New York Giants Plagued with Injuries Late in the Season

New York Giants’ wide receiver Hakeem Nicks will most likely sit out in week 17 with a broken toe. The news was released today that the injury was in fact a broken big toe on his left foot. It is not clear whether the injury occurred during the game on Sunday against Green Bay. The Giants lost that game 45 to 17.

Injuries to the great toe are extremely common in turf sports such as football. The combination of flexible shoes on a hard surface creates the perfect combination for the development of turf toe, which is a hyperextension injury to the first metatarsopahalangeal joint (MTPJ). This joint connects the great toe to the rest of the foot.

Fractures of the great toe may also be due to a single traumatic event, or to repetitive stress to the bones. In Nicks’ case, it is unclear whether the injury occurred during a game or during practice.

Nicks’ injury comes at an awful time for the New York Giants, whose playoff hopes are dwindling fast. Their injury report is crowded with players already, some of which are other foot and ankle injuries.

Center Shaun O’Hara has missed nine games this season due to Achilles, ankle, and foot injuries. O’Hara was also picked for the NFC Pro Bowl roster, a decision which many sports fans see as ill-advised. O’Hara will also be doubtful for week seventeen, as his Achillles condition has flared up in the past few days.

Running back Ahamad Bradshaw is also questionable for this week’s game with an ankle injury that limited his production in week sixteen. The official report has him listed with a sprained ankle. Lateral ankle injuries are often very difficult to rehab, as we’ve written about before. The key to non-operative treatment is adding to stability to the joint with the use of braces.

Other players on the Giants’ injury report include Will Blackmon (knee), Chris Canty (neck), Antrel Rolle (ankle), Dave Tollefson (knee), Justin Tuck (chest), Osi Umenyiora (knee), and Corey Webster (ribs).

Injuries like those plaguing the Giants, many of which are injuries to the lower extremity, can be extremely common in football. Especially late in the season, when fatigue and inclement weather start to play a greater factor, lower extremity injuries start popping up everywhere, effecting nearly every team. Proper training and conditioning is essential to avoiding these types of injuries, not only in the professional athlete, but in the casual athlete as well.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com

Microfracture Surgery for Greg Oden

Greg Oden, of the Portland Trailblazers, will be forced to miss the rest of the NBA season this year. The center, who was the #1 pick in the 2007 draft, has just recievd microfracture surgery of his left knee. Oden received a similar surgery on his right knee during his rookie year, which postponed his professional start.

Microfracture surgery is a treatment for an osteochondral lesion, which is damage to the articular cartilage within a joint. The knee is a common place for these types of injuries to occur, as well as the ankle. The surgery involves making tiny holes in the damaged cartilage, which allows for blood to access the area more easily. This brings in healing and growth factors, which can promote the generation of cartilage in the area. The new cartilage that forms is fibrocartilage, which not quite the same as the hyaline cartilage that forms the cartilage of the joint. However, this fibrocartilage does allow for a more normal range of motion postoperatively, and often can reduce the pain associated with an osteochondral lesion. In podiatry, it is common to see an osteochondral lesion of the talus following an ankle injury, which sometimes may be corrected with microsurgery.

A study out of Drexel University College of Medicine studied NBA players that received microfracture surgery of the knee between 1997and 2006. The study looked at a number of factors, and analyzed the player efficiency ratings (PER) of the NBA players both before and after the surgery. The study found that twenty-percent of the players did not return to the NBA. It also found that of the players that did return, only 17 of 24 players continued to play for more than two years, and that universally all players saw a reduction in their player efficiency rating as well as the number of minutes played.

What will be the fate of Greg Oden following his second microfracture surgery? There’s no way to know for certain, but the NBA is hopeful that he will recover and have a successful career. Certainly he will be able to have a normal life after the surgery, but will his knees be able to withstand the high impact of an NBA player? The high forces placed through the lower extremity during running and jumping, as well as the sheer forces place on the knees during cutting and pivoting moves may prove to be to much for the Portland Trailblazers’ center.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com

Platelet-Rich Plasma Therapy

In the world of sports injuries, healing time is of the utmost importance. The difference in a week for full recovery can mean the difference between making the playoffs and ending the season early. Because of this need for fast-tracking healing times, different innovations have become more popular in medicine. One of these innovations is the use of platelet-rich plasma.

Platelet-rich plasma (PRP) had been used previously as an adjunct to healing in spinal surgeries and in plastic surgeries with extensive soft tissue damage. The process involves drawing a small amount of blood from the patient (between 30mL and 60mL), putting the blood into a centrifuge, and spinning it down to separate the blood components. The plasma is separated from the cells, but the platelets are kept in the plasma. This platelet-rich plasma can then be injected back into the same patient, in the area that healing is needed. PRP has gained popularity, and has been used to treat tendon injuries, ligament injuries, cartilage injuries, muscle injuries, and for chronic wounds.

Part of PRP’s recent surge in popularity is due to its use in treating sports injuries. Professional athletes like Tiger Woods, Troy Polamalu, and Hines Ward have all received media attention from PRP therapy. Recently, Houston Texans wide receiver Andre Johnson has made the news for receiving platelet-rich plasma treatment. As more and more professional athletes use PRP therapy, it becomes more common for amateur athletes and weekend warriors to ask their doctors about the treatment.

The theory behind how PRP therapy works is somewhat simple. Platelets in the blood normally release chemical signals to promote healing at a specific site. These signals attract more platelets to the area, which increases the amount of signal being release, and thus the healing process continues. By removing blood from a person and concentrating the amount of platelets in a particular area, the healing time is theoretically increased.

