Treating Ankle Pain without Surgery

16 Jun 2017 Joint Health

Ankle problems are common for people who’re on their feet a lot. However, there is a fine line between tired feet and an injury, and it is important to recognize when an injury has occurred in order to avoid aggravating the problem. We experience pain for a reason, and when our body experiences pain, it is like a flashing sign to us that something is wrong, and we need to pay attention to it.

The problem is, we often try to ignore and disregard the pain, hoping it will subside with time. It is very easy to turn a minor injury into a major one by not taking proper care, especially if the fear is that surgery is the only option to get better. There are several non-surgical treatments that can treat arthritis, sprains and strains, or even a hairline fracture. These methods include:

1. Casting and braces: For ankle pain or even ankle fractures, surgery is not always the answer. Putting a cast or brace on the injury will provide support and help aid in faster healing. Especially the case with minor sprains and some hairline fractures, support and rest is often the best treatment.

2. Weight Management: Maintaining a healthy weight and regular exercise are essential tools to help reduce joint pain and stiffness, build strong muscle around the joints, and increase flexibility. While losing weight may not reverse the damage that has been done to a joint, research has shown that even moderate weight loss can have a dramatic effect on the relief of joint pain.

3. Physical Therapy: The goal of physical therapy is to help a person return to daily activities as quickly as possible. Physical therapists use their knowledge of the body to help people do customized movements and exercises to relieve their chronic pain.

4. Medication and Injections: There are many medications out there that can help as an alternative to surgery. Cortisone injections are beneficial in helping reduce pain and inflammation in the targeted area.

To learn more about non-surgical methods that can help treat your ankle pain, call Tucson Orthopaedic Institute at our East Tucson office at (520) 784-6200, Northwest Tucson office at (520) 382-8200, or Oro Valley office at (520) 544-9700. To request an appointment, you can call or use our secure online appointment request form.

Ankle Pain: Common Causes

9 Jun 2017 Joint Health , , , , , , ,

Did you know that your ankle is a synovial hinge joint made up of three bones? It is actually much more complex than you might guess, with a total of 28 bones and 25 joints in the foot and ankle, creating a very stable and powerful platform that allows your ankle to move only slightly from side to side, yet still flex up and down in order to stand, walk, jump and run. Your ankle also has a complex array of connective and soft tissues, nerves, and blood vessels, all combined in one neat little compartment. Because of the massive stress and weight that the ankle regularly carries, it is vulnerable to injury and other conditions. Below are some common causes of ankle pain.

Common Causes of Ankle Pain

Ankle pain can be caused by a variety of conditions or injuries. Some of the most common include:

Achilles tendonitis – This is often caused by overuse. The Achilles tendon is a strong band of connective tissue that attaches the calf muscles to the heel bone of the foot. Achilles tendons can rupture, especially if they are already inflamed and irritated.

Sprained ankle – Sometimes caused by a roll or twisting that stretches or even tears the strong connective tissues that anchor the bones and muscles. If you think of a rubber band being pulled too far, you can imagine what happens when the ligaments are forced beyond their normal stable points. Some sprains are mild, others require surgical intervention or other medical care, such as bracing.

Broken ankle or foot – Bones of the ankle tend to be very strong, however they are not immune to fractures from repeated stress or a sudden (acute) injury. You can break an ankle simply by stepping off a curb the wrong way, making a sudden change of direction while running during a sports event, or being involved in an accident of some kind. The bones in the feet can become fractured in many different ways, from awkward landings to dropping heavy objects on them. The treatment required will depend on the exact location of the break and the severity.

Gout – The pain of gout can be so severe that it becomes debilitating. Gout is a complex form of arthritis that causes swelling, pain, redness and tenderness in the affected joint, caused by the formation of tiny uric acid crystals within the joint. Patients with gout can be treated with medications and dietary changes to reduce the amount of uric acid in the body.

Other common causes of ankle pain include:  plantar fasciitis (an inflammation of the connective tissues of the foot), arthritis (rheumatoid, psoriatic, or osteoarthritis), pseudogout, stress fractures, bursitis, and septic arthritis. Depending on the underlying cause and severity, an ankle condition may require surgery or even a total ankle replacement.

