Winning an Olympic gold medal is the greatest accomplishment an athlete can have. All of the training, work and anticipation for the completion can be slammed into a halt if one suffers an injury near the games. Evan Lysacek has been struggling with a foot injury and was still able to put on a performance of a lifetime and win a gold medal.
Prior to the world championship, Lysacek suffered from a stress fracture in his foot. For this reason, he chose to remove the quadruple jump from his performance. After winning the competition, the champion spent time in a walking boot and had to rest from training in order to allow the fracture to heel. By the time the U.S. championship came around, Lysacek’s foot was back on track and he was fearless in performing a quadruple jump in his performance.
Stress fractures are small overuse fractures commonly seen in athletes. Unlike traumatic fractures, stress fractures are very small and thus referred to as a hairline fracture. These fractures can be very difficult to see on x-ray. Since the injury is so minor, the treatment is quite simple. Rest, rest and more rest is a straightforward treatment but a very difficult thing to do. Athletes have a very difficult time sustaining from their work out regimens; but if one does not rest, the stress fracture can progress to a complete fracture that would demands surgery.
Evan Lysacek was able to skate through his injury at the world championship, and then allowed himself to heal completely afterwards. Ignoring the injury or not allowing for proper healing, the fracture could have jeopardized his future in skating. After his quadruple jump at the U.S. championship, Lysacek started to feel similar foot pain all over again. He was not diagnosed with a stress fracture, but it was the wakeup call that he needed to focus on his training and performance techniques.
The quadruple jump is the most difficult trick a male ice skater can perform and only a few people in the world can execute it with grace and precision. Due to the difficulty, and the unnatural forces caused by the takeoff and landing of the jump, injuries can easily occur. Evan Lysacek knew his body’s limits and chose to discontinue training and performing quadruple jumps. This put him at a huge disadvantage in competitions, but this did not stop him from perfectly executing every element of his program.
All athletes, including the Olympic champions, YMCA junkies and weekend warriors need to pay closer attention to their body. You can only be a good as your body can handle. No one can be their best while injured. Lysacek dissected his body’s capabilities and was still able to walk away from Vancouver as a champion without the most prestigious element of an ice skating presentation. His performance had the world at the edge of their seats and he still kept his foot safe from reinjuring.
Sunday, February 21, 2010
Saturday, February 13, 2010
Being In Love May Reduce Foot Pain?
The University of California Los Angeles recently did a study that showed thinking of a loved one decreased a person’s pain. While having heat applied to their forearm, 25 women were asked to rate their pain levels. When the women were shown pictures of their significant others or when they were allowed to hold their significant others hand their pain level consistently reduced.
Love is patient, love is kind, but is love an anti-pain medication? When one is suffering from a serious illness, it is obvious that having support from loved ones helps one get through the rollercoaster’s of pain and suffering. But, can love help with your everyday aches and pains? According to this study it can!
Medically, there is no definitive answer on why this may happen. Pain can only be measured by the person’s perception of the pain. Thus there is great variation in pain from one person to another. This is what we refer to as “pain threshold.” One may say they have a high pain tolerance, meaning it takes a lot before the pain “affects” them. I see this often in my clinic when I give a people injections. Some people are 100% calm, cool and collected and don’t even blink when I prick them with the needle. Others are jumping for the chandelier and screaming at the top of their lungs when all I am doing is putting a relatively small needle under their skin.
So can being in love increase your pain tolerance? Plantar fasciitis is one of the most common causes of heel pain. I see several patients a day with this common foot problem and when I ask the patients to rate their pain on a scale from 1-10, I can never predict their response. There is absolutely no consistency on how much pain this problem causes. The description is always the same “It hurts the most in the morning or after rest.” But since everyone perceives pain on a different threshold, not everyone rates it the same number. I have never dove into my patients personal lives to discover whether a pain rated a 10 actually means that they just lost the love of my life and as a result their foot hurts.
There is no doubt in my mind that having someone supportive in your life that makes you happy can help you deal with or handle your pain with slightly greater ease, but there is always a reason for the pain. .
Love is patient, love is kind, but is love an anti-pain medication? When one is suffering from a serious illness, it is obvious that having support from loved ones helps one get through the rollercoaster’s of pain and suffering. But, can love help with your everyday aches and pains? According to this study it can!