In podiatry, common uses for PRP therapy include plantar fasciitis and Achilles tendon tears/ruptures. Both of these areas are prone to chronic injuries that can be very difficult to heal, and can often take a very long time for the symptoms to go away. Therefore, platelet-rich plasma therapy becomes an interesting option for these patients. These areas of injury can also have a relatively low blood supply, which may be why they are prone to injury in the first place. Injecting platelet-rich plasma into these areas can promote healing in an area that may be difficult for platelets to reach on their own.

While platelet-rich plasma seems to be a great therapy to boost the healing of certain types of injuries, there are certain limitations to its use. The studies that have been performed show inconsistencies in the method of use, as well as small sample sizes and a lack of control subjects. Additionally, there are many studies that show inconclusive results as to the efficacy of PRP. This takes away from the studies that show PRP to be an effective method of treatment, as the results may not be able to be repeated.

While there may be some controversy over its efficacy, PRP is still becoming a popular method of treatment for chronic injuries, particularly among professional athletes. This is due to a vast amount of resources for this patient group, as well as the desire to fast-track recovery time. As more studies are performed on the topic, watch for more solid results to be shown.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com

Metatarsalgia (Forefoot Pain)

The term metatarsalgia translates to “pain in the metatarsals”. It is most commonly used to describe pain in the metatarsal heads, at or near the ball of the foot. Though it is sometimes used as a discrete diagnosis, the term metatarsalgia is a very general term that does not offer a reason for the pain. There are a number of different conditions that can cause metatarsalgia, and many others that may mimic the findings.

True metatarsalgia results from increased pressure in the metatarsal heads. This is most commonly the result of biomechanical deformities such as hallux valgus or an elevated first ray. Conditions like this may also be associated with bunion formation. Most frequently it is associated with a flatfoot, or a foot that is prone to pronation syndrome. However, increased pressures through the metatarsal heads may also be seen in a high-arched foot, or pes cavus.

Another common cause of metatarsalgia is a thinning of the fat pads at the bottom of the foot. Fat pads are normally found underneath the heel and at the ball of the foot. These well-organized structures help to cushion the forces applied to the foot while walking. In older people, the fat pads can thin as a normal part of aging, a component of some disease processes, or with the use of some drugs such as oral steroids. When the fat pad at the ball of the foot thins, the cushioning underneath the metatarsal heads is lost, and metatarsalgia may ensue.

Pain in the metatarsal heads is also commonly seen with hammertoes, as the contracted digits force the metatarsal heads into the ground with excessive force. Over time, this can create a painful situation.

Other conditions of the foot may appear as metatarsalgia, but may actually be a different pathological process. Neuromas, particularly those found between the metatarsals such as Morton’s neuroma, can appear at first as metatarsalgia. Stress fractures of the foot may also lead to pain in the ball of the foot or at the metatarsal heads.

Rheumatoid arthritis may appear initially as metatarsalgia, and should be ruled out as a part of the clinical exam. This may include x-rays as a diagnostic study, which can also look for avascular necrosis of the metatarsal heads as a cause of the pain. Tendinitis, bursitis, and capsulitis (a swelling of the joint capsule) can also appear as metatarsalgia. It is up to the clinician evaluating the patient to differentiate between these pathologies.

The best treatment, therefore, for metatarsalgia, is to address the underlying cause of the condition. If it is a biomechanical etiology, such as from over-pronation, conservative therapy may address correcting the deformity. The use of custom orthotics or another type of shoe insert is commonly employed as a first-line treatment. Simply resting and icing the area while taking anti-inflammatory medications may alleviate the pain, but can also delay the proper and necessary treatment. Custom orthotics, specialized shoe inserts, a change in shoes, and possibly shoe modifications will all help the person with a loss of the protective fat pads found on the bottom of the foot as well.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com

Pes Cavus

A high-arched foot, referred to medically as pes cavus, is a foot in which there is a large opening of the inside of the foot when bearing weight. A high-arched foot is the opposite of flat feet, and is considerably less common than flat footedness.

Pes cavus may be an asymptomatic foot type, and may actually be beneficial in sports such as long distance running. The foot is fixed in a downward position, or plantar flexed, and is often quite rigid.

In the symptomatic patient, there may be difficulty in shoe fitting. Custom orthotic devices for the foot are often necessary, and children with high-arched feet may have difficulty walking. Some common complaints of symptomatic pes cavus patients include metatarsalgia, ankle instability, and corns and calluses of the feet where ill-fitting shoes may be rubbing.

The causes of pes cavus are as varied as people with the foot type. There is often no identifiable underlying cause, most commonly observed in the asymptomatic patient. There are a number of neurological disorders that can lead to pes cavus, including Charcot-Marie-Tooth, cerebral palsy, and multiple myeloma. Pes cavus may also be seen in some cases of diabetes and following stroke.

When being evaluated by your physician for pes cavus, there are a number of questions you may be asked. Some topics might be:

• Progression: Have your feet always had a high arch, or is it a new development?

• Location: Is the high arch on both feet? Is it noticeably higher on one side? Have you noticed any changes to your hands?

• Associated Symptoms: Have you had any burning, tingling, numbness or pain in the hands or feet? Have you recently been sick or been caring for an ill person? Have you had any previous injuries to the foot?

Generally, the treatment for high-arched feet is to accommodate any injuries, prevent further injuries with the use of orthoses, and to use properly fitting shoes. This conservative treatment is effective in most.

Surgical treatment is only used for severely symptomatic feet, and only after conservative treatment has failed. The goal of surgical treatment in pes cavus is to bring the foot flat to the ground, thus allowing for weight to be distributed evenly through the foot. A number of different surgical procedures and techniques exist, and each patient should be considered unique. Often there is a combination of soft tissue and bony procedures that are required, and a joint fusion (arthodesis) may be necessary for proper function.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com

Hammer Digit Syndrome

Hammer digit syndrome refers to a group of deformities of the toes that causes the toes to be in a fixed position. Depending on the type of deformity, this fixed position may be flexed (where the toes are pointed downwards) or extended (where the toes are pointed upwards). The deformities come in a wide range, with names like mallet toe, claw toe, and hammertoes. Of these types of digital deformities, hammertoes are the most common form.

