Thursday, October 11, 2012

Ask Dr. McCormick

Question:  “I sprained my ankle last spring while I was running.  The ankle doesn’t really hurt anymore, but it keeps ‘giving out’.  What should I do?”

Answer:  Ankle sprains are the most common foot and ankle injury in sports.  Typically, sprains occur when the foot inverts with an awkward step while running or jumping.  As the foot rotates inward, the ligaments on the outside, or lateral aspect of the ankle, are stretched, causing swelling and pain.  Most frequently, sprains will recover completely with rest, ice, compression, elevation and early mobilization.
In less than 10% of cases, while ankle swelling and pain improves, the ankle continues to “give out” or feel unstable.  Classically, this occurs when walking on uneven ground or when stepping off of a curb.  Repeated episodes of “giving out” is a condition called chronic ankle instability.  Most frequently, this is a result of incomplete recovery from an acute ankle sprain that leaves the ankle with weakness and impaired postural control.
The initial treatment for chronic ankle instability is a program of structured rehabilitation with the help of a physical therapist.  Exercises are aimed specifically at strengthening the peroneal tendons which run on the outside aspect of the ankle.  The regimen should also include use of a balance board or similar device to work on proprioception – awareness of the position of the foot and ankle in space.  Improved proprioception helps the ankle react more quickly to stresses, preventing future sprains.
After 6-8 weeks of intensive therapy, if the ankle continues to feel unstable, one might be a candidate for surgery to reconstruct the injured ankle ligaments.  At this point, an MRI is helpful to identify any underlying injury such as cartilage damage at the ankle or peroneal tendon tears.  Complete recovery from surgery takes at least 3 months, but patients will typically be able to return to full activity without limitation, and, most importantly, without the sensation of their ankle “giving out”.

Wednesday, October 10, 2012

Ask Dr. Klein

I have bunions, but my feet don't hurt. My sister says that I should have them fixed before they become worse. Is this true?

Many people have bunions, but not all bunions are painful. A bunion is more than a "bump" on the side of your foot. It is a deformity of the great toe that frequently runs in families. If bunions run in your family, you may be predisposed to developing a bunion over time. Bunions range from mild to severe and are most common in populations of people who wear shoes.

In fact, shoe wear plays a significant role in the development of a bunion deformity. Bunions can worsen over time and become painful if your shoes are not an adequate width for your foot. High-heeled shoes also influence the development of a bunion by increasing pressure on the forefoot. As bunions become worse, they can become painful or the lesser toes can become painful.
Many bunions do not become painful or change over time. With appropriate shoes, bunions can remain stable and may not limit your activity level. The primary indication for surgical treatment of a bunion is pain. If you are having pain that limits your ability to wear most shoes and limits your activities, you may consider surgical correction of your bunion. If you are not having pain, there is no reason to correct a bunion today due to concerns that it may become worse in the future.

Surgical treatment for bunions usually involves an osteotomy, or a cut in a bone to realign the great toe. Sometimes multiple osteotomies are necessary to correct the deformity. The surgical treatment depends on the
specific deformity causing the bunion and may vary from person to person. If hammertoe deformities of the lesser toes develop, these are often corrected at the same time. If you have foot pain related to a bunion, an orthopedic foot and ankle surgeon can provide you with a surgical evaluation.