If you or a loved one has ankle pain, or you would like to know more about our advanced ankle care, or to schedule an appointment at any of our offices, please call us in East Tucson at (520) 784-6200, Northwest Tucson at (520) 382-8200, or Oro Valley at (520) 544-9700, or request an appointment online.

5 Signs You May Have Hip Arthritis

22 Nov 2016 Doctors, General, Joint Health , , ,

Written by: Dr. Ali Dalal 

Degenerative joint disease is a very common cause of hip pain. Figuring out whether the true source of pain is the hip or the back can be a diagnostic challenge for both the doctor and the patient. Indeed, several patients have both back and hip problems. Here are 5 common signs that the pain you are experiencing is coming from your hip.

1. Do I need a different car?

It’s something we do every day and for some people, several times a day. For patients with hip arthritis, the simple act of swinging their leg to get in and out of a car can cause severe discomfort.

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2. “Honey, can you grab my flip-flops?”

Stooping forward to put on shoes and socks becomes extremely difficult and or painful due to loss of mobility. Frequently patients will report that their husband or wife assists them with this activity. In places with warmer climates, patients resort to wearing slip-on shoes.

via GIPHY

3. Get between the toes!

Frequently patients with hip arthritis experience pain when bending to wash their feet in the shower.

via GIPHY

4. Can’t stop counting sheep?

In advanced cases, patients have sleep disturbances because they cannot position their hip in a comfortable way to fall asleep. Oftentimes patients will only be able to sleep with a pillow underneath the thigh.

via GIPHY

5. It can’t be my hip; the pain is in the front.

Contrary to what many people think, the anatomic location of the hip is not the side of the upper thigh. The hip is located in the front in the crease of the groin. Groin pain and limited hip motion are the most reproducible signs of a hip problem.

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If any of these symptoms sound familiar, you may be suffering from hip arthritis. The diagnosis can be confirmed with a quick X-ray and treatment is usually non-operative in the early stages.  Come see Dr. Dalal at Tucson Orthopaedic Institute so you can stop living with pain and start living your life!

Bisphosphonate Femur Fractures: An Ounce of Prevention is Worth a Pound of Cure

19 Jul 2016 Doctors, Joint Health , , , , ,
Written by: Ali Dalal, MD

view post on original source – LinkedIn

7/17/2016- Bisphosphonates (BPs) are a revolutionary class of medicines that can preserve bone health and prevent fractures caused by osteoporosis. They go by the trade names of Boniva™, Fosamax™, and Reclast™ among others. They have been shown to decrease spine fractures by 40-70% and hip fractures by 20-50%. They are truly life changing treatments when one considers that 1 in 3 women and 1 in 5 men will experience an osteoporotic fracture after the age of 50.

Like all medicines, BPs have side effects. One especially fearsome side effect of BP treatment is atypical femur fracture (AFF). AFFs are fractures caused by BPs. They are characterized by aching pain in the thigh or groin with weight bearing. They are easily visible on x-rays in their early stages and are much easier to treat before they become complete fractures. To be clear, AFFs are very rare and bisphosphonates most definitely prevent more fractures than they cause. However, the prolonged course of healing and the unpredictable nature of AFFs have caused great concern among patients and the media. A link between the number of years BPs are taken and the risk of AFF has been established. A task force of leading bone doctors and scientists has provided guidelines in 2016 on how to prevent AFFs based on individual patient risk factors. The guidelines are as follows:

Post-menopausal women treated with oral (pill form) bisphosphonates for 5 continuous years or intravenous (IV) bisphosphonates for 3 continuous years should be re-evaluated. If they have not had an osteoporotic fracture during treatment with the medicine (hip, spine, wrist, shoulder fracture), do not have osteoporosis on a DEXA scan (bone mineral density test) and are not considered to be a “high fracture risk” based on age and other factors, they should consider a temporary stoppage of medicine or a “drug holiday” for 2-3 years.  After this time period they should be re-evaluated. The drug holiday allows some of the potential harmful effects of BPs to decrease.