Types of Deformity: The lesser digits of the foot (all but the hallux, or great toe) consist of three bones called phalanges, which are connected to a longer bone called a metatarsal. The joints between theses bones are named for the bones they connect, referred to as metatarsophalngeal joints, and the proximal and distal interphalangeal joints.

With hammertoes, the deformity is seen across all of the joints. This causes the toes to curl up in a predictable pattern, as seen in the picture above. The metatarsophalangeal joint will be fixed in an extended position (with the joint bent upwards) and the proximal interphalangeal joint will be fixed in a flexed position (with the joint bent towards the ground). The distal interphalangeal joint will commonly be bent in an extended position as well.

Mallet toes show a flexed joint only at the distal interphalangeal joint (the joint furthest down the toe, closest to the nail). Claw toes will show a flexion deformity at both the distal and proximal interphalangeal joints, which will curl the toe in the shape of a claw. Hence the name, claw toes.

Causes of the deformity: Normally, the toes are kept in their straight position by a balance from the muscles the insert into the digit. These include both intrinsic and extrinsic muscles of the foot. The extrinsic muscles the insert into the lesser digits are the extensor digitorum longus on the top (dorsal surface) of the foot, and the flexor digitorum longus on the bottom (plantar surface) of the foot. The intrinsic muscles include the lumbricales and interossei muscles, as well as the flexor digitorum brevis and the extensor digitorum breivs. Together, all of the muscles will help to balance the toes, keeping them straight.

When the muscular balance of the digits is lost, it can cause hammer digit syndrome to develop. Most commonly, this will result in the hammertoe variety. There are several different ways that this imbalance can occur.

· Flexor Substitution: The extrinsic flexors of the foot and toes all originate from the back of the leg, or the posterior compartments. These muscles insert into the foot , and act to bring the bones of the foot, including the toes, towards the ground. This is known as plantarflexion. When these muscles become weakened, particularly the soleus muscle, the other flexors are forced to substitute for the soleus. When the flexor digitorum longus substitutes for the soleus, it causes the toes to curl. This can contribute to hammer digit syndrome.

· Extensor Substitution: This is essentially the same mechanism as flexor substitution, but the problem originates with the extrinsic extensors of the foot. The extensors are located in the anterior compartment of the leg. In particular, when the tibialis anterior becomes weakened, the extensor digitorum longus will increase its pull on the toes. This will cause the toes to curl up.

· Flexor Stabilization: This is a problem with the intrinsic muscles of the foot, in particular the interossei and the lumbricales. These two groups of muscles function to stabilize the toes. When the muscles become weakened, such as in flat feet, the relative pull from the flexor digitorum longus increases. This will cause the toes to curl.

High-Heeled Shoes and how they contribute to Hammertoes: It is commonly accepted among podiatrists and other foot and ankle specialists that high-heeled shoes can help contribute to the development of hammertoes. This is due to the position that the foot is put in when wearing high-heels. When a foot is placed in a high heeled shoe, the foot is in a plantar-flexed position. This lengthens the extensor muscles of the foot (especially the tibialis anterior), which effectively weakens the pull of the muscle on the foot. Thus, extensor substitution is allowed to take place. Similarly, when a person wears high-heeled shoes all day, the flexors and intrinsic musculature is not functioning in its optimal motion. The long flexors of the toes can be over-worked, causing further curling of the toes. Therefore, he use of high-heeled shoes creates the perfect situation for hammertoes and other varieties of hammer digit syndrome to develop.

Complications of Hammer Digit Syndrome:

Because the toes are no longer straight in hammer digit syndrome, they may no longer fit properly into shoes. A toe that is curled up inside a shoe may be forced to rub up against the shoe, causing pain and hotspots to develop. These areas of friction can quickly develop into corns and calluses. The areas of friction are commonly seen on the top of the toes, at the joints.

Additionally, when the toes are curled up, weight can no longer be placed on the toes in the proper way. Therefore, the weight is shifted more onto the ball of the foot, which can cause large calluses to develop on the bottom of the feet.

Treatment: There are a number of factors that play into the treatment of the different varieties of hammer digit syndrome. Most commonly a conservative approach is taken first. This would include things like trimming of the corns and calluses, a change in shoe gear to accommodate the deformity, and different padding techniques to help alleviate some of the pain. All of these measures will help relieve the pain associated with hammertoes, but will not correct the deformity.

The only way to truly correct the deformity is to have surgery on the toes. Depending on the extent of the deformity, the surgery may address only the soft tissues of the toes (the ligaments and tendons influencing the deformity) or it may include the removal of some of the bone in the toes.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com

The Barefoot Running Debate

Barefoot running is a topic of much debate. The trend of runners shedding their bulky running shoes for lighter weight shoes or even no shoes at all as been progressively getting bigger over the past several years. More and more runners are joining the movement, and the shoe companies are responding. Nike’s Free series of running shoes have different gradients of cushioning depending on the level of barefootedness that a runner desires; Vibram makes a shoe that looks more like a glove for the foot, with individual toes and a durable rubber sole, but virtually no support or cushioning.

Advocates of the barefoot running movement point to the natural biomechanics of the body as the reason to follow suit. With barefoot running, the tendency to strike with the heel first is erased. The foot hits the ground in the midfoot area first, allowing forces to be displaced more evenly and to allow for the natural shock absorbing mechanisms of the body to work. Barefoot runners claim that this causes less overuse injuries like tendonitis and arthritis, as well as a decrease in knee and hip pain.

The other side of the argument points out that there are many hazards to running barefoot, particularly in a city on pavement. Foreign objects like rocks, glass, and metal may find their way into the runner’s feet, causing injury and possibly infection. Furthermore, the opposition to barefoot running points out that there are very few “perfect” feet out there, and that most people will require some level of cushioning and support.

