Posts for tag: Surgery
Most of the surgery that our doctors perform here at Advanced Foot and Ankle care is considered elective, but that does not mean that we do not take it seriously. When we start discussing surgery as an option with our patients we like to go over our protocol for surgical patients and why we have these protocols in place. While our protocols can seem particular to some, there are many reasons for each.
One mandatory thing we require for each of our surgical patients is called PRP, or platelet rich plasma. This is process where a patient’s own blood is enriched with above average levels of platelets to promote healing. Since many of our surgeries requiring manipulating bone, we see anything that can help aid in the healing process as a must. PRP has been around for several decades and is still being studied for its possible applications. New research is showing it may help with arthritis. Since this procedure uses the patient’s own blood, it has little to no side effects. PRP is also a great base for physical therapy, which many of our surgical patients go on to do.
While we use PRP strictly for surgical patients, there are studies coming out that show in office PRP may be able to help with tendonitis. We are always interested in possible applications and processes that are non-invasive but allow for our patients to live better lives.
The 5th metatarsal is the one of the most common bones fractured in the foot. Situated just below the 5th toe, the anatomy of this bone influences the type of fracture that develops. The metatarsal itself is comprised of a base, tuberosity, shaft, neck, and head. The tuberosity, which is the posterior-most aspect of the bone near the midfoot, is clinically evident as it protrudes laterally (some people complain that this rubs in their shoes). Tuberosity fractures, also known as avulsion fractures, can be displaced or non-displaced. The position of the fracture will determine the type of treatment. For non-displaced fractures, the treatment is conservative and focuses mainly on symptoms. This includes protected weightbearing in a hard-soled walking boot or a short-leg walking cast. Pain usually resolves after a few weeks, and healing of the fracture fragment itself on x-ray is evident after approximately 6-8 weeks post-injury. These types of fracture generally heal well with no long-term complications. Larger, displaced fragments are commonly treated surgically, which varies from percutaneous pinning (making a small cut in the skin and inserting a screw without having to expose the entire metatarsal) to open reduction with internal fixation (exposing the metatarsal and placing pins, plates, and / or screws across the fracture site).
Another common type of 5th metatarsal fracture is known as a Jones fracture. The location of this injury is slightly more anterior to the tuberosity (1 cm from the joint, closer to the toes than the tuberosity fracture). The Jones fracture takes a longer time to heal because of the poor blood supply at this particular location in the bone. Treatment can be either conservative or surgical, depending on the patient's age, health, and activity level. Conservative treatment involves 6-8 weeks of strict non-weightbearing cast immobilization, followed by a few additional weeks of weightbearing boot or cast immobilization. Surgical treatment, which is similar to that described for tuberosity fractures, is generally recommended for athletes and more active individuals and allows shorter periods of immobilization with faster healing times.
Common to both types of fracture are soft tissue attachments found at the base of the 5th metatarsal. A muscle tendon (peroneus brevis muscle) from the lateral leg compartment courses down into the foot and attaches at the base. The lateral band of the plantar aponeurosis (which can occasionally be the culprit of infamous heel pain known as "plantar fasciitis") also attaches here. These two soft tissue structures have the potential to pull at the fracture fragment, thus causing possible displacement and, unfortunately, complicated fracture healing. This is why it is extremely important to seek treatment with myself or one of our doctors immediately at Advanced Foot and Ankle Care if you suspect that you have sustained a 5th metatarsal fractures.
Lady Gaga has been in the news a lot recently, but not for the reasons that you might think. Instead of talking about her music, or her fashion sense, most news outlets have been reporting on the fact that Lady Gaga had to cancel some of her tour dates because of a condition known as “synovitis” affecting her hip. For this reason, this week I thought I’d write about synovitis to shed some light on this condition.
What is Synovitis?
Synovitis is a joint disorder that can occur in many joints other than the hip, including the shoulder, hand, wrist, knee, and especially the ankle and the joints in the foot. It is an inflammation of a special kind of tissue that lines these joints, called the synovial membrane. This membrane is very important because it produces a fluid that acts as a lubricant that helps the joint move. When the membrane is inflamed, the joint becomes swollen with this fluid, and is often very painful.
What causes it?
What are the symptoms?
Symptoms of synovitis include joint swelling, warmth, redness, and pain, especially when moving the joint.
How is it treated?
Over the counter medications like aspirin and ibuprofen may work in some cases to relieve pain and swelling. For more severe cases either oral or injectable steroids may be indicated. Surgery is rarely necessary, and reserved only for persistent cases.
Unfortunately for Lady Gaga, it was reported that her problems were more severe than just synovitis. She recently underwent surgery to repair a soft tissue tear in one of the structures of her hip joint; with this type of surgery, she will most likely face a lengthy recovery period.