Medically, there is no definitive answer on why this may happen. Pain can only be measured by the person’s perception of the pain. Thus there is great variation in pain from one person to another. This is what we refer to as “pain threshold.” One may say they have a high pain tolerance, meaning it takes a lot before the pain “affects” them. I see this often in my clinic when I give a people injections. Some people are 100% calm, cool and collected and don’t even blink when I prick them with the needle. Others are jumping for the chandelier and screaming at the top of their lungs when all I am doing is putting a relatively small needle under their skin.
So can being in love increase your pain tolerance? Plantar fasciitis is one of the most common causes of heel pain. I see several patients a day with this common foot problem and when I ask the patients to rate their pain on a scale from 1-10, I can never predict their response. There is absolutely no consistency on how much pain this problem causes. The description is always the same “It hurts the most in the morning or after rest.” But since everyone perceives pain on a different threshold, not everyone rates it the same number. I have never dove into my patients personal lives to discover whether a pain rated a 10 actually means that they just lost the love of my life and as a result their foot hurts.
There is no doubt in my mind that having someone supportive in your life that makes you happy can help you deal with or handle your pain with slightly greater ease, but there is always a reason for the pain. .
Monday, January 18, 2010
Winter De-Feet
Winter is knocking on our doors and bringing cold air to chill our bones. The cold air gives us so many reasons to snuggle up in bed or cozy up by the fire, but it also gives us so many reasons to enjoy the outdoors.
Skiing, ice-skating, snowshoeing, snowmobiling, and snowboarding are all common winter activities that expose our bodies to the cold. It is important to protect yourself from the cold weather. Many are unaware that you can still acquire cold injuries in weather above freezing! Sometimes we underestimate the weather, or sometimes we just don't have a pair of boots to go with our outfit. Whether on a ski hill or walking to work, you need to keep your feet protected from the cold.
Chilblains is an extremely common cold injury that does not involve freezing of the body's tissues. After exposure to cold weather, areas of the skin will be painful, red to purple, and swollen. The discomfort can last for days and eventually subsides. Occasionally, the affected area will permanently have an increased sensitive to cold Trench Foot occurs after the foot is exposed to cold and wet conditions. This was a common injury in soldiers of WWII. As in Chiliblains, none of the body's tissues are freezing but the cold weather does cause damage. The foot will be very painful, red, and blotchy. Depending on how long the foot was exposed and how cold the foot got, determines the severity. In rare cases, trench foot can lead to gangrene and the need of an amputation.
Frostbite is the actual freezing of the affected area and is the most severe of cold induced injuries. Ice crystals form and damage the surrounding tissues due to the lack of blood flow and heat. The longer the body is exposed or the colder the air, the more severe the injury. The skin may appear, pale, blue, red and will be extremely painful. Eventually the injury will cause nerve damage and loss of sensation. Blisters may form shortly after the injury.
The prognosis varies from mild complications to amputations. Those who are more susceptible to cold injures are children and elderly. Children have very small toes and fingers and therefore it is easier for these small areas to become cold. The elderly tend to have poor circulation and less mobility. Blood flow helps keep our extremities warm, thus anybody with poor circulation is at a greater risk for cold injuries. If you know you are going to be exposed to cold weather, make sure to dress for the occasion. Wear layers but make sure no area is too tight. Tight clothes can restrict circulation. Bring extra clothes and stay dry. If you have sweaty feet, try changing your socks as often as possible. Avoid drinking alcohol or using illicit drugs since these products can alter your perception of the weather. Take some time to warm up when you are getting cold. Going indoors and enjoying a cup of hot chocolate is sometimes the best part of playing outdoors!
Skiing, ice-skating, snowshoeing, snowmobiling, and snowboarding are all common winter activities that expose our bodies to the cold. It is important to protect yourself from the cold weather. Many are unaware that you can still acquire cold injuries in weather above freezing! Sometimes we underestimate the weather, or sometimes we just don't have a pair of boots to go with our outfit. Whether on a ski hill or walking to work, you need to keep your feet protected from the cold.
