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