Knee, Ankle, & Foot
Hi, today we're going to talk about ankles. The most common ankle injuries is the outside of the ankle, we call this the lateral ankle. The fibula makes up the outside part of the ankle, the widest portion of the bone, and it has three ligaments that attach to the ankle, one here, one here, and one back here. When you have an ankle sprain, what happens is everything opens up like this and sometimes it goes back into the proper alignment and sometimes it just always remains loose. When that happens, we call that a chronic ankle sprain. People who have chronic ankle sprains, will typically re-sprain that ankle over and over again or have a weakness or instability at the foot.
We use prolotherapy to treat at the attachments, the attachments are usually where the ligamentous injury occurs, and then we treat into the joint as needed. Sometimes we treat this joint as well, they can all be injured in an ankle sprain. A high ankle sprain is when the injury occurs into this area right here, this is the interosseous ligament, and what happens with a high ankle sprain is that the entire complex right here, this and this, splits open. This is the most severe injury, it hurts a lot and usually the athlete can't go back into sport for a while. The treatment again, is prolotherapy or PRP right into the ligament as well as the ligaments down here. Hi, I'm Dr. Jennifer Stebbing, I'm a sports medicine physician and I treat ankle sprains very commonly. Thanks.
Hi. Today we're going to talk about plantar fascia pain. The plantar fascia is tissue that is not muscle and it's not tendon, but it forms a bridge on the bottom of the foot. The plantar fascia can be injured in a number of ways. Usually it has to do with the way that people's feet are structured, and it can also have something to do with the way that the ankle hits the ground or an it can be either improved or worsened by shoe wear. There's a lot of reasons for it and there's lots of different ways to treat it.
The typical algorithm that I was taught initially included using a brace, night splints, steroid injections to the area and sometimes a walking boot. There's a lot of different things that have worked for people. And when all these things fail, there's two things that I think about. One is, was the diagnosis really plantar fasciitis. And number two, is there a tear or something else going on in the plantar fascia and that's the reason why it's not healing?
The way that we evaluate plantar fascia is by ultrasound. We put the ultrasound on here. There's two different fibers or trajectories of the fiber here. Sometimes the injury can be in one fiber, which the inside one is the most common. The other is the outside and that's less common, but there can be an injury there so it's worth evaluating by ultrasound. We look at the ultrasound both lengthwise this way and also widthwise.
If there is an injury, what we term as plantar fasciosis or an enthesopathy, it's a chronic injury where there's a loss of blood supply to the area. When that occurs the whole thing looks thickened. There are occasions where there's a tear in there and you'll see some fluid or a change in the thickness of the tissue, meaning it gets thinner or you stop seeing the tissue at its attachment by ultrasound.
The other thing that can be involved in what appears to be heel pain at the bottom of the foot is that there's a nerve that comes around the ankle ... it comes around down here and it comes into here ... and it can be injured. Sometimes a scar can do that. Sometimes shoe wear can do that, but it can present just like plantar fasciitis.
I typically will say, the first thing that we need to do is look or examine the area. The second thing we need to do is evaluate by ultrasound to see if the plantar fascia is the normal size or not. And if it is the normal size, then we can't call it a plantar fasciitis or plantar fasciosis or an enthesopathy, we have to think about the nerve as being the injury or the culprit.
The treatment, if it's a nerve, is nerve hydro-dissection. You can look at that in my website, neural prolotherapy to the area.
The other misnomer that occurs here is that there's a spur. People will tell you that the spur is the injury. The spur is a consequence to tight plantar fascia. So if there's a spur ... so the spur is a growth of bone that comes out in that direction ... the bone grows along the line of stress. So calcium gets deposited along the line of stress. That's a cardinal rule that has happened over and over again and what we noticed in arthritis. So we have to think about that as being a line of stress. It just tells us that there's a long term injury there.
The most important thing about the success of the treatment, whether you do any type of injection treatment, is the alignment of the calcaneus or the heel bone afterwards. There's a role for orthotics, there's a role for some of the other things that go into it, as well as retraining the foot with physical therapy.
Thanks. My name is Dr. Jennifer Stebbing. I'm a sports medicine physician who specialize in regenerative orthopedic procedures. Please contact me if you have any other questions. Thank you.
Hi, today we're gonna talk about Achilles injuries. The Achilles tendon, tendons attach muscles to bone, it's comprised of two muscles, the Gastroc and the Soleus muscle, which both attach or come together and attach to the Calcaneus.
When you have an Achilles injury, it hurts to put on shoes, snow boots, ski boots and the like because there's a compression right at the area that hurts. The tendon itself can become swollen, it can become enlarged, and it's very tender to touch, and anything that stretches the tendon, disposition of the foot, irritates it.
In most cases, what you do first, is go to physical therapy, and they do exercises called eccentric contraction, where they lengthen the muscle tendon complex. You can do this at home too, you start off with simply standing on a broomstick. So you put your toes on the broomstick and you kind of let your heels sink down to the floor, and that can be an easy way to start off the stretch into the Achilles. However, the caveat to this, is that your position of your foot has to be in neutral position. So if you supinate your foot or you pronate your foot, so pronators lose their arch, supinators have a really high arch, and if you do one or the other of those and your foot, your ankle position isn't in neutral, you can actually make the injury worse.
So some of the other treatments for Achilles tendon, include night splints, orthotics, good shoe wear, stretching exercises, trigger point releases, occasionally I can also treat with a nerve, to the nerve to regularize.
But if all those things fail, you can move on to the regenerative medicine treatment, and this includes prolotherapy and PRP, and the treatment can occur either right at the attached main large tendon, which is called enthesopathy. Or it can happen into the middle portion of the tendon.
The reason why the middle portion is injured, so this is the tendon sits right over the backside of the joint, so here's the ankle joint, it's upside down just cause I have the skeleton backwards, is because the blood supply to the tendon is compromised. You can usually get the blood supply down the muscle to the tendon or you can get it from the heel bone up into the muscle and so there's an area that doesn't get good blood supply and this is called a water shed area and this is the reason why the Achilles is at a high risk for injury than other tendons.
So you can use prolotherapy or PRP, and its usually just one injection of PRP, to help restore the blood supply to the tendon and then it heals from there. There are other issues that can come into play with tendonopathies, which I'm happy to review if they are involved in your case.
My name is Dr. Jennifer Stebbing, I'm a sports medicine physician that specializes in regenerative orthopedics. Please get in touch with me if you have any other questions. Thank you. " />
– Knee Cap Pain or Patellar Femoral Tracking issues
– Meniscus Injuries
– Medial Collateral Ligament Injuries
– Lateral Collateral Ligament Injuries
– Pes anserine Pain- pain under the joint at the top of the tibia
– Joint Effusion (Fluid on the Knee)
– Tibia-Fibula Joint Pain or movement (outside of the knee)
– Saphaneous Nerve Injury
– Obturator Nerve Injury
– Knee hypermobility
– Dislocations after the joint has been re– placed in correct position
– Scar and Pain after Surgery
Foot & Ankle
– Ankle & Toes Arthritis
– Chronic Ankle Sprains & Instability
– Peroneal Tendinitis or Tendinopathy
– Plantar Fasciitis
– Tibia Nerve Entrapment
– Peroneal Nerve Entrapment
– Plantar Fasciitis or other foot pain
– Scar pain
– Continued pain after surgery