Chilblains is an extremely common cold injury that does not involve freezing of the body's tissues. After exposure to cold weather, areas of the skin will be painful, red to purple, and swollen. The discomfort can last for days and eventually subsides. Occasionally, the affected area will permanently have an increased sensitive to cold Trench Foot occurs after the foot is exposed to cold and wet conditions. This was a common injury in soldiers of WWII. As in Chiliblains, none of the body's tissues are freezing but the cold weather does cause damage. The foot will be very painful, red, and blotchy. Depending on how long the foot was exposed and how cold the foot got, determines the severity. In rare cases, trench foot can lead to gangrene and the need of an amputation.
Frostbite is the actual freezing of the affected area and is the most severe of cold induced injuries. Ice crystals form and damage the surrounding tissues due to the lack of blood flow and heat. The longer the body is exposed or the colder the air, the more severe the injury. The skin may appear, pale, blue, red and will be extremely painful. Eventually the injury will cause nerve damage and loss of sensation. Blisters may form shortly after the injury.
The prognosis varies from mild complications to amputations. Those who are more susceptible to cold injures are children and elderly. Children have very small toes and fingers and therefore it is easier for these small areas to become cold. The elderly tend to have poor circulation and less mobility. Blood flow helps keep our extremities warm, thus anybody with poor circulation is at a greater risk for cold injuries. If you know you are going to be exposed to cold weather, make sure to dress for the occasion. Wear layers but make sure no area is too tight. Tight clothes can restrict circulation. Bring extra clothes and stay dry. If you have sweaty feet, try changing your socks as often as possible. Avoid drinking alcohol or using illicit drugs since these products can alter your perception of the weather. Take some time to warm up when you are getting cold. Going indoors and enjoying a cup of hot chocolate is sometimes the best part of playing outdoors!
Saturday, January 16, 2010
A Painful Foot Tattoo
You can get a tattoo just about anywhere of anything. Surprisingly, the foot has become a tattoo hot spot. Young and old tattoo enthusiasts are racing to get their foot art. Even though the feet are one of the most painful areas to get a tattoo, their popularity is growing! Is it safe for anyone to get a tattoo on their foot?
The foot has many tendons, ligaments, bones, blood vessels, and nerves. The bottom part of the foot is nicely cushioned with fat, but the top of the foot has a very thin layer of skin and fat. Thus, there is very little protecting the delicate structures underneath. The less fat an area has, the more painful the tattoo sight. The skin is basically made up of three parts called the epidermis, dermis, and hypodermis. The epidermis is the skin that regularly flakes off on a daily basis. The dermis is deeper and is the layer that tattoo ink is injected into. The tattoo needle injecting the ink is not intended to go into the hypodermis that contains larger blood vessels and nerves. There are tiny nerve endings in the dermis and thus the tattoo procedure will be very painful. One reason that foot tattoos are extremely painful and tedious is due the fact that the skin is thinner on the top of the foot and there is little space between the layers.
In simple terms, a tattoo is a wound with a dye injection. The skin which is a protective barrier to bacteria is broken and a foreign object, the dye, is injected into the sight. The body reacts to the dye and “walls it off” to protect the rest of the body from this foreign object. As a result, a permanent tattoo is formed. Most tattoos do not lead to serious complications, but occasionally a foot tattoo can go sour. It is important to keep the tattoo sight clean and protected after the procedure. Unfortunately the foot is often in socks and shoes that can harbor bacteria. The foot also bears a lot of weight and can put stress on the structures surrounding the tattoo and the tattoo itself. Many have to resort to flip flops or other non-supportive shoes for days to weeks before returning to their normal shoes. If your feet are not used to being in unsupportive foot gear, this may lead to generalized or focal foot pain. Still, it is more important to keep the tattoo sight clean since the complication is much more severe than not wearing proper shoe gear. Once the tattoo sight has healed, one should go back to wearing socks and supportive shoes during regular day activities.
Since tattoos are wounds, there is a population that should avoid getting a tattoo on the lower extremity and especially the foot. Peripheral Arterial Disease (PAD) is an extremely common disease among diabetics, and all people over 50 years old. It is the aging of the arteries that causes the vessels to be narrower than normal and thus decreases the blood supply to the feet. Wounds need blood and oxygen to heel. Remember, a tattoo is a wound and it also needs blood and oxygen to heel. Thus, if you have diabetes or PAD, your wound could turn into an ulcer that is limb threatening. People with lymphatic diseases and those who are have lost feeling in their feet are also at increased risk for developing an ulcer.
