Special Report on Chronic Ankle Instability

Chronic Ankle Instability Do you frequently sprain your ankles? Do you feel like your ankles are weak? Is your gait (walking pattern) unsteady? Is balance an issue? If you answered “yes” to any of these questions you may suffer from chronic ankle instability. What is Chronic Ankle Instability? Chronic ankle instability is a condition characterized by a recurring "giving way" of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Usually the "giving way" occurs while walking or doing other activities, but it can also happen when you're just standing. Many athletes, as well as others, suffer from chronic ankle instability. People with chronic ankle instability often complain of: • Repeated turning of the ankle, especially on uneven surfaces or when participating in sports • Persistent (chronic) discomfort and swelling • Pain or tenderness What Causes It? Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and "retrain" the tissues within the ankle that affect balance. Repeated ankle sprains often cause -- and perpetuate -- chronic ankle instability. Having an ankle that gives way increases your chances of spraining your ankle repeatedly. Each subsequent sprain leads to further weakening (or stretching) of the ligaments -- resulting in greater instability and the likelihood of developing additional problems in the ankle. Evaluation and Diagnosis If your ankle feels wobbly or unstable and gives way repeatedly, or if you've had recurring ankle sprains, see a foot and ankle surgeon to have your condition evaluated and treated. Chronic ankle instability that is left untreated leads to continued instability, activity limitations, arthritis, and tendon problems. In evaluating and diagnosing your condition, the foot and ankle surgeon will ask you about any previous ankle injuries and instability. Then he or she will examine your ankle to check for tender areas, signs of swelling, and instability of your ankle as shown in the illustration. X-rays, CT scans, or MRIs may be helpful in further evaluating the ankle. Treatment Options Treatment for chronic ankle instability is based on the results of the examination and tests, as well as on the patient's level of activity. Non-surgical treatment may include: • Physical therapy. Physical therapy involves various treatments and exercises to strengthen the ankle, improve balance and range of motion, and retrain your muscles. As you progress through rehabilitation, you may also receive training that relates specifically to your activities or sport. • Bracing. Some patients wear an ankle brace to gain support for the ankle and keep the ankle from turning. Bracing also helps prevent additional ankle sprains. • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to reduce pain and inflammation. In some cases, the foot and ankle surgeon will recommend surgery based on the degree of instability or lack of response to non-surgical approaches. Surgical options mainly involve repair or reconstruction of the damaged ligament(s). However, other soft tissue or bone procedures may be necessary depending on the severity of your condition and whether you have other problems in the foot or ankle. The length of the recovery period will vary, depending on the procedure or procedures performed. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Lateral Ankle (Peroneal) Tendons

