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Posts for: March, 2014

March 25, 2014
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Should I use ice or heat for my injury?  This is one of the most common questions I get in my practice.  The answer is "it depends".   Both can be beneficial.  For most conditions and injuries I see in my practice the answer is ice.  The general rule is to use ice for injuries within the first 24 hours and for injuries that continue to produce pain and swelling.  Most injuries to the lower extremity are being "re-injured" all day long as we walk on them.   Therefore, icing the area is effective after activity and again at the end of the day.  I  recommend utilizing an ice pack (frozen peas or corn work well too) for about 15 minutes at a time.  It is generally safe to ice an area for 15 minutes per hour.  A paper towel or similar material should first be placed on the skin so the icepack is not in direct contact with the body. Some people like to soak their feet in ice water.  I do not recommend this due to the risk of frostbite.  It is crucial to ice the area immediately following an injury.   A certain amount of swelling is ok because that is how the body brings the proper cells and nutrients to the area that are required to heal.   However,  our body tends to overreact and excessive swelling will add to the pain and time it takes to heal.  The icing works by causing the small blood vessels to constrict and limit the fluids moving into the area.   Icing also has a numbing effect on the nerves, which is welcome when you are in pain.

  Heat has the effect of relaxing muscles and is generally used in postural muscles, such as the lower back.  Heat is also often helpful in easing arthritic joints.  Heat serves as a vasodilator.   This means it opens the small blood vessels.  Extra blood flow is helpful to an arthritic joint and can help temporarily increase the range of motion.  Heat alone should not be used in acute injuries because the dilating of the blood vessels will increase the swelling further.  Moist heat is most effective and there are many heating pads available today.  Usually applying the heating pad for  20 to 30 minutes is ideal.   One needs to be careful not to make the pad too hot and risk a burn.   Falling asleep while a heating pad is on can be dangerous too.

There is a treatment utilized on athletes that need swelling to an extremity reduced quickly called contrast baths.  It involves alternating between soaking the injured limb in warm and cold water baths.  This works by forcing fluid out to the area by alternately constricting and dilating the blood vessels.  The extremity is in each bath for 5 to 10 minutes and then switched to the other bath.   Total treatment time is 45 minutes.   This technique is best left to trained professionals.  

March 16, 2014
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Achilles tendinitis is generally viewed as an overuse injury of the Achilles tendon, the band of tissue that connects the calf muscles to the back of the foot.  Achilles tendinitis is often seen in runners who have suddenly increased the intensity or duration of their runs. It is also common in middle-aged people who play sports on the weekends or somewhat infrequently.  The injury results in inflammation and minor tears within the tendon.   More serious cases may result in larger tears and/or partial or complete ruptures requiring surgical repair.  The injury is first evaluated by physical examination for changes in the achilles tendon.  Diagnostic ultrasound may be used to visualize the tendon.  Ultimately, an MRI may be ordered to best determine the extent of the injury.   Radiographs can be ordered if bony injury is suspected.

The achilles tendon does not receive a good blood supply.  Therefore, healing may take an extended amount of time.   It is not unusual for healing to take multiple weeks or even months.  Common treatments include icing, taking anti-inflammatory medications, supportive shoes and heel lifts, limiting activity and physical therapy.  In more severe cases, using crutches and/or a walking boot are beneficial to decrease the stresses on the achilles tendon and provide rest to the area.   I like to say that if we have an "overuse" injury, then "underusing" it is important for it to heal.  

I like to utilize night splints to hold the foot in a neutral position while the patient sleeps.   This prevents the achilles tendon from tightening up overnight in a shortened position, while not putting too much tension on the fibers of the tendon.  

Achilles tendon injuries are relatively common and efforts to lower your chances of an issue developing are worth taking.   Performing stretching exercises of the calf muscles increases flexibility and lowers the risk of injury.   Supportive shoes and sneakers support the arch and result in less pull being applied by the achilles tendon.  Finally, gradually increasing the intensity of any new sport or exercise is highly recommended.   


March 02, 2014
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Our clocks "spring ahead" on March 9th.  Its been a long, cold, snowy winter, but spring is really around the corner.   I've blogged about the risks of frostbite and the importance of keeping your feet warm.  We have discussed proper winter shoes and the pros and cons of Uggs and similar boots.  Like all the seasons and so many other things in life, spring will present opportunities along with risks.  The warmer temperatures will allow us  to wear less cumbersome shoes.  Late spring will bring on open toed shoes and sandals.  There will be more days we can wear supportive sneakers.   The added daylight time allows us to enjoy the great outdoors longer and increase our activity level.  However, April showers and melting snow puts the feet at risk of becoming wet.  Bacteria and fungus love the dark, moist environment present inside our shoes, even under good conditions.  It is essential to dry feet well and change out of wet socks and shoes as soon as possible.  Waterproof boots and shoes or covering shoes with rubber enclosures are highly advisable in these environments.  Many women will begin to wear lighter shoes as the temperatures warm.  Please remember the importance of good arch support.  When evaluating a shoe, be sure to notice that there is some arch support built into the shoe and that the heel counters are sturdy.  This allows the heel to be stabilized and prevent overpronation (extreme flattening of the arches).   Those that are benefitting from the use of over the counter and custom made inserts (orthotics) should be sure to switch them from shoe to shoe.  Finally, as we approach late spring, it is beneficial to wear shoes that "breath well".  Most of the quality sneakers available allow air to pass through the upper part of the sneaker.  This allows moisture to escape and prevents the feet from excessive sweating.  So lets take advantage of the spring and enjoy the weather to walk more in a healthy way for our feet, as well as our heart and lungs.  Can't wait to see you out there!