arthroscopy of the Foot & Ankle
• Arthroscopic Cartilage Repair
• Total Ankle Replacement

Meet Dr. Ng