The truth most likely lies somewhere in between these two extremes. There are many runners out there that would benefit from strengthening of the muscles of the foot, which may be achieved from running barefoot. However, this population is limited – not everyone will reap the benefits. For many athletes, particularly the less serious and beginners out there, the risks of barefoot running outweigh the advantages.

There is a ton of information on barefoot running, whether it is coming from the Internet or from a published book or from “expert” opinions. If you are one of the many that is considering or currently participating in barefoot running, it is important to be skeptical about this information, and to ease into any new exercise program. Running long distances barefoot takes a long time to work up to, and it may be difficult to achieve for the average runner.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW. Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com

Is it Athlete’s Foot, or Something Else?

That dry, itchy, burning feeling on your feet hasn't gone away in weeks. Is it athlete’s foot, or could it be something else?

Athlete’s foot is a common presentation to the podiatric physician. It is a fungal infection of the superficial skin layers, usually of the fungal genus Trychophyton, and is also called tinea pedis or ringworm of the foot. It causes flaking and scaling of the skin, which can lead to itching and other unpleasant sensations. It is common for tinea pedis to spread to other parts of the body, most notably the toenails. When the fungal infection spreads to the toenails (or it may originate at that location) it is known as onychomycosis. Tinea pedis and onychomycosis are a very common combination.

Athlete’s foot may be treated with a number of different pharmaceuticals, including over-the-counter medications as well as prescriptions. Over-the-counter medications include tolnaftate (sold as Tinactin), miconazole nitrate, and terbinafine (sold as topical Lamisil). Oral medications are available by prescription. Regardless of the type of medication used, however, the timeline for curing tinea pedis can often last more than six weeks.

The fungal infection is transmitted via contact, typically in damp environments such as locker rooms and bathhouses. Preventative measures against tinea pedis can be taken by preventing contact with public surfaces. Wearing sandals or bath-shoes in areas like this can help, as well as washing the feet with soap and water, drying completely, and wearing absorbent cotton socks. Excessive sweating of the feet, or hyperhidrosis, is often associated with tinea pedis, due to the increase in moisture in the area.

However, not all that looks like athlete’s foot is tinea pedis. Blisters of the bottom of the foot, particularly diffuse blisters from chronic friction, can often look like tinea pedis. These friction blisters may come from poorly fitting shoes or sandals, and are often seen in runners.

Erythrasma is a bacterial infection of the skin between the toes that can look like tinea pedis. The two diagnoses are differentiated with the use of a Wood’s Lamp, as well as a culture of the area.

Some other conditions that may mimic athlete’s foot include psoriasis, candidiasis (also a fungal infection, but of a different genus), and allergic reactions.

Additionally, there are several different forms that tinea pedis may take. The inflammatory form of tinea pedis may show as small blister-like lesions on the foot, which are filled with either a clear or slightly opaque fluid. The blisters may pop and ooze, causing more pain. This form of tinea pedis should be dealt with aggressively, as the discontinuities of the skin can lead to infection.

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW. Winter Haven, Fl. 33881
863-299-4551
www.FLFootandAnkle.com

Analyzing the Marcus Thames Injury

Marcus Thames, of the New York Yankees, suffered an ankle injury in Wednesday’s game against the Rays. He is now listed as day-to-day, as the X-rays have reportedly come back negative.

The injury came after Thames stepped on his own bat after a single to left field. Footage of the play can be seen on the MLB.com website, which you can check out here.

After watching the footage, the injury appears to have been an inversion injury of the ankle. Incidents like this can lead to ligament strains and ruptures, tendon tears, and even fractures of the fibula or tibia. The X-rays ordered following Thames’ injury was likely to rule out fractures.

Being listed as day-to-day is likely an indication that Thames’ injury is not very severe. A possible ligament strain or partial tear is possible, particular of the anterior talo-fibular ligament. This structure composes part of the ligamentous support of the lateral ankle, and is susceptible to injury.

Another diagnosis that is highly possible is an injury to the peroneal tendons. There are a number of different ways for a tendon to be injured, most of which are classified by which layer or area of the tendon is injured, or by whether the etiology is acute or chronic. In this situation, the etiology would be acute (from the incident of the injury) and the area injured would most likely be in the tendon close to the insertion into bone. If we were looking for a fracture, it would most likely be found at the base of the fifth metatarsal (where the peroneus brevis inserts) or at the base of the first metatarsal and medial cuneiform (where the peroneus longus inserts).

Since the X-rays were “negative”, a fracture of this nature is not likely. This should come to good news to Thames and the Yankees, who have seen a plague of outfielder injuries this spring.

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW. Winter Haven, Fl. 33881
863-299-4551

www.FLFootandAnkle.com

David Beckham Tears Achilles Tendon

David Beckham returned to Britain on Monday after being sidelined with an injury last week in Finland. The soccer superstar suffered a total tear of the Achilles tendon during the game, and will be sidelined for several months to recover. This comes as a huge blow to Beckham, who was hoping to play in the World Cup this June. This would have been Beckham’s fourteenth consecutive appearance in the World Cup.

The injury occurred last Sunday, in an AC Milan game. Beckham has been on loan to AC Milan from the Los Angeles Galaxy. Beckham came to Major League Soccer’s L.A. Galaxy in 2007 when he signed a $250 million dollar deal, a record for soccer players, and throwing him into the ranks of some the biggest sports contracts ever.

Following the injury, Beckham was brought to Turku, Finland where he was operated on.

According to Dr. Sakari Orava, the surgeon who performed the procedure, Beckham will be in a cast for three to four weeks, followed by months of rehabilitation. In general, the time it takes for a complete recovery takes around six months. This is likely to be minimum amount of time it will take for David Beckham to return to playing.

