DeMarco Murray out for Season with Broken Ankle

DeMarco Murray, running back for the Dallas Cowboys, will be out for the rest of the season with a broken ankle.  The injury came this Sunday night in the first quarter of the game against the New York Giants, as Murray was pulled down at the end of an eight-yard gain.  His ankle was pinned against the turf, and the injury is being reported as an ankle fracture and a high ankle sprain.

The rookie was a key asset to the Cowboys’ offense this season in their search for a playoff spot, but will sit the rest of the season as the injury heals.  He had run for 25 yards already in the game, giving him 899 for the season.  The combination of ankle fracture and high ankle sprain will certainly require some attention from the Dallas medical staff and trainers. 

Ankle fractures are a common pathology during sports, and can occur from either direct or indirect mechanisms.  Indirect mechanisms imply a twisting force placed across the ankle when the foot is held in place.  This is particularly common in football, as is the diagnosis of a high ankle sprain. 

A high ankle sprain refers to damage to the ankle syndesmosis, which is a structure that keeps the tibia and fibula in close contact, helping to create and stabilize the ankle joint.  An injury to the syndesmosis can often lead to long-term damage and instability in the joint.  These sprains are often treated with surgery, where a screw is placed across the syndesmosis to prevent it from moving while the tissues are allowed time to heal.  In the case of DeMarco Murray, it is uncertain whether surgery will be necessary. 

 Ankle fractures can be treated conservatively, often immobilizing the ankle and leg in a short leg cast or a removable boot and keeping weight off of the leg while it heals.  For ankle fractures that have become displaced, meaning that the ends of the broken bone do not line up with each other, surgery may become necessary to achieve a favorable outcome. Surgery for ankle fractures involves the use of screws and plates, which may be necessary to use on both sides of the ankle.  In the case of ankle fracture combined with high ankle sprain, it becomes very important to stabilize the ankle sprain with a screw across the tibia and fibula, the leg bones that create the ankle joint.  Without this stabilization, motion across the screw will cause the screw to fail, and the fracture fragments will be allowed to move apart.

As for DeMarco Murray, he will hopefully be able to heal his injury rapidly, and return to a productive career.  The rookie running back was having a great season before the injury, rushing for 293 yards in October, the seventh-most in the history of the NFL.

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

Despite Sprained Foot, Roethlisberger Gets It Done

Earlier in the week, it looked like Steeler’s quarterback Ben Roethlisberger may have broken his foot.  He hobbled all week in practice, and was nowhere near full speed.  While the team never released details of exactly what the injury was, it looked like a sprain in his foot. 

That sprain didn’t slow him down one bit on Sunday, as he and the Steelers roled over the Tennessee Titans, with a final score of 38-17.  Roethlisberger threw for 228 yards and five touchdowns.

While there was no diagnosis released to the press, the pain was reported as being across the forefoot, and Big Ben hobbled noticeably at times during the game.  With the pain being localized around the metatarsophalangeal joints, the possibility of a plantar plate injury, tendinitis, irritation of the capsular ligaments of the MTP joints, and many other conditions become possibilities. 

Of his foot, Roethlisberger told the press “I told ya, I was just faking it, I’m a wimp.”

Over the next week, fans will have to keep an eye on Roethlisberger during practice to determine the fate of his left foot. 

Most likely, it seems as though Roethlisberger may have sprained one of the capsular ligaments of one of the lesser metatarsophalangeal joints.  These injuries are typically minor, and will resolve with rest, ice, and compression.  If that is the case, he should be fine for next week, when the Steelers face the Arizona Cardinals. 

Sprains of the foot are treated conservatively.  This involves PRICE therapy, with protection, rest, ice, compression, and elevation.  Depending on what joint is affected, various types of braces may be used.  Sprains of the rearfoot and ankle can be particularly worrisome, and will usually require various splinting and bracing techniques. 

A sprain happens when a ligament of a joint is extended past its normal range of motion.  Extra stress is placed on the ligament as it is brought through an abnormal range of motion, and this creates a painful situation that is quickly followed by inflammation around the joint.  This inflammation adds to the pain, and is the reason that a sprain can last several weeks and is slow to get over.  In order to fight the inflammation, non-steroidal anti-inflammatories are often added to the treatment protocol, as well as compression and elevation. 

Roethlisberger performed strongly on Sunday, but may not be out of the woods yet.  He is a player that performs strongly when he’s hurt, but he’ll have to practice smart over the next week.

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

Kevin Williams will play despite plantar fasciitis

Kevin Williams, the All-Pro defensive tackle of the Minnesota Vikings, said that he will play through his plantar fasciitis in the opening day matchup against San Diego.  “It’s a situation where I feel it’s not going to go away until maybe the offseason,” Williams said to the press.  “We’re just going to deal with it and try to grin and bear it”.  It sounds as though Williams knows that his left foot won’t be feeling much better any time soon, but he’s willing to shake it off and continue on with practice and with the beginning of the season. 