If you are interested in expressing body art on your feet, make sure your feet are healthy! Visit your podiatrist to have a foot exam to evaluate the health of your feet. If you have decreased pulses or sensation, your cool foot statement could lead to a not so beautiful wound or even an amputation!
The foot has many tendons, ligaments, bones, blood vessels, and nerves. The bottom part of the foot is nicely cushioned with fat, but the top of the foot has a very thin layer of skin and fat. Thus, there is very little protecting the delicate structures underneath. The less fat an area has, the more painful the tattoo sight. The skin is basically made up of three parts called the epidermis, dermis, and hypodermis. The epidermis is the skin that regularly flakes off on a daily basis. The dermis is deeper and is the layer that tattoo ink is injected into. The tattoo needle injecting the ink is not intended to go into the hypodermis that contains larger blood vessels and nerves. There are tiny nerve endings in the dermis and thus the tattoo procedure will be very painful. One reason that foot tattoos are extremely painful and tedious is due the fact that the skin is thinner on the top of the foot and there is little space between the layers.
In simple terms, a tattoo is a wound with a dye injection. The skin which is a protective barrier to bacteria is broken and a foreign object, the dye, is injected into the sight. The body reacts to the dye and “walls it off” to protect the rest of the body from this foreign object. As a result, a permanent tattoo is formed. Most tattoos do not lead to serious complications, but occasionally a foot tattoo can go sour. It is important to keep the tattoo sight clean and protected after the procedure. Unfortunately the foot is often in socks and shoes that can harbor bacteria. The foot also bears a lot of weight and can put stress on the structures surrounding the tattoo and the tattoo itself. Many have to resort to flip flops or other non-supportive shoes for days to weeks before returning to their normal shoes. If your feet are not used to being in unsupportive foot gear, this may lead to generalized or focal foot pain. Still, it is more important to keep the tattoo sight clean since the complication is much more severe than not wearing proper shoe gear. Once the tattoo sight has healed, one should go back to wearing socks and supportive shoes during regular day activities.
Since tattoos are wounds, there is a population that should avoid getting a tattoo on the lower extremity and especially the foot. Peripheral Arterial Disease (PAD) is an extremely common disease among diabetics, and all people over 50 years old. It is the aging of the arteries that causes the vessels to be narrower than normal and thus decreases the blood supply to the feet. Wounds need blood and oxygen to heel. Remember, a tattoo is a wound and it also needs blood and oxygen to heel. Thus, if you have diabetes or PAD, your wound could turn into an ulcer that is limb threatening. People with lymphatic diseases and those who are have lost feeling in their feet are also at increased risk for developing an ulcer.
If you are interested in expressing body art on your feet, make sure your feet are healthy! Visit your podiatrist to have a foot exam to evaluate the health of your feet. If you have decreased pulses or sensation, your cool foot statement could lead to a not so beautiful wound or even an amputation!
Wednesday, January 6, 2010
Aaron Rodgers and Brett Favre: The Foot Comparison!
You cannot watch football this season without hearing about Brett Favre and Aaron Rodgers. They have been over analyzed in every way possible. So much attention surrounds the legend and the rising star who replaced him. They have faced each other twice already this season, both with a Favre victory, yet the discussions don't seem to subside for a moment. So, to add on to this intense analysis, let us explore the foot injuries of the two athletes!
Prior to the Viking and Packer game, Favre had his first report on the Viking's injury list with foot pain. Nothing more was said about the issue other than that he had a sore foot. The irony of the situation is that after the game, Rodgers suffered from a foot and a toe sprain. Is this the beginning of the end? Did Favre get the last word through foot injuries?
A sprain describes an injury in which a ligament between two bones is stretched, damaged or torn. A Grade 1 injury is fairly mild with only minor damage to the ligament. A Grade 2 injury is a partially torn ligament and a Grade 3 is a ligament that is completely torn. With a grade 1 injury, the recovery time is short with very few possible complications.