The Achilles tendon is a continuation of the gastrocnemius and the soleus muscles, which are collectively considered to be the muscles of the calf. The muscles combine to form the Achilles tendon, with then inserts into the calcaneus (heel bone).

With tight calf muscles, there is extra strain put on the tendon. With enough downward force, such as from landing on the foot from a jump, can tear the tendon. The calf muscles play a huge role in most sports, as they help us run, jump. Pivot, and maneuver in many different activities.

In Beckham’s case, and in many other cases, the tendon can be completely ruptured. When this happens, there are both surgical and non-surgical options. Surgically, the tendon is sewn together with durable sutures. The foot is then put into a cast for three to four weeks, or until the tendon can heal itself.

In non-surgical treatment, the foot may be put into a cast without any repair of the tendon itself. The tendon will actually heal itself over time. Studies show that after one year, the results of both surgical and non-surgical care are about the same.

Surgical intervention, however, has been shown to provide results faster than non-surgical options. There is also a slightly greater chance of a second tear or rupture when the tendon is not repaired surgically. For these reasons, it is understandable that David Beckham and his trainers and doctors opted for surgical treatment.

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW.
Winter Haven, Fl. 33881
863-299-4551
http://www.FLFootandAnkle.com

The Battle at Marathon

As the spring approaches, we are entering into the marathon-training period (if you haven’t begun training already, that is). The arduous task of running 26.2 miles is taken on by thousands of people every year. The training is an intense process, usually lasts about three months, and is topped off with the physically, mentally, and emotionally draining challenge of running a marathon. You may be asking yourself at this point, “Why would anyone want to do this?”

Well, it all begins with the Greek legend of Pheidippides. The story goes that at the Battle of Marathon, the messenger Pheidippides was sent to Athens to report that the Persians had been defeated. After running the entire distance without stopping, Pheidippides burst into assembly to exclaim “Nenikekman”, which is translated as ‘We Have Won’. Pheidippides then collapsed and died.

The distance that Pheidippides had just completed is where the distance of a marathon run comes from. The Greek messenger, in travelling from Marathon to Athens, would have had to either crossed or ran around Mount Penteli. If he had travelled South around the mountain, which he presumptively had done, he would have completed a distance of just over 26 miles. There is some debate as to whether Pheidippides ran South of the mountain, or if perhaps he ran through the mountain, crossing straight rather than around. If he had done this, the original distance that Pheidippides ran would be significantly less than 26 miles.

The modern marathon evolved from more recent events. The marathon was first introduced during the 1896 Summer Olympics in Greece. The event was not designed with a set distance in mind, but rather with the route extending from Marathon to Athens. This was a distance of 24.85 miles. Spiridon “Spiros” Louis was the first winner of the marathon, with a time of 2 hours 58 minutes and 50 seconds.

The Olympics committee would use the idea of connecting two points on a map together as a design for the marathon event for the next six Olympic games. It wasn’t until the 1924 Olympics that the set distance of 26.22 miles was adopted. The official distance, set by the International Amateur Athletic Federation (IAAF) measures exactly 26 miles and 385 yards. This is now the distance that is used as a standard for marathon runs.

There are over 800 marathons that are organized every year. Of the most prestigious are the Boston, New York, Chicago, London, and Berlin marathons. The Boston Marathon is the longest standing of any of the annually held marathons. The tradition was started in 1897, following the popularity of the event from the 1896 Olympics. It is held every year in April, and attracts an average of about 20,000 registrants. The record for registrants was set in 1996, with 38,000 people registered to run. Time trials for the event make it difficult to enter, and it sets the scene for a very competitive event. Winners receive cash prizes, with first place overall in both men’s and women’s receiving $500,000 each.

The marathon experience has come a long way since its beginnings. What was once a Greek legend has turned into a rite of passage for serious runners. It is a distance that once attained warrants a bumper sticker, showing a glimpse of history in a strong symbol of modernism.

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW.
Winter Haven, Fl. 33881
863-299-4551
http://www.FLFootandAnkle.com

Highlights from the Winter Olympics

The Vancouver games have come and gone, and with them came great athletes into our homes and onto our televisions. The spotlight is on skiing, snowboarding, skating and hockey, the last of which has desperately tried to reach out to fans from the professional level. Well this past February, that light has shone in attention for the NHL and more.

Al Michaels and Bob Costas handled most of the NBC broadcast, guiding us through the world that is the Olympics. Stories of the highs and lows of tremendous athletes’ careers were told to us.

There was Joannie Rochette, the Canadian figure skater won the bronze medal just days after her mother died of a heart attack.

And Nodar Kumaritashvili, the Georgian luge slider that died in a horrendous crash while practicing.

And there was the USA-Canada hockey rivalry in the women’s division followed by the same set-up in the men’s division, of which both gold medal games went to the Canadians, in Canada.

Names like Bode Miller, Lindsey Vonn, and Shani Davis are etched into our memories, their gold medals gleaming.

Certainly, the drama was thick.

Through all of the back-stories and interviews, through the kiss-and-cry area in figure skating, and through the entire Olympics backdrop, there were some incredible displays of athletic performance.

Apollo Ohno, the U.S. speed skater that came into the games a heavy favorite demonstrated his strength both on and off the ice. NBC aired footage of Ohno working out on dry-land, stretching and warming up for the race. The stretches put so much weight on the lateral ligaments of the ankle, that the commentary mentioned the “do not try this at home” cliché.

The lateral ankle, of course, is a site of common pathology. Strains, sprains, tears and fractures all occur frequently at this site.

The exercise Ohno was performing demonstrated his strength and balance necessary for speed skating.

Shaun White showed us how to fly through the air, flipping around on a snowboard and landing a gold medal with an incredible performance. White’s signature move, the Double McTwist, had to wait to be displayed until after the official event in an encore run. The trick was deemed to be too dangerous for the Olympic games, and was thus banned from Vancouver.

