Retrocalcaneal refers to “behind the heel bone.” Bursitis means inflammation of a bursa, which is a fluid filled sac commonly found between tendons and bones. Retrocalcaneal bursitis is a common problem in athletes and is often associated with Achilles tendonitis.

Symptoms include:

• Pain at the back of the heel with running or with impact activity
• Pain with closed heel shoes
• Tenderness and swelling at the back of the heel
• Pain with side to side compression of the Achilles tendon

The bursa allows the Achilles tendon to smoothly glide over the heel bone without pain. An increase in pressure, friction, impact activity or change in shoe gear can cause the bursa to become inflamed. A tight Achilles tendon or heel spurs are the main contributing factors of retrocalcaneal burisits.

A bursitis in general responds well to conservative treatment. Athletes are encouraged to rest and avoid impact activities. Cross training exercises such as bicycling, elliptical and rowing are a few alternative activities to running. Icing, anti-inflammatory medications and ultrasound can help reduce inflammation and swelling. An off-loading pad such as a donut shaped pad can be placed over the Achilles tendon to relieve pressure from the bursa. Stretching the Achilles tendon and use of heel lifts or a high-heeled shoe will decrease the pull of the Achilles tendon and thus reduce inflammation and swelling of the bursa. In some cases a small amount of cortisone can be injected into the bursa, but it is crucial that the cortisone be injected into the bursa, and not the Achilles tendon as it can cause a rupture of the tendon. An alternative to cortisone is Traumeel, a natural anti-inflammatory medication that can be injected into the bursa with no risk of rupturing the Achilles tendon.

For more information about retrocalcaneal bursitis, come see one of our physicians at Foot & Ankle Doctors, Inc

Dr. Nejad

 

Pistons backup guard, Spencer Dinwiddie is expected to be out until early March with an ankle sprain according to reports by CBS Sports.  A syndesmosis injury is common with an excess twisting motion of the ankle. It doesn’t sound like Dinwiddie is suffering from a syndesmosis injury, but it is something to consider with ankle injuries.

The syndesmosis is composed of three ligaments that provide stability to the ankle joint. These ligaments can become stretched, torn or detached if the ankle bones are broken.  If an individual is unable to bear weight on their ankle it could be a sign of a syndesmotic injury.

At  Foot & Ankle Doctors, Inc we check the integrity of the syndesmosis by performing provocative clinical exams such as the Squeeze test and the external rotation stress test.  Radiographs, CT and MRI imaging can be used to detect syndesmotic injuries if clinical examinations are positive for an injury.  Non-weight bearing in a CAM boot or cast for 2-4 weeks can treat syndesmosis injuries non-operatively. Operative treatment options depend on the type of syndesmotic injury but include: screw fixation, and tightrope fixation.

For more information come see us at Foot & Ankle Doctors, Inc

Dr. Dardashti

 

Kansas City Chiefs tight end Travis Kelce suffered an ankle sprain on August 31 during practice. Fortunately, his injury is nothing but a low-grade sprain and won’t keep him from playing the regular season.

Ankle sprains are common sports injuries. A sprain occurs when the ankle rolls outward and the foot turns inward and rolls under the leg. This causes the ligaments on the outside of the ankle to stretch and tear resulting in pain, swelling and bruising. The most common injured ankle ligaments are the anterior talofibular ligament, which connects the talus to the fibula and the calcaneal fibular ligament, which connects the fibula to the calcaneus.

The severity of the ankle sprain determines the course of treatment.

• Grade 1 sprain: slight stretching of the ligament
• Grade 2: partial tearing of the ligament
• Grade 3: complete tear of the ligament

 

Treatment in the first 48 to 72 hours consists of following the R.I.C.E guidelines

• Rest
• Ice for 20 minutes every 2-3 hours
• Compression with an ACE wrap
• Elevate leg above the level of the heart
• Depending on the severity of the sprain and the degree of ankle instability, you may need a cast or walking boot to immobilize your ankle so that it can heal properly. In rare cases of severe ligament tears, you may require surgery to repair the damage.

Based on reports Kelce suffered a low grade sprain and will make a full recovery and return to normal activities. To prevent future ankle sprains or ankle instability it is important for Kelce to restore his ankle’s flexibility, range of motion and strength.

Dr. Dardashti

Kinesio taping techniques have become popular among athletes in both treating and preventing injuries. David Beckham, Serena Williams, Tiger Woods and Lance Armstrong have all been spotted wearing kinesio tape. Athletes like it because it is lightweight and there are no harsh chemicals in it. Kinesio tape is an elastic latex free tape that can stretch up to 50-60% of its length. It is heat-activated and can withstand excessive sweat staying in place for up to one week without causing irritation to the skin.

Kinesio tape is lightweight and comfortable to wear and provides similar support to wearing a brace but without the bulk. It is applied along muscles, ligaments and tendons and can be used to treat Achilles tendonitis, shin splints, ankle sprains and plantar fasciitis.

Benefits of Kinesio tape:

• Limits motion
• Removes edema by directing fluid towards lymph ducts
• Reduces inflammation and pain
• Increase circulation to the damaged area

Kinesio tape has to be applied properly to be effective. If you have an injury and would like to learn more about Kinesio tape come see us at Foot & Ankle Doctors, Inc.

