Posts for category: Sports Medicine
Patient's who suffer from Achilles tendinitis and/or partial tendon ruptures may benefit from this minimally invasive procedure (PRP) and avoid surgery and its possible complications.
I treated a patient yesterday, who lives in West Babylon, NY 11704 and is suffering from this condition.
Please click on the link below to watch a short YouTube video on this procedure:
If you have this condition or have other foot problems call
Dr. Landy's office to discuss treatment options:
631-669-5440 or 516-938-6000
Os Trigonum Syndrome
What is the Os Trigonum?
The os trigonum is an extra (accessory) bone that sometimes develops behind the ankle bone (talus). It is connected to the talus by a fibrous band. The presence of an os trigonum in one or both feet is congenital (present at birth). It becomes evident during adolescence when one area of the talus does not fuse with the rest of the bone, creating a small extra bone. Only a small number of people have this extra bone.
What is Os Trigonum Syndrome?
Often, people don’t know they have an os trigonum if it hasn’t caused any problems. However, some people with this extra bone develop a painful condition known as os trigonum syndrome.
Os trigonum syndrome is usually triggered by an injury, such as an ankle sprain. The syndrome is also frequently caused by repeated downward pointing of the toes, which is common among ballet dancers, soccer players and other athletes.
For the person who has an os trigonum, pointing the toes downward can result in a “nutcracker injury.” Like an almond in a nutcracker, the os trigonum is crunched between the ankle and heel bones. As the os trigonum pulls loose, the tissue connecting it to the talus is stretched or torn and the area becomes inflamed.
Signs and Symptoms of Os Trigonum Syndrome
The signs and symptoms of os trigonum syndrome may include:
- Deep, aching pain in the back of the ankle, occurring mostly when pushing off on the big toe (as in walking) or when pointing the toes downward
- Tenderness in the area when touched
- Swelling in the back of the ankle
Os trigonum syndrome can mimic other conditions such as an Achilles tendon injury, ankle sprain, or talus fracture. Diagnosis of os trigonum syndrome begins with questions from the doctor about the development of the symptoms. After the foot and ankle are examined, x-rays or other imaging tests are often ordered to assist in making the diagnosis.
Treatment: Non-surgical Approaches
Relief of the symptoms is often achieved through treatments that can include a combination of the following:
- Rest. It is important to stay off the injured foot to let the inflammation subside.
- Immobilization. Often a walking boot is used to restrict ankle motion and allow the injured tissue to heal.
- Ice. Swelling is decreased by applying a bag of ice covered with a thin towel to the affected area. Do not put ice directly against the skin.
- Oral medication. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
- Injections. Sometimes cortisone is injected into the area to reduce the inflammation and pain.
When is Surgery Needed?
Most patients’ symptoms improve with non-surgical treatment. However, in some patients, surgery may be required to relieve the symptoms. Surgery typically involves removal of the os trigonum, as this extra bone is not necessary for normal foot function.
As it happens every January, you can bet that millions of New Yorkers have made well-intended resolutions to eat better, exercise more and lose weight. But, if you are among the 72 percent of Americans who say they cannot exercise because of foot pain, those good intentions will never become reality. NOW is the time to take action and get help. The foot specialists of the New York State Podiatric Medical Association are using January as a springboard for educating the public as to the importance of foot health and safety when beginning an exercise program.
With rising obesity statistics also comes an increase in diabetes, heart disease and other related illnesses; exercising and maintaining a healthy weight are two preventative measures that require healthy feet. But the numbers show that Americans view their feet as the least important body part and yet the number one to experience pain! In spite of its prevalence, foot pain is not normal and should be treated by a specialist.
Podiatrists recommend that before beginning an exercise program, make sure your feet are fit, flexible and strong. And always consult with a physician before embarking on any new fitness regimen. Considering that a120-pound person walking a single mile exerts the equivalent of approximately 63 tons, which is a force greater than 125,000 pounds on each foot, it’s no wonder that foot injuries are so common among Americans.
Here are some simple foot exercises that can be done at home or at the gym, before you work out:
1. Toe Points - While standing, do toe raises, toe points and toe curls. Hold each position for five seconds and repeat ten times. This is a perfect way to help alleviate toe cramps and strengthen calf muscles.
2. Toe Squeezes - Place a foam toe separator between your toes and squeeze for five seconds. Repeat ten times. This is a good strengthening exercise for people who suffer from hammertoes or toe cramps.