Yes, the Winter Olympics is a grand affair. They bring us sports that we would otherwise rarely see. Curling, Nordic freestyle skiing, Biathalon, and ice dancing all become a part of our vernacular, if only for a brief time.

In addition to the athleticism on display, the theatrics of the Olympics holds nothing back. The grand finale: Michael Buble on a float in the arena that houses hockey and ice skating, singing ‘O Canada” with an amazing amount of Canadian celebrities and Mounties and dancers in a parade. It is an impressive event, and it fit well within the Vancouver 2010 Winter Olympics.

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW.
Winter Haven, Fl. 33881
863-299-4551
http://www.FLFootandAnkle.com

South Korea Take First Gold Medal, Canadian Women Dominate Hockey

The Favorite Kim Yu-Na of South Korea grabbed the gold medal in figure skating last night, shattering her former record of point totals and beating the silver medalist by a 23-point margin. The 19-year-old Kim, who is known as “Queen Yu-Na” by her fans, sealed the deal with a total score of 228.56. That is a new record for Kim, and it gives South Korea their first gold medal in the Winter Olympics.

Japan’s Mao Asada took home the silver medal, and bronze went to Canada’s Joannie Rochette, who was skating just days after her mother died tragically of a heart attack.

Kim Yu-Na skated to Gershwin’s “concerto in F”, which she performed nearly flawlessly. That performance gave her a score of 150.06 points, which brought her total to 228.56.

In women’s hockey news, the Canadian team defeated the U.S. team 2-0 to win the gold medal. The match-up paired the only two serious contenders in women’s hockey against each other, setting up a fiery rivalry.

Two early goals from Canada’s Marie-Phillip Poulin in the first period would put the Canadians on top, a deficit that the American would never come back from. The shutout was held intact by a sensational performance by Canadian goalie Shannon Szabados, who made 28 consecutive saves in the game.

"We played a great game and this is an incredible moment," Szabados said. "It was unbelievable. I just had to be calm and poised. I just tried to relax and have fun. You always want to be confident out there."

The U.S.-Canada rivalry in hockey extends back to 1998 when the sport was introduced to the Winter Olympics. The Americans won the first gold medal in 1998, followed by Canadian victories in 2002 and 2006. With 2010 under their belt, that makes three gold medals in a row for the Canadian women. With the exception of the 2006 games when the U.S. was upset early by Sweden, the Canadians and Americans have met in every single gold medal game.

Of course, that rivalry also extends to the U.S. and Canada’s men’s hockey teams. In the semifinal games today, the U.S. will play Finland and Canada will play Slovakia. It is very likely that the U.S. and Canada will both win their games today, setting up a final game in men’s hockey for Canada to play the United States. Not only would this an interesting parallel to the women’s hockey tournament, but it would set up a rematch for the early round upset when the U.S. beat Canada.

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW.
Winter Haven, Fl. 33881
863-299-4551
http://www.FLFootandAnkle.com

Olympics Update – Men’s Hockey Quarterfinals

Maybe it was the fact that they lost to the fifth-seeded U.S. team in the first round. Maybe it came from playing in their home country, with over 17,000 people watching. Whatever the motivation, the Canadian men’s hockey team came out swinging last night, and beat the Russians in the quarterfinals 7-3.

The first period was a blistering attack on Russian goalie Evgeni Nabokov. Canadian Ryan Getzlaf was the first to score in the game, followed by back-to-back goals from Dan Boyle and Rick Nash, opening up the game with a three to nothing run.

The Russians would never recover from that deficit, and superstar Alex Ovechkin was effectively taken out of the game by the Canadian defense keeping him up against the boards for much of the game. A frustrated Ovechkin broke three sticks through the first two periods of play.

Russian goalie Ilya Bryzgalov summed up the game nicely by saying that the Canadian team “came out like gorillas out of a cage.”

The other games of the quarterfinal round were less thrilling, but still showed impressive talent to move the winning teams on to the semifinals. The United States shutout Switzerland 2-0, with a pair of goals in the third period from Zach Parise. Finland topped Czech Republic with a score of 2-0 as well, and Slovakia beat Sweden with a score of 4-3.

This sets up a semifinal round for Canada to play Slovakia, and the United States to play Finland. The winners of each of the games will face each other in the finals for the gold medal.

The U.S.-Finland game will be a rematch of a feud between the two teams. At the 2006 winter Olympics in Turin, Italy, Finland earned the silver medal after defeating the Americans 4-3 in the quarterfinal round. This is the game in which U.S. forward David Backes and Finnish defensemen Anssi Salmela got into a brawl at the buzzer, with Salmela’s face by smashed by Backes.

The Canadians in last night’s game had a similar revenge match with the Russians. Russia knocked Canada out of the 2006 Olympic tournament in the quarterfinal round. Canada finished in seventh place that year, a dismal position for a team that is generally a favorite for a medal.

Semifinal games will take place on Friday, February 26. The U.S.-Finland game is scheduled for 12:00pm PST, and the Canada-Slovakia game is scheduled for 6:30pm PST. Both games should prove to be excellent hockey, with a lot at stake for the competitors.

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW.
Winter Haven, Fl. 33881
863-299-4551
http://www.FLFootandAnkle.com

U.S. Hockey Team Upsets Canada

Last night in a huge upset, the young United States Men’s Hockey team defeated the heavily favored Canadian team 5-3. This marks only the second time that the U.S. team has beat the Canadian team – the last time was in 1960. The United States came out wearing the throwback 1960’s sweaters, an homage to that last victorious team.

Now, as the United States heads into the 12-team tournament as the #1 seed, they have set the standard for what is to come from the young team.

Coached by Ron Wilson (head coach of the Toronto Maple Leafs), the Americans took the lead early in the first period with a goal from Brian Rafalski (of the Detroit Red Wings) within the first minute of play.