On the other hand, a grade 3 can takes months to heal and is often extremely painful. Foot sprains are rare in the general population, but are common in sports that put the foot in abnormal twisting positions. Such injuries usually result in a grade 1 or grade 2 damage and complete recovery can be seen within the season with much improvement in only weeks.
Treatment consists of rest, icing, strapping, and anti-inflammatory drugs. A sprained big toe is better known as turf toe. This usually results when the big toe is abnormally hyper-extended. This injury can often be more debilitating than a foot sprain because of the important role the big toe plays in pushing off the ground when running. The grading system is the same as a foot sprain with Grade 1 being a minor injury and grade 3 being more severe.
To prevent further damage with the ability to continue activities, taping techniques have been proven quite effective. The severity of the foot injuries of Favre and Rodgers has been downplayed and seeing their continued performance on the field allows us to assume they are minor.
Still, these injuries can be very painful and increases the risk for a more severe injury. To prevent further injuries, both players should be undergoing physical therapy and switch to a more stable shoe gear. The cleats and the flexibility of football shoes increase the chance that the foot will be twisted in a position that could worsen the injury.
Rodgers' first line of treatment should be to have more protection on the field. It is likely that the injury resulted after one of his many sacks this season. Favre, has age working against him. Younger athletes tend to recover better and faster than older athletes, but Favre has proven that age does not define his ability to play football. Only time will tell if these injuries will advance to a more serious problem that will take them off the field.
The likelihood of these injuries progressing is unlikely since they seem to be only presenting with minor symptoms. Thus, the live football drama series of Favre versus Rodgers will continue.
Prior to the Viking and Packer game, Favre had his first report on the Viking's injury list with foot pain. Nothing more was said about the issue other than that he had a sore foot. The irony of the situation is that after the game, Rodgers suffered from a foot and a toe sprain. Is this the beginning of the end? Did Favre get the last word through foot injuries?
A sprain describes an injury in which a ligament between two bones is stretched, damaged or torn. A Grade 1 injury is fairly mild with only minor damage to the ligament. A Grade 2 injury is a partially torn ligament and a Grade 3 is a ligament that is completely torn. With a grade 1 injury, the recovery time is short with very few possible complications.
On the other hand, a grade 3 can takes months to heal and is often extremely painful. Foot sprains are rare in the general population, but are common in sports that put the foot in abnormal twisting positions. Such injuries usually result in a grade 1 or grade 2 damage and complete recovery can be seen within the season with much improvement in only weeks.
Treatment consists of rest, icing, strapping, and anti-inflammatory drugs. A sprained big toe is better known as turf toe. This usually results when the big toe is abnormally hyper-extended. This injury can often be more debilitating than a foot sprain because of the important role the big toe plays in pushing off the ground when running. The grading system is the same as a foot sprain with Grade 1 being a minor injury and grade 3 being more severe.
To prevent further damage with the ability to continue activities, taping techniques have been proven quite effective. The severity of the foot injuries of Favre and Rodgers has been downplayed and seeing their continued performance on the field allows us to assume they are minor.
Still, these injuries can be very painful and increases the risk for a more severe injury. To prevent further injuries, both players should be undergoing physical therapy and switch to a more stable shoe gear. The cleats and the flexibility of football shoes increase the chance that the foot will be twisted in a position that could worsen the injury.
Rodgers' first line of treatment should be to have more protection on the field. It is likely that the injury resulted after one of his many sacks this season. Favre, has age working against him. Younger athletes tend to recover better and faster than older athletes, but Favre has proven that age does not define his ability to play football. Only time will tell if these injuries will advance to a more serious problem that will take them off the field.
The likelihood of these injuries progressing is unlikely since they seem to be only presenting with minor symptoms. Thus, the live football drama series of Favre versus Rodgers will continue.
Wednesday, October 28, 2009
The Ankle Sprain that Doesn’t Improve
25% of all musculoskeletal injuries are ankle sprains! What does spraining the ankle actually mean? The ankle joint is made up of three bones: the tibia, fibula and talus. These bones are held into proper position by a number of ligaments. The soft tissues surrounding the joint help stabilize the bones so they do not move too much in the wrong directions. Sprains usually occur during athletic activities but sometimes we step down or trip on a rug and put abnormal pressures on our ankle. Most often, a sprain occurs when the foot gets tilted inward or inverted. These abnormal forces causes stretching or tears to the ligaments that stabilize the joint.