What are the Peroneal Tendons? A tendon is a band of tissue that connects a muscle to a bone. In the foot, there are two peroneal tendons. They run side-by-side behind the outer ankle bone. One peroneal tendon attaches to the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of the arch. The main function of the peroneal tendons is to stabilize the foot and ankle and protect them from sprains. Types of Peroneal Tendon Injuries Peroneal tendon injuries may be acute (occurring suddenly) or chronic (developing over a period of time). They most commonly occur in individuals who participate in sports that involve repetitive ankle motion. In addition, people with higher arches are at risk for developing peroneal tendon injuries. The following are the three basic types of peroneal tendon injuries: Tendonitis is an inflammation of one or both tendons. The inflammation is caused by activities involving repetitive use of the tendon, overuse of the tendon or trauma (such as an ankle sprain). Symptoms of tendonitis include: •Pain •Swelling •Warmth to the touch Acute tears are caused by repetitive activity or trauma. Immediate symptoms of acute tears include: •Pain •Swelling •Weakness or instability of the foot and ankle As time goes on, these tears may lead to a change in the shape of the foot, in which the arch may become higher. Degenerative tears (tendonosis) are usually due to overuse and occur over long periods of time -- often years. In degenerative tears, the tendon is like taffy that has been overstretched until it becomes thin and eventually frays. Having high arches also puts you at risk for developing a degenerative tear. The signs and symptoms of degenerative tears may include: •Sporadic pain (occurring from time to time) on the outside of the ankle •Weakness or instability in the ankle •An increase in the height of the arch Subluxation occurs when one or both tendons have slipped out of their normal position. In some cases, subluxation is due to a condition in which a person is born with a variation in the shape of the bone or muscle. In other cases, subluxation occurs following trauma, such as an ankle sprain. Damage or injury to the tissues that stabilize the tendons (retinaculum) can lead to chronic tendon subluxation. The symptoms of subluxation may include: •A snapping feeling of the tendon around the ankle bone. •Sporadic pain behind the outside ankle bone. •Ankle instability or weakness. Early treatment of a subluxation is critical, since a tendon that continues to sublux (move out of position) is more likely to tear or rupture. Therefore, if you feel the characteristic snapping, see a foot and ankle surgeon immediately. Diagnosis Because peroneal tendon injuries are sometimes misdiagnosed and may worsen without proper treatment, prompt evaluation by a foot and ankle surgeon is advised. To diagnose a peroneal tendon injury, the surgeon will examine the foot and look for pain, instability, swelling, warmth and weakness on the outer side of the ankle. In addition, imaging studies such as an MRI or ultrasound may be needed to fully evaluate the injury. An ankle sprain may sometimes accompany a peroneal tendon injury. The surgeon is trained to look for signs of this and other related injuries. Proper diagnosis is important because prolonged discomfort after a simple sprain may be a sign of additional problems. Treatment Treatment depends on the type of peroneal tendon injury. Options include: •Immobilization. A cast or splint may be used to keep the foot and ankle from moving and allow the injury to heal. •Medications. Oral or injected anti-inflammatory drugs may help relieve the pain and inflammation. •Physical therapy. Ice, heat or ultrasound therapy may be used to reduce swelling and pain. As symptoms improve, exercises can be added to strengthen the muscles and improve range of motion and balance. •Bracing. The surgeon may provide a brace to use for a short while or during activities requiring repetitive ankle motion. Bracing may also be an option when a patient is not a candidate for surgery. •Surgery. In some cases, surgery may be needed to repair the tendon or tendons and perhaps the supporting structures of the foot. The foot and ankle surgeon will determine the most appropriate procedure for the patient's condition and lifestyle. After surgery, physical therapy is an important part of rehabilitation. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on “Fallen Arches” Otherwise Known as Posterior Tibial Tendon Dysfunction

What is Posterior Tibial Tendon Dysfunction (PTTD)? Seemingly overnight, one or both of your arches have flattened. You don’t remember your foot looking like this in the past. What has happened? What is going on? You probably have a condition called posterior tibial tendon dysfunction (PTTD) commonly called “fallen arches.” PTTD is an inflammation and/or overstretching of the posterior tibial tendon in the foot. An important function of the posterior tibial tendon is to help support the arch. But in PTTD, the tendon's ability to perform that job is impaired, often resulting in a flattening of the foot. The posterior tibial tendon is a fibrous cord that extends from a muscle in the leg. It descends the leg and runs along the inside of the ankle, down the side of the foot, and into the arch. This tendon serves as one of the major supporting structures of the foot and helps the foot to function while walking. PTTD is often called "adult-acquired flatfoot" or “fallen arches” because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse -- especially if it isn't treated early. Symptoms of PTTD The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change: • When PTTD initially develops, typically there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. • Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. • As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle. What Causes PTTD? Overuse of the posterior tibial tendon is frequently the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs. Non-Surgical Treatment Approaches Because of the progressive nature of PTTD, it's best to see your foot and ankle surgeon as soon as possible. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities. In many cases of PTTD, treatment can begin with non-surgical approaches that may include: • Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle stirrup brace or a custom orthotic device that fits into the shoe. • Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight bearing for a while. • Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization. • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. • Shoe modifications. Your foot and ankle surgeon may advise you on changes to make with your shoes and may provide special inserts designed to improve arch support. When is Surgery Needed? In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Surgical treatment may include repairing the tendon, realigning the bones of the foot, or both. Your foot and ankle surgeon will determine the best approach for your specific case. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Ankle Sprains

What is an Ankle Sprain?