That goal would then be answered by Ryan Getzlaf (of the Anaheim Ducks) on the Canadian team, which would then be followed by another goal from Rafalski.

The player of the game, however, was certainly Ryan Miller, the goalie for the United States. Miller stopped 42 of 45 shots from the Canadians, an impressive game from the Buffalo Sabre.

Next on the agenda for the U.S. team is the winner of the Switzerland-Belarus qualifying game set for Tuesday. The Americans beat Switzerland last week 3-1, but the victory did not come easy. If the United States is to play Switzerland, who is the favorite, expect the Swiss to come out with a vengeance.

The United States is not alone in receiving a bye into the quarterfinals. They are joined by Russia, Sweden, and Finland in that qualification. Other teams that will have to fight it out for a position in the quarter finals are the fifth-seeded Czech Republic vs. No. 12 Lativa, Canada (No. 6) vs. Germany (No. 11), Slovakia (No. 7) vs. Norway (No. 10), and Switzerland (No. 8) vs. Belarus (No. 9).

If you’ll be one of the millions watching Men’s Hockey in the Olympics, pay attention the footwork involved in the game. Think of how hard it is do move quickly in shoes, now try that on the ice. That should give you an appreciation of the difficulty of the sport. Many professional hockey players, including the Olympians, opt for functional orthoses to be put into their skates. This helps them get optimal function out of the foot-skate interface, allowing for quick stops and pivots. It will be quick footwork that wins the game – stay tuned for more updates on the 2010 Winter Olympics from Vancouver!

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW.
Winter Haven, Fl. 33881
863-299-4551
http://www.FLFootandAnkle.com

Olympics Update – Marit Bjoergen Wins Gold

In an incredible display of endurance, Norway’s Marit Bjoergen has won the gold medal in the Ladies’ 15km Pursuit with a time of 39:58.1. Sweden’s Anna Haag will bring home the silver, and Poland’s Justyna Kowalczyk narrowly edged out Norway’s Kristin Sotermer Steira in a photo finish for Bronze.

Bjoergen’s gold medal performance in the 15km Pursuit adds to her list of medal-earning performances at the 2010 Vancouver Olympics. She also won a gold medal in the Ladies’ Individual Sprint Classic, and earned the bronze in the Ladies’ 10km freestyle.

The 15km pursuit exemplifies the difference between classic and freestyle cross-country skiing. In classic skiing, the skis used are long and thin, sometimes referred to as “skinny skis”. This allows for speed, but does not offer much for lateral movement. In freestyle cross-country skiing, also known as skating, the skis are slightly wider, and curved on the edges. This allows for more lateral motion, or a motion that more closely resembles ice-skating.

During the combined pursuit event, the Olympians exchange their skis halfway through the race. They begin with classic skis, and exchange them in the middle for the freestyle skis. This exchange proves to be a pivotal point in the race, as Bjoergen’s smooth transition allowed her to keep pace as the leader.

In both types of cross-country skiing, the boot is attached to the ski at the toe, but not at the heel. This allows for a gait that can closely resemble walking, especially when the skiers are racing up hill. It is clear to see that the heel is coming off of the ski during the race, which is characteristic of cross-country skiing. Cross-country skiing in general consists of both uphill and downhill movement, and the heel lift is essential for the uphill portions of the race.

The event is truly a test of endurance, as the 15km race is roughly equally to almost 9.5 miles! You can see while watching the event that the skiers grab water and sports drinks during the race, much like a runner in a marathon. This is to keep hydrated and keep a steady supply of energy, as muscle glycogen stores (the way that our bodies keep a reserve of fast-acting energy) can become depleted very quickly during such a long event.

The men’s pursuit race, which is a distance of 30km (15km classic and 15km freestyle) is scheduled for February 20 at 1:30pm PST.

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW.
Winter Haven, Fl. 33881
863-299-4551
http://www.FLFootandAnkle.com

Shaun White Repeats Gold, Torah Bright takes Women’s Gold

Wednesday night proved to be Shaun White’s night as he took the gold medal in the men’s halfpipe event. White won with a score of 48.6 following an incredible display of athleticism and agility.

The 23 year old athlete came into the Olympics defending the gold medal in the same event, and successfully repeated. He has also previously won the vert competition in skateboarding at the 2007 X Games.

The silver medal in men’s halfpipe snowboarding went to Peetu Piiroinen of Finland, and the Bronze went to the United States’ Scott Lago.

In the women’s halfpipe snowboarding competition, Australia’s Torah Bright took the gold medal home with a score of 45.0. Torah Bright, also 23 years old, helped to break the long-standing U.S. domination of women’s halfpipe snowboarding. Americans Hannah Teter and Kelly Clark took the silver and bronze medals home, with scores of 42.4 and 42.2, respectively.

The amount of force placed on the body during an event such as snowboarding is incredible. Seeing the heights that Shaun White, Torah Bright, and the other snowboarders reach during the event shows just how much impact they are coming down with. While the forces placed on the body while snowboarding have never been studied and published, the forces during skateboarding have. While skateboarding, ground reactive forces can reach up to 10-20 times the skateboarder’s body weight. It would be very interesting to see exactly what the forces are being placed on the feet, ankles, knees and hips during snowboarding.

Non-professional snowboarders are likely to be familiar with these forces. Going off of a jump, it is important to land with the knees slightly bent, bringing the entire body down closer to the ground while landing. This helps lessen the impact on the body. Landing with a straight knee joint and rigid ankle joint can seriously injure the participant.

Snowboarding injuries that are typically seen include ankle sprains and knee ligament injuries. These occur from the twisting motions of the body over a stationary knee and ankle. Without the proper attention to detail, the amateur snowboarder can find himself or herself in an immense amount of pain following this type of injury.