Amongst athletes both professional and amateur, this reaction to plantar fasciitis is quite common.  Many people will chose to perform through the pain, and eventually it may even stop. 

The plantar fascia is a strong piece of fibrous tissue, organized into an aponeurosis, that runs along the bottom of the foot.  It attaches the heel bone (calcaneus) to the digits.  An increase in pressure and force along the plantar fascia can often create a painful sensation, most commonly in the bottom of the heel.  The pain is especially strong with the first few steps out of bed in the morning, or after a long period of sitting. 

Plantar fasciitis is extremely common, and accounts for approximately 15% of all podiatry visits.  It is the most common cause of heel pain in adults, and accounts for roughly 9% of all running injuries.  Between 1995-2000, there were over 1 million patient visits to U.S. hospitals and hospital-based outpatient centers that were diagnosed with plantar fasciitis.  It is easy to see that professional football players and other athletes are not the only ones affected by plantar fasciitis.  It is also commonly associated with obesity, flat feet, poorly fitting shoes, and excessive periods of walking, standing, or running. 

The vast majority of plantar fasciitis cases are treated conservatively.  This will generally includes such things as rest, ice, various taping methods, orthotics, steroid injections, and night splints, as well as a change in shoegear.  Rarely do these cases go on to surgical intervention. 

As for Mr. Williams, it may be quite accurate that his heel pain does not totally resolve until the season is over.  Will it hinder his ability on the field?  That is something for Vikings fans to wait and see.  However, it is quite possible that with aggressive conservative therapy, which he is likely already receiving, he will be just fine to continue with the season. 

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

Titus Brown out with High Ankle Sprain

Cleveland Browns’ linebacker Titus Brown will be sidelined with a high ankle sprain. The Browns have been pummeled with injuries this preseason. Titus Brown will join teammates Eric Steinbach (tackle) and Brandon Jackson (running back) and Jordan Norwood (wide receiver) on the injured list. With a season opener on September 11 against the Cincinnati Bengals, things are not looking good for Cleveland.

A high ankle sprain is an injury to the syndesmosis between the tibia and fibula. The ligaments that attach the tibia to the fibula aid in stabilizing the ankle joint. These ligaments can become sprained or even torn when the leg is forced to rotate outwards with a planted foot. This is a common injury in contact sports, football in particular.

The syndesmosis is composed of the anterior and posterior inferior tibiofibular ligaments. In a sprain, usually only one of these ligaments is injured. The syndesmosis can also be injured in ankle fractures, where the fibula is destabilized and allowed to rotate.

The diagnosis is usually suspected through history and physical examination, and may be confirmed with x-rays and an MRI. MRI may not be necessary for everyone, but can help differentiate between a sprain and a tear of the ligaments. For high-level athletes, MRIs are typically ordered swiftly.

Once the diagnosis is confirmed, high ankle sprains are treated with a period of immobilization in a cast for about 6 weeks. Anti-inflammatory medications and pain relievers may also be used in conjunction with immobilization to relieve the symptoms. Following immobilization, a period of rehabilitation will begin. This generally involves aggressive stretching and strengthening exercises, with a slow return to full weight bearing and activity.

For cases requiring surgery, a screw may be placed across the syndesmosis from the fibula to the tibia. This screw helps immobilize the joint while the ligaments heal, and is left in place for about three months. Patients are instructed not to walk on the leg while the screw is in place, as it could break with motion. The screw is taken out once the ligaments have healed, and an aggressive physical therapy rehabilitation program begins.

As for Brown, no surgery has been scheduled, and he’s been placed in a cast. For Cleveland Browns fans, this is good news, as the linebacker will likely return later in the season. While he won’t be ready for the regular season opener, he may be ready to return to play mid-season.

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

Lions’ Leshoure Out with Achilles Rupture

Detroit Lions rookie running back Mikel Leshoure will be out for the season following an Achilles tendon rupture sustained during practice on Monday. The Lions drafted Leshoure in the second round from the University of Illinois, and were hoping to have him take turns carrying the ball with Jahvid Best. Of Leshoure, Coach Jim Schwartz said "He’ll have surgery very soon, probably tomorrow, and he’ll be back. He won’t be back this year, but he’ll be back. And he was doing very well."

Achilles tendon injuries can be a career-ending injury, which certainly takes some air out of the tires of the Detroit Lions, who sports pundits are predicting to have a turn-around year. In a systematic review of statistics from the NFL, Parekh et al showed that 36% of skill-players (running backs, wide recievers, defensive backs, cornerbacks, and linebackers) never returned to play professionally.