An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue -- like rubber bands -- that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.
Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.
What Causes a Sprained Ankle?
Sprained ankles often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position. Ankle sprains commonly occur while participating in sports, wearing inappropriate shoes, or walking or running on an uneven surface.
Sometimes ankle sprains occur because of weak ankles, a condition that some people are born with. Previous ankle or foot injuries can also weaken the ankle and lead to sprains.
What are the Symptoms?
The signs and symptoms of ankle sprains may include:
• Pain or soreness
• Swelling
• Bruising
• Difficulty walking
• Stiffness in the joint
These symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people with previous ankle sprains -- instead, they may simply feel the ankle is wobbly and unsteady when they walk. Even if you don't have pain or swelling with a sprained ankle, treatment is crucial. Any ankle sprain -- whether it's your first or your fifth -- requires prompt medical attention.
If you think you've sprained your ankle, contact your foot and ankle surgeon for an appointment as soon as possible. In the meantime, immediately begin using the "R.I.C.E." method -- Rest, Ice, Compression, and Elevation -- to help reduce swelling, pain, and further injury.
Why is Prompt Medical Attention Needed?
There are four key reasons why an ankle sprain should be promptly evaluated and treated by a foot and ankle surgeon:
1. An untreated ankle sprain may lead to chronic ankle instability, a condition marked by persistent discomfort and a "giving way" of the ankle.
2. You may also develop weakness in the leg.
3. You may have suffered a more severe ankle injury along with the sprain. This might include a serious bone fracture that could lead to troubling complications if it goes untreated.
4. An ankle sprain may be accompanied by a foot injury that causes discomfort but has gone unnoticed thus far.
Rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.
In evaluating your injury, the foot and ankle surgeon will take your history to learn more about the injury. He or she will examine the injured area, and may order x-rays, an MRI study, or a CT scan to help determine the severity of the injury.
Non-Surgical Treatment and Rehabilitation
When you have an ankle sprain, rehabilitation is crucial -- and it starts the moment your treatment begins. Your foot and ankle surgeon may recommend one or more of the following treatment options:
• Immobilization. Depending on the severity of your injury, you may receive a short-leg cast, a walking boot, or a brace to keep your ankle from moving. You may also need crutches.
• Early Physical Therapy. Your doctor will start you on a rehabilitation program as soon as possible to promote healing and increase your range of motion. This includes doing prescribed exercises.
• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.
• Icing. You may be advised to ice your injury several times a day until the pain and swelling resolves. Wrap ice cubes, or a bag of frozen peas or corn, in a thin towel. Do not put ice directly on your skin.
• Compression Wraps. To prevent further swelling, you may need to keep your ankle wrapped in an elastic bandage or stocking.
When is Surgery Needed?
In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments. The foot and ankle surgeon will select the surgical procedure best suited for your case based on the type and severity of your injury as well as your activity level.
After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome. Be sure to continue to see your foot and ankle surgeon during this period to ensure that your ankle heals properly and function is restored.


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
www.sarasotafootcarecenter.com

X-rays Negative on NBA MVP Derrick Rose

Derrick Rose, the Chicago Bulls superstar and likely leage MVP, had some good news the other day. The x-rays on his injured left ankle came back negative. That is to say that there is no fracture of the bones. The ligaments, soft tissues that hold bones together, can not be seen on an x-ray. The most frequent ankle injury is called an inversion ankle sprain. This is when the foot rolls to the pinky toe side of the foot. Rose suffered this injury coming down on another players foot in a game against the Pacers. Rose continued to play and the Bulls put away the Pacers but now that the Atlanta Hawks have won game one, all of a sudden Rose's ankle is very important. I do respect Derrick Rose's determination, but if the ligaments are truly torn he will be very limited in his lateral movement. This could be very bad for the Bulls. Lucky for Derrick Rose that he has around the clock access to physical therapy on his ankle. For anyone who is not an elite, multi-million dollar athlete, the treatment for ankle sprains is P-R-I-C-E. Protection, Rest, Ice, Compression and Elevation. Motrin or Advil will also help with the pain. If the pain lasts longer than a week or if you are unable to bear any weight on the ankle, you should see a podiatrist immedatly to have an x-ray. Often bracing combined with physical therapy will get you back out on the court in a few weeks. Lucky for you, the entire city of Chicago is not counting on you to bring home a championship!


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
www.sarasotafootcarecenter.com