Keep watching the Olympics to see how your favorite athletes prepare their bodies for the impact with the ground. Notice how they move their legs, knees and feet when landing in snowboarding and ski jumping. Ski jumping is set for February 22, with several rounds being televised.

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW.
Winter Haven, Fl. 33881
863-299-4551
http://www.FLFootandAnkle.com

Winter Olypmics 2010 and Foot Health

No matter what you’re favorite Olympic event, there’s bound to be something to keep your interest in the 2010 Winter Olympics from Vancouver. Whether it is hockey, figure skating, or the biathlon, the Winter Olympics give us an opportunity to watch some of the most elite athletes in the world compete in their sport.

Foot health is something that the Olympian, just like all other athletes, must be aware of. In sports such as snowboarding, alpine skiing, and ski jumping, there is an incredible amount of force that is applied to the feet, ankles, and knees in particular. This force is many times the normal force of walking, and can lead to serious injury and fracture if the proper measurements are not taken. Athletes must be aware of their form and technique, as well as the feet that they are landing on.

Many skiers and ice skaters wear orthotic devices in their ski boots and ice skates. This is a common practice among downhill skiers and hockey players, from Olympic athlete to amateur. The reason for this is that a custom orthotic can make an otherwise uncomfortable boot much more comfortable, as well as add a significant amount of function to the clunky footgear.

The Olympic games, which began on February 12, is an exciting time to watch the world come together in Vancouver. The games will continue through February, with the closing ceremony on February 28.

You can follow the games online at www.vancouver2010.com, where you can get updates on medal counts, event schedules, and lots of other information.

Check back here for updates on the Olympic games and foot health, and plenty of other information on podiatry and related topics!

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW.
Winter Haven, Fl. 33881
863-299-4551
http://www.FLFootandAnkle.com

Born to Run?

Were we, as human beings, born to run? The anatomy and physiology of our bodies certainly indicates that the answer to this question is yes.

There are twenty-eight bones in the human foot alone, making up joints designed to absorb and distribute the forces associated with walking and running evenly through our bodies. Moving up the leg, our ankle, knee and hip joints help us absorb these forces, carrying them through our spines all the way up into our neck and head. Our movement is studied in terms of biomechanics by podiatrists, pedorthists, orthopedists, and other professionals.

Biomechanically speaking, we are in fact born to run. When studying the gait cycle, or the movements we make while running and walking, it has been shown that running is a much more efficient process than walking. That is, more of the energy that gets put into running gets translated into forward motion. While walking, much of the energy that gets put into walking gets translated into up-and-down motion, as well as motion from side-to-side. In the biomechanical world, this is referred to as frontal plane and transverse plane motion, respectively.

Additionally, our muscles are designed for longer strides and greater forces than we usually use them for during walking. Take for example the gluteus maximus. The gluteus maximus is one of the largest muscles of the lower extremity, yet is barely used at all in walking. When we pick up the pace and begin running, our gluteus maximus becomes more active. This is especially apparent when running up-hill.

Consider the shape of the foot. The ball of the foot is a muscular and well-padded area, designed to absorb impact and keep us steady. In proper running form, the ball of the foot is where we ideally want to land, which propels us into the next stride. When we strike with our heel first, it can set us up for a number of running-related problems. Many running purists are turning to barefoot running, which embraces the natural design of the foot as a running tool.

A number of other factors come in to play when discussing the idea of running as human nature. Our body’s chemistry allows us to run for long distances at a moderate pace, whereas most other mammals sprint short distances followed by periods of rest. This is made possible by our storage of energy, which we can readily use. We store carbohydrates simply for the purpose of burning them for energy when we need them, such as in intense exercise.

Of course, running in the modern human is more exercise and less necessity. We don’t necessarily have the need to run away from a predator anymore, or chase down our dinner in a field. The evolutionary traits, however, are still around from our Caveman ancestors.

So the next time you are struggling through that run, just remind yourself of this: You were born to do this!

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW.
Winter Haven, Fl. 33881
863-299-4551
http://www.FLFootandAnkle.com

Which Running Shoes to Buy?

Have you ever browsed through a running store looking for the right pair of shoes? It can be a daunting task, given all the options available to the consumer. Any good running store will have at least five or six brands heavily stocked. Within each brand, there may be a dozen or so choices, so how do you know which one to pick for yourself?

The easiest thing would be to have a trained salesperson help you decide which shoe is right for you. They may watch you walk, try to analyze your gait, and put you in a shoe that they think will be most appropriate for you. However, a trained salesperson may not always be available. With that in mind, there are a few things you’ll want to look for in a shoe.

1. First thing’s first – you’ll need to know what type of shoe to get. Breaking down the various types of running shoes most generally, you’ll find two basic types; shoes that are meant for cushioning and shoes that are meant for controlling the motion of your foot.

A shoe that controls the motion of your foot, or a “motion-control” shoe is usually used for someone that over-pronates, has a very flexible foot, or generally has a lot of movement in their gait. They may have a lower arch, which can be measured by stepping with a wet foot onto a piece of paper.

If you tend to put a lot of pressure on the lateral, or outside portion of your foot, you’ll be more likely in need of a cushioning shoe. These shoes are meant to support the natural movement of your foot, while giving it extra padding through the stresses of running.

Within each running shoe brand, there are various levels of support and motion control-type shoes. Think of it as a sliding scale. There are several places to read reviews of particular styles of both types of shoes, available through magazines like Runner’s World, and online reviews such as http://www.motioncontrolrunningshoes.info/ and http://www.cushionrunningshoes.com/. You may also find that experienced and well-trained salespeople, where available, will have opinions regarding some styles, brands, and types of shoes.

2. Get the right size. Find out how to pick the right size HERE.

Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW.
Winter Haven, Fl. 33881
863-299-4551
http://www.FLFootandAnkle.com