3. The Roll - Applying light pressure and rolling a golf ball under the ball of your foot for approximately two minutes creates an instant massage for the bottom of the foot. This exercise is perfect for people who suffer from plantar fasciitis (heel pain syndrome), cramps or arch pain (and it feels great!). If a golf ball is not readily available, any type of small ball will work just as well.
4. Towel Scoop - Place your gym towel on the floor and pick it up by only using your toes. Repeat this exercise five times. Try this if you have hammertoes, toe cramps, pain in the ball of your foot, or for overall strengthening.
Foot Massage Techniques
A foot massage not only helps to release tension in your feet, but also increases circulation and maintains the health of the skin on your feet. The first step to a perfect foot massage is to be sure that you and your partner are sitting comfortably in separate chairs. If you are giving yourself a foot massage, simply lift your foot across your lap to begin.
Next, apply a generous amount of emollient-enriched skin lotion or Vitamin E cream to hydrate the skin. This not only moisturizes your foot, but also allows your hands to move smoothly.
1. Warm-Up - To begin stimulating circulation and warming up your foot, hold the foot in your hands. Starting at the top of the foot, begin a long, slow stroking motion with your thumbs, from the tips of the toes, down your sole to your heel and up to your ankle. Retrace your strokes back to the toes and repeat 3-5 times or until the foot feels warm.
2. Ankle Rotations - To loosen the ankle joint and relax your feet, cup the foot under the back portion of the heel in order to brace the foot and leg. Grip the foot with the other hand and turn it slowly at the ankle five times in each direction.
3. Toe Stretch - Grasp the foot at the arch. With the other hand, starting with the big toe, hold the toe with your thumb and index finger and firmly pull the toe, slowly moving and squeezing your fingers up the sides of the toe. Repeat this movement twice on each toe.
4. Arch Release - To help release tension in your foot’s arch, hold the heel of the foot and use the other hand to apply pressure. Slide the heel of your hand along the arch from the ball of the foot toward the base of the ankle and back up the sole of the foot. Repeat five times.
5. Cool Down - End your foot massage with the same technique used in the warm-up. Then, remove all excess lotion that may be left between your toes with soap and water and dry thoroughly.
In cases of chronic achilles tendonitis that is not responding to conservative care, a great in-office option is platelet rich plasma injection. The idea of platelet rich plasma (PRP) injection is to allow the growth factors in the blood to be used to cause an inflammation process in the injured tissue to allow an increase in the healing response of the body. The blood is drawn and spun down. Under ultrasound guidance and local anesthesia in the office, the injection of the PRP is placed in the damaged tissue. This allows an increased growth factor release in the area that sparks the healing process.
How does PRP therapy help?
The body’s first response to soft tissue injury is to deliver platelet cells. Packed with growth and healing factors, platelets initiate repair and attract the critical assistance of stem cells. PRP therapy’s natural healing process intensifies the body’s efforts by delivering a higher concentration of platelets. To create PRP therapy, a small sample of your blood is drawn (similar to a lab test sample) and placed in a centrifuge that spins the blood at high speeds, separating the platelets from the other components. The concentrated platelet rich plasma (PRP) is then injected into and around the point of injury, jump-starting and significantly strengthening the body’s natural healing signal. Because your own blood is used, there is no risk of a transmissible infection and a very low risk of allergic reaction.
How long does it take?
The procedure takes approximately one to two hours, including preparation and recovery time. Performed safely in a medical office, PRP therapy relieves pain without the risks of surgery, general anesthesia, or hospital stays and without a prolonged recovery. In fact, most people return to their jobs or usual activities right after the procedure.
How often should this procedure be done?
Up to three injections may be given within a six-month time frame, usually performed two to three weeks apart. You may, however, gain considerable to complete relief after the first or second injection.
What are the expected results?
Because the goal of PRP therapy is to resolve pain through healing, it could prove to have lasting results. Initial improvement may be seen within a few weeks, gradually increasing as the healing progresses. Research studies and clinical practice have shown PRP therapy to be very effective at relieving pain and returning patients to their normal lives. Both ultrasound and MRI images have shown definitive tissue repair after PRP therapy, confirming the healing process. The need for surgery can also be greatly reduced by treating injured tissues before the damage progresses and the condition is irreversible.