Dr. Nejad

We are hoping David Pastrnak, forward for the Boston Bruins will return to the ice soon after suffering from a non-displaced fracture in his foot almost 8 weeks ago. The injury occurred back in October when he stopped a puck with his foot. The impact of the puck caused a small fracture in one of his bones. The initial x-rays did not reveal a fracture, however swelling and pain persisted. It is not uncommon for a fracture not to appear on x-ray until 14 days after the injury. A CT scan revealed a non-displaced fracture in an awkward area. Luckily the fracture was not severe enough to undergo surgery and a more conservative approach was taken. Bone takes 6 to 8 weeks to heal. Course of treatment includes icing and elevating for the first week. Ibuprofen and other NSAIDs should be avoided as they can delay bone healing. Tylenol can be taken to help with the pain. A walking boot or short leg cast can be used for 4 weeks at which point physical therapy can commence. At this point, the bone should be healed if Pastrnak has been compliant to his course of treatment.

If you have sustained an injury to your foot and continue to have pain come and see us for a comprehensive assessment at Foot& Ankle Doctors, Inc.

Dr. Dardashti

 

 

 

 

 

 

 

Brooklyn Nets forward Rondae Hollis-Jefferson is out indefinitely after fracturing the posterior aspect of his right talus. He recently underwent successful surgery with two screws to repair the fracture. He is expected to be out for the next 8 to 10 weeks.

The talus articulates with the tibia and fibula and plays an important role in ankle function and stability. The back of the talus is composed of a medial and lateral tubercle. The lateral tubercle is more commonly injured when the ankle is plantarflexed beyond a normal range or with forced inversion. Tenderness over the posterolateral talus or plantarflexion of the ankle may reproduce pain. The medial tubercle of the posterior talar process can fracture with excessive dorsiflexion with pronation. Tenderness between the medial malleolus and the Achilles tendon will produce pain.

Originally doctors thought Rondae Hollis-Jefferson was suffering from a mild ankle sprain since x-rays showed no signs of fractures. CT scans revealed a more serious injury.

Minimally displaced fractures can be managed with a non-weight bearing short leg cast for 4 to 6 weeks. Rondae Hollis-Jefferson must have had a significant displacement of the posterior process of the talus to have undergone surgery.

Our staff at Foot& Ankle Doctors, Inc. wish Rondae Hollis-Jefferson a full recovery.

Dr. Nejad

Peroneal tendon subluxation is a common injury in athletes especially skiers. It occurs when the ankle is rapidly dorsiflexed or the ankle is everted with intense contraction of the peroneal tendons. Pivoting motions of the foot and ankle in activities such as golfing, ballet, and gymnastics can also lead to subluxation of the tendons.

Our physicians at Foot & Ankle Doctors, Inc. will perform a thorough history and exam to differentiate peroneal subluxation from other lateral ankle disorders. Patients often report a popping or snapping sensation at the time of injury, which is indicative of a peroneal subluxation. On physical exam, it is common to find swelling posterior the lateral malleolus and a palpable bump over the peroneal tendons. Provocative tests can be performed to visually watch the subluxation of the peroneal tendons confirming diagnosis.

Radiographs may reveal an avulsion of the distal tip of the lateral malleolus along the course of the tendons. An MRI may be ordered for more severe injuries.

Conservative treatment options include immobilization in a short leg cast or splint in addition to RICE for 6 weeks. Surgical treatment is indicated in acute tendon dislocations in serious athletes who are eager to return to sports quickly. Surgical options include groove-deepening procedure or repair of the superior peroneal retinaculum.

Complications following surgical intervention include recurrence of the peroneal tendon subluxation as well as nerve injury. The sural nerve may be damaged and patients may experience numbness or a burning sensation to the outside of their foot.

 

Dr. Dardashti

 

 

Tight end, Randall Telfer for the Cleveland Browns was placed on the reserve list. We are hopeful he has recovered from his Lisfranc injury back in December.

A Lisfranc injury involves the joints and ligaments in the middle of the foot. A simple fall or twisting motion of the foot can tear the ligaments at the joint of the midfoot. There are three types of Lisfranc injuries, which can occur in combination:

• Sprain: ligaments that connects the metatarsal to the tarsal bones in the midfoot can be stretched (sprained) or torn leading to instability
• Fracture: Ligaments connects bone to bone. In some cases the force of the injury can cause the ligament to avulse a piece of bone resulting in a midfoot fracture
• Dislocation: The bones of the Lisfranc joint become unstable and buckle or shift out of place

Telfer tried treating his injury conservatively and postponed surgery until February. The goal of surgical treatment is to adequately realign the joints and return the broken bone fragment(s) to a normal position. The bones are reduced and held in correct alignment with plates or screws. In severe cases where the joint cannot be reduced back to its original position, a fusion of the bones is recommended so the bones heal into a single, solid piece.

After surgery, Patients are non-weight bearing for 6 to 8 weeks in a cast or boot. Weight bearing commences once the x-rays reveal proper bone healing.

Out staff at Foot& Ankle Doctors, Inc hope Telfer can return to the field without further injuries.

Dr. Nejad

Corey Peters, defensive tackle for the Arizona Cardinals is out for the 2015 season after tearing his left Achilles tendon. Peters recovered from a 2013 torn right Achilles, and unfortunately has to endure the same road of recovery again.

The Achilles tendon is the largest tendon in the body. It connects the calf muscle to the back of the heel. The Achilles helps to raise the heel off the ground and is used with every step and jump we make. The Achilles tendon can be partially torn or completely torn when the tendon is stretched beyond its capacity. As a result it can no longer function normally.

Most individuals report a sudden pain and a popping or snapping sound after tearing their Achilles tendon. Tears are commonly caused by a trip, fall, sudden pivot or sudden acceleration when running.

The tendon ends start to retract 3-4 days following rupture and therefore is crucial that the injury be treated non-surgically with a cast or surgically repaired. Surgical intervention will provide a faster return to activity and decreases the chance of re-rupture in the future. Peters’ surgeon will decide which surgical repair method is best suited for him.  It will take 6-8 weeks to recover from surgery followed by physical therapy/rehabilitation.

Dr. Nejad