The injured ligaments will lead to swelling, inflammation, and pain. If the injury is severe, there may be a fracture present. It is standard for doctors to order x-rays and do multiple different maneuvers to the foot and ankle to asses which ligaments are damaged and if any of the bones are broken. When no bones are involved, rest, ice, compression, elevation, and anti-inflammatory medication usually does the trick. When a fracture occurs there may be need for surgical intervention.
Many people recover from ankle sprains with no problems, but about 10% of ankle sprains do not improve with traditional therapy. In these patients, the ankle sprain was only part of the problem. Below the ankle is another joint between the talus and the calcaneus called the subtalar joint. Thus the talus bone is connected to both the ankle and the subtalar joint. You can imagine that if abnormal forces are put on the talus there will sometimes be damage to the ankle joint and the subtalar joint. Just as ligaments are torn or damaged at the ankle joint, ligaments can be damaged at the subtalar joint.
Unfortunately, it is nearly impossible to tell the difference between ankle instability and subtalar joint instability by physical evaluation. To evaluate the damage, radiographs have to be carefully evaluated and some non-traditional evaluations should be utilized. Placing the foot in specific forced positions is necessary to open up the joint spaces to assess the damage. These can be very painful and a local anesthetic may be necessary in order to complete the exam. Ultrasound has shown to be a great way to evaluate injuries, but not all medical care centers have this modality available. If this injury is caught early , the treatment is mostly non-surgical. Different immobilization devices and physical therapy can usually strengthen the ligaments. Occasionally the injury will become a chronic problem that requires surgery.
Since this injury is hard to assess and difficult to differentiate from ankle joint injuries, your doctor may have a difficult time recognizing the issue. It is important to communicate your symptoms and pain as thorough as possible. Knowing how the injury occurred and the position your foot was in when the injury occurred can be very useful information for your doctor to determine what ligaments were injured. If you had an ankle sprain that doesn’t seem to be getting better, it may be an unstable subtalar joint that is the root of your problems.
The injured ligaments will lead to swelling, inflammation, and pain. If the injury is severe, there may be a fracture present. It is standard for doctors to order x-rays and do multiple different maneuvers to the foot and ankle to asses which ligaments are damaged and if any of the bones are broken. When no bones are involved, rest, ice, compression, elevation, and anti-inflammatory medication usually does the trick. When a fracture occurs there may be need for surgical intervention.
Many people recover from ankle sprains with no problems, but about 10% of ankle sprains do not improve with traditional therapy. In these patients, the ankle sprain was only part of the problem. Below the ankle is another joint between the talus and the calcaneus called the subtalar joint. Thus the talus bone is connected to both the ankle and the subtalar joint. You can imagine that if abnormal forces are put on the talus there will sometimes be damage to the ankle joint and the subtalar joint. Just as ligaments are torn or damaged at the ankle joint, ligaments can be damaged at the subtalar joint.
Unfortunately, it is nearly impossible to tell the difference between ankle instability and subtalar joint instability by physical evaluation. To evaluate the damage, radiographs have to be carefully evaluated and some non-traditional evaluations should be utilized. Placing the foot in specific forced positions is necessary to open up the joint spaces to assess the damage. These can be very painful and a local anesthetic may be necessary in order to complete the exam. Ultrasound has shown to be a great way to evaluate injuries, but not all medical care centers have this modality available. If this injury is caught early , the treatment is mostly non-surgical. Different immobilization devices and physical therapy can usually strengthen the ligaments. Occasionally the injury will become a chronic problem that requires surgery.
Since this injury is hard to assess and difficult to differentiate from ankle joint injuries, your doctor may have a difficult time recognizing the issue. It is important to communicate your symptoms and pain as thorough as possible. Knowing how the injury occurred and the position your foot was in when the injury occurred can be very useful information for your doctor to determine what ligaments were injured. If you had an ankle sprain that doesn’t seem to be getting better, it may be an unstable subtalar joint that is the root of your problems.