The study analyzed the power ratings of the players who did return to play professionally. Power ratings are statistics used to measure a player's level of play, such as rushing and passing yards. Of the 64% who returned to play (21 players total), all showed a significant decline in their power ratings as well as the number of games played. This 64% is slightly lower than the previously reported 71% of patients returning to full activity following surgical repair of Achilles tendon ruptures. This difference may be attributed to size, weight, strength, and overall physical demand of professional football players when compared to the average young athlete.

The study by Parekh et al looked at the three seasons before injury and the three seasons following injury, and averaged statistics for the players over those three years. It was found that the power ratings fell by average of almost 50%, and that the amount of games played fell from 11.67 to 6.17. This suggests that even if a player is able to recover from the injury and return to their previous level of play, they may never regain their original quality of play.

Current treatment regimens hinge on surgical repair of the ruptured tendon. While studies have shown promising reults with conservative non-surgical treatment combined with aggressive rehabilitation protocols, the incidence of re-rupture is lower in surgically repaired Achilles tendons, and the time to full recovery is also faster. Surgeons are trending towards earlier, aggressive physical therapy regimens following surgery instead of the six to eight weeks of immobilization previously set as the standard of care.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com

Better Workout – Running or Walking?

Whether walking or running provides a better workout is a debate that could go either way, and could be discussed for hours. Advocates of each can point out the benefits of their exercise method of choice. In the end, the truth is that either form of exercise is generally good for you, and the choice should come down to which you are more comfortable with. Regardless of which side you’re on, here are some tidbits about each that might help you make up your mind.

Yes, running will burn more calories that walking. However, this is only true when you compare them based on the amount of time each activity is performed. When you compare them based on distance, the amount of calories burned is the same. For example, running for twenty minutes will burn roughly twice as many calories as walking for twenty minutes. However, running three miles and walking three miles will burn the same amount of calories.

Running or jogging can work different muscles than walking, and can work them harder. This is because more force and strain is placed on the muscles while running. However, walking allows your body to be a state of elevated cardiovascular demand for a longer period of time, which will actually help improve cardiovascular health over time, perhaps even more so than running.

Generally speaking, runners are more prone to injury because of the increased demand on the muscles of the lower extremity during activity. This can lead to overuse injuries such as tendinitis and stress fractures. But, for young and healthy people, running provides a great source of exercise and can help train for other sports. It also provides the “runner’s high” that avid runners talk about, which you won’t be able to get from walking.

For many people, though, walking is a great source of exercise. Particularly in older populations and overweight people beginning an exercise program, walking is generally the first form of exercise initiated. It is often recommended for weight loss in obesity, to prevent arthritis, and as an adjunct treatment to osteoporosis. Of course, speak with your doctor before starting any new exercise or walking program.

Walking and running can both be incorporated into a successful exercise program. Podiatrists can be a great source of information for those beginning a walking or running program, particularly if you are experiencing any foot or ankle problems. Sometimes the use of orthotics or even simple exercises for the lower extremities can help prevent some of these problems.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com

Accessory Bones of the Foot

The normal human foot contains twenty-eight bones. These bones help to give shape and function to the foot, and help provide the framework for shock absorption and mechanics that make movement possible. Sometimes, though, a foot contains more than twenty-eight bones. A number of accessory bones may be present in the foot as well, which may or may not be pathologic.

Accessory bones can be divided into two categories – ossicles and sesamoids. Sesamoids are small, round bones found within tendons in the foot. The two common sesamoids are within the flexor hallucis brevis, and help comprise the sesamoid apparatus. The sesamoid apparatus aids in function of the first metatarsophalangeal joint.

Some of the more common accessory sesamoids include:

• Os peroneum – located within the tendon of the peroneus longus, commonly seen near the peroneal notch of the cuboid.
• Os interphalangeus – Located within the long flexor tendons, adjacent to the interphalangeal joints of the digits.
• Capsular sesamoids – these are located within the tendons crossing the metatarsophalangeal joints, typically in the long flexors

Accessory ossicles differ from sesamoids in the way they develop. They develop from a separate center of ossification in close proximity to the normal anatomy. Some of the more common accessory ossicles include:

• Os Trigonum – develops as a separate ossicle posterior to the lateral tubercle on the posterior surface of the talus. When the ossicle is fused, it is known as a Steida’s process. These can often become pathologic as they can cause friction on the tendon of the flexor hallucis longus, which can cause irritation and pain.
• Os tibiale externum – located on the medial side of the foot in close proximity to the navicular. There are several variations of this accessory bone that exist, including those that have fused to the navicular. These are often symptomatic, and may also be referred to by some clinicians as a pre-hallux
• Os supranaviculare – also referred to as os talonavicular dorsale, it is found on the dorsal aspect of the talonavicular joint.