As you can tell, the guidelines are not simple. As a doctor I had to read it a few times before it sank in.  Stopping or continuing the medicine requires significant judgment on the part of the doctor prescribing it. These medicines should not be stopped without a consultation with the prescribing doctor. As a patient, the important thing to take away is that if you have been on these medicines for years and are experiencing the symptoms of AFFs, don’t ignore them. AFFs are much easier to treat in the early stages. Secondly, if you have been taking these medicines for years but haven’t seen the prescribing doctor in a while, it might be time to find out where you stand in terms of your risk. With AFFs, an ounce of prevention is worth a pound of the cure.

  1. Adler et al. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. Journal of Bone and Mineral Research. Volume 31, Issue 1, pages 16–35, January 2016

Muscle-sparing surgery for hip replacement

1 Jul 2016 Joint Health , ,

Joint replacement surgery is one of the oldest procedures in history. Since 1891, orthopedic surgeons have been replacing faulty hips due to fracture, arthritis, and structural abnormalities. Thanks to 125 years of innovation, modern-day hip replacements are arguably the most advanced orthopedic surgery performed today.

The way the artificial hip is designed and the material it is made of has been the focus of many researchers and companies. The goal is to provide an artifical joint that functions and feels like a natural joint as much as possible.

Orthopedic surgeons are continually looking for ways to make surgery less invasive, less painful, and less risky. Minimally invasive procedures are the way of the future. For hip replacements, the anterior approach is gaining popularity as a less-invasive alternative to your grandmother’s hip replacement.

The anterior approach to hip replacement is a muscle-sparing technique that offers the following benefits:

  • Less pain and bleeding
  • Faster recovery
  • Better results
  • Most people are candidates

Instead of making an incision on the side or back of your hip, the surgeon accesses the hip joint from the front (anterior) side. From this side, there are no muscles that need to be cut in order to remove and replace the joint. This makes it easier to resume activity after hip surgery, because the supportive muscles remain intact. It’s also less painful than traditional hip replacement. Additionally, using the anterior approach allows for better placement of the new joint, which leads to improved outcomes for patients.

To learn more about the technique, check out this YouTube video.

Many people do not realize that the anterior hip replacement is not new. It was first done nearly 70 years ago in France, although the modern-day version was implemented in the 1960s. The reason it has not been widely performed is likely due to the complexity of the procedure. Advanced training is needed to master this technique, but there are clear benefits for the patient that make it worth the extra work.

To learn more about this muscle-sparing procedure for hip replacement, please contact Tucson Orthopaedic Institute for an appointment.

Image Source: Johns Hopkins Mediicne

Want Healthy Joints? Hydrate!

3 Jun 2016 General, Joint Health ,

Each task you perform requires your brain to collaborate with the musculoskeletal system. Muscles, tendons, ligaments, bones – they must all be in good working order to allow for joints to move properly.Hydrate for healthy joints

What fuels your machine so that you have pain-free movement with a full range of motion? Water – among other things such as exercise and proper nutrition.

Water helps keep joints lubricated. A component of synovial fluid, water is necessary to help prevent joint friction. Synovial fluid lubricates and cushions the joints and cartilage surrounding them, keeping bones from rubbing together.

Water helps build muscle to further protect the joints. Muscle tissue consists of about 75 percent water, which helps to form protein in muscles, stabilizing and protecting joints. Dehydration can reduce muscle tone by preventing muscles from contracting.

Joint pain improves with hydration. Hydrated cartilage is soft and smooth. When dehydrated, however, it can cause friction, which leads to pain. Similar to a soft, flexible wet sponge, cartilage becomes stiff when it dries out. Water also helps to reduce swelling, thereby reducing pain.

How much water you need depends on your size, weight, activity level, and environment (temperature and humidity). In general, you should aim to drink between half an ounce and an ounce of water (including beverages that contain water) for each pound you weigh, every day. You don’t just have to drink your water though. Many raw vegetables and fruits such as watermelon contain a high water content.

If you’re experiencing joint pain or dysfunction, contact one of our convenient Tucson locations near you or request an appointment online.

 

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