A number of accessory bones exist in the foot, which may or may not become symptomatic. Clinically, accessory bones can often appear as fractures on x-ray, and may even mimic them in their symptoms. Sesamoids may appear as bipartite, meaning they are split in two pieces, or tripartite, meaning they are split into three pieces. Bipartite and tripartite sesamoids can often resemble fractures on x-ray.

Accessory bones, when symptomatic, can be treated by offloading the area, debridement of callus that forms over them, or even surgical resection for some.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com

Oilers’ Hall Goes Down with Ankle Injury

Edmonton Oilers rookie sensation Taylor Hall was injured in a fight in Thursday’s game against the Columbus Blue Jackets, when he went up against Derek Dorsett. The injury came as the two went down to the ice, when Hall twisted his ankle.

The Oilers announced that Hall would be getting an MRI on Friday afternoon. Hall will be unable to travel with the team as they begin a five-day road trip this weekend.

Lucky for hall, there doesn’t appear to be a fracture of the ankle at this time. The MRI was most likely ordered to check for a high ankle sprain or any other type of injury to the soft tissues of the leg and ankle.

A high ankle sprain involves an injury to the tissues connecting the two bones of the leg, the tibia and the fibula. This tissue, known as the syndesmosis, helps keep the ankle joint in line and plays a critical role in stabilizing the ankle. The syndesmosis can be strained or torn in an ankle injury, and can be a particularly difficult injury to heal. They typically take longer to heal than a normal ankle sprain.

A high ankle sprain is typically treated with a cast for 6 weeks, so long as the injury is stable. When the injury is unstable, surgery may be necessary to place a screw through both the tibia and fibula, holding the syndesmosis together while it heals. These screws are typically left in for 3 months. Patients are instructed not to walk on the injured leg while the syndesmotic screw is in place. There is normally some motion between the two bones when walking, and this motion may break the screw.

Another surgery may be required after the syndesmosis is healed to remove the screw, while some doctors will let the patient begin to walk on the leg until the screw breaks. The reason for this is that there are very few reported problems with a broken screw. If there is a problem, then the screw can be removed as it would have been anyway. This way, the patient is saved an extra surgery until they need it.

If Taylor Hall is shown to have a high ankle sprain or a serious sprain or tear of the ankle joint, he will have to miss a few months of the season until he can heal.

Hall is leading his team with 22 goals this year, along with 20 assists. He is in contention for rookie of the year. Thursday’s game against the Blue Jackets gives Hall his first career “Gordie Howe Hat Trick”, in which a player scores a goal, an assist, and gets in a fight all in the same game.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com

Negative Pressure Wound Therapy

Negative pressure wound therapy (NPWT), also known as topical negative pressure, sub-atmospheric pressure or vacuum sealing technique, has become a topic of much interest in the area of acute and chronic wound healing. Particularly in the diabetic population, where chronic wounds run rampant, this technology has been explored as a potentially promising therapy.

NPWT is just one of several technological advances in wound care therapy that has emerged in the past several decades. This list also includes bioengineered skin equivalents, bone marrow-derived stem cell therapy, and growth factor therapy. However, the science behind Negative Pressure Wound Therapy is quite interesting.

The vacuum sealing technique involves placement of a special device, sometimes referred to as a wound-vac, on the chronic or acute wound. This device consists of a foam or gauze dressing applied directly to the wound, then sealed tight with a clear, plastic-wrap-like dressing. The dressing is then attached to an electronic device that creates a negative pressure in the newly created seal, similar to a vacuum. This negative pressure ranges anywhere from 50-175 mmHg.

The system created turns an open wound into a controlled, closed wound while removing cellular debris and excess fluid from the wound. This allows the wound to be well-controlled in terms of exudate management. Granulation tissue, the tissue that indicates the ability for the wound to heal, is stimulated to generate within the wound. There is also a decrease in the bacterial load of the wound, reducing the incidence of infection, as well as increased blood flow to the wound.

Published case-studies and small cohort studies have shown negative pressure wound therapy to be effective in the treatment of diabetic foot ulcers. However, a Cochrane review pointed to the fact these trials consisted of too few enrolled subjects to be considered significant evidence to support the use of wound-vacs. However, the growing popularity of the device may lead to more extensive research in the area, as well as better designed studies.

Another area of concern for the use of negative pressure wound therapy is the cost associated with its use. However, several studies have looked at the cost-effectiveness of NPWT, and have found that the decrease in staff required for dressing changes not only balances, but exceeds the cost-effectiveness of standard wound care therapy. Because the NPWT dressings only need to be changed after 48-72 hours, there is less maintenance required for the wound. Therefore, the staff demands are decreased in the management of chronic wounds using NPWT.

Negative pressure wound therapy remains a promising choice for the treatment of diabetic foot ulcerations. The diabetic population is particularly prone to chronic wounds, and NPWT may be a useful technology.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com