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Ankle sprains and ligaments of the ankle joint.
Ankle sprains are among the most common sporting injuries that occur during a variety of activities. Spraining refers to wrenching or twisting a ligament aggressively which can lead to swelling, pain and decreased range of motion. To thoroughly understand the mechanism of injury we must first understand the structures that provide stability and structural support to the ankle joint. Ligaments are fibrous connective tissue that connect two or more bones together between a joint space. Ligaments act as protective structures that create structural boundaries to the natural movement of joints. There are two major sets of ligaments surrounding the ankle joint; these are the medial collateral ligaments AKA deltoid ligament and the lateral collateral ligaments. The deltoid ligament complex are those found in the interior portion of the ankle or the medial side, they are composed of the following ligaments: Posterior and anterior tibiofibular ligaments, tibiocalcaneal and tibionavicular ligaments. The deltoid ligament collectively is considered the strongest ligament of the ankle joint providing the most solid structural integrity to the interior portion of the ankle joint. The lateral ligament is the most commonly sprained ligament of the ankle joint, specifically the anterior talofibular ligament. Torsional, or excessive rotational movements, ankle rolling outward damages the lateral ligaments causing swelling, redness and decreased movement; symptoms arise almost immediately.
How are ankle sprains diagnosed?
The patient may be able to walk with decreased range of motion, but will complain of excessive pain and tenderness especially when touched. Obtaining a good history of the injury as well as X-ray imaging of the ankle can provide evidence as to whether there is also a bony injury in conjunction with the sprain. Your doctor may perform a few tests to check for stability of the ankle joint. In more severe cases, an MRI may be needed to rule out other injuries.
How are ankle sprains treated?
The primary treatment is the RICE approach which stands for: Rest, Ice, Compression and Elevation.
Non-steroidal Anti-inflammatory medication such as Ibuprofen. During the first 24-48 hours using ice packs intermittently can decrease the swelling in the area surrounding the sprain. An ACE wrap should be used to keep compression over the ankle joint to reduce the swelling, it is important to note that ace wraps do not provide rigid structural integrity the way a cast or walking boot does, and therefore weight bearing should still be limited. Elevation above the level of the heart for 3 hours a day will also help diminish swelling in the area. In some cases Crutches may be used until weight bearing does not produce pain. Physical therapy is vital to strengthening the surrounding muscles in the area.
Returning to sports or regular activities.
After proper rehabilitation, wearing an ankle brace during weight training or exercise can help preserve the structural integrity of the ankle. Typically, once an ankle is sprained it is subject to re-spraining, wearing shoes with lateral support can also help prevent injury. If for some reason pain persists after rehabilitation, a physician may order an MRI and perhaps surgical treatment.
For more information visit us at www.texasfootdoctor.org
For an appointment call us at (817) 424-FOOT (3668).
With Temperatures dropping below freezing points in the upcoming days frostbite can become a real concern. Frostbite can potentially cause irreversible damage if not caught in time!
What exactly is Frostbite?
Just like liquids turn to ice in freezing temperatures, your toes, fingers, ears and nose can freeze if not properly covered in cold weather. Icicles form in the soft tissues causing damage to cells. Permanent damage can occur in as quickly as 5 minutes in frigid temperatures!
There are Four stages:
Stage 1: Normal
Stage 2: Also known as Frostnip; exposed skin becomes red and sore. May notice some irritation with Pins and Needles sensation.
Stage 3: Superficial Frostbite: Blisters may form but no major damage is seen to deeper layers of skin.
Stage 4: Involves all layers of skin and can cause permanent irreversible damage that may result in amputation.
How can I avoid getting frostbite?
Hands and feet account for 90% of frostbite cases! Frostbite can be prevented by limiting cold exposure and keeping the feet as warm and dry as possible. Make sure you are wearing dry wicking socks to avoid moisture in your feet, followed by a warm lined water proof boot/shoe.
Double socks work well by using a synthetic moisture wicking fabric inner layer (such as polypropylene) and an insulating outer layer such as wool or cashmere.
Change out of wet socks immediately.
Tobacco users and Patients with Diabetes and Peripheral Vascular Diseases should take extra precautions since they are at a higher risk for developing frostbite due to decreased blood flow their hands and feet.
What to do if I think I have frostbite?
Seek Medical care immediately if you think you may be developing frostbite. Move to a warm area and remove constricting or wet shoes and socks and insulate your feet. Do not use hot water, fire, or heating pad because these methods may cause burns to the skin if numbness is present. Your doctor will ask you questions about your exposure to cold including temperature and length of exposure, and will examine you for superficial and deep injury. Prognosis will depend on the extent of injury. The severity of the injury may not be seen until the injured area rewarms.
For more information
Academy foot & ankle specialists
(817) 424- FOOT (3668)
Introducing The Surgeons of Academy Foot and Ankle:
While you can read his professional bio on our website (http://www.texasfootdoctor.org/staff.html#dacus), here are some fun facts about our very own Dr. Dacus!
Meet Dr. Joel Dacus
•My hobbies are: flying amphibious aircraft and air camping
•If I could spend the day with one person (alive or passed) it would be (and why): I always wanted to meet Neil Armstrong the first man on the moon. Though I never got to meet Mr Armstrong, his courage, strong stable principles and his accomplishments were always an inspiration. I could easily spend a day with him talking all about his experience on the moon and his trip through space.
•I would like to meet: Felix Baumgartner the daring pioneer who jumped from a helium balloon at over 125,000 ft from near space.
•Some things about my family: I am happily married to the best woman on the planet! A true stable partner who gives me strength and purpose. We have three children- two boys and a girl of which we are so proud. All our children are accomplished and entering early adult life. One of our boys flys for the United States Navy.
•The most important thing to me: Jesus Christ, Wife and children and grand children
•My favorite pace I’ve traveled: Mt Kilimanjaro Kenya and Victoria Falls Zimbabwe
•My top bucket list item: Flying my plane across Australia to Tasmania with my wife
Make an appointment with Dr. Dacus today at our Keller location! 817-424-3668.
Soccer season: Prime time for foot, ankle injuries
Southlake, TX 76092 August 31, 2015 -- Soccer season is in full swing and a local foot and ankle surgeon strongly urges parents and coaches to think twice before coaxing young, injury-prone soccer players to “play through” foot and ankle pain.
“Skeletally immature kids, starting and stopping and moving side to side on cleats that are little more than moccasins with spikes – that’s a recipe for foot and ankle sprains and worse,” cautions Dr. Suttle, a member of the American College of Foot and Ankle Surgeons.
“Kids will play with lingering, nagging heel pain that, upon testing, turns out to be a stress fracture that neither they, their parents nor their coaches were aware of,” she said. “By playing with pain, they can’t give their team 100 percent and make their injuries worse, which prolongs their time out of soccer.”
Dr. Suttle said she has actually had to show parents x-rays of fractures before they’ll take their kids out of the game. “And stress fractures can be subtle – they don’t always show up on initial x-rays.”
Symptoms of stress fractures include pain during normal activity and when touching the area, and swelling without bruising. Treatment usually involves rest and sometimes casting. Some stress fractures heal poorly and often require surgery, such as a break in the elongated bone near the little toe, known as a Jones fracture.
“Soccer is a very popular sport in our community, but the constant running associated with it places excessive stress on a developing foot,” Dr. Suttle said. She added that pain from overuse usually stems from inflammation, such as around the growth plate of the heel bone, more so than a stress fracture. “Their growth plates are still open and bones are still growing and maturing – until they’re about 13 to 16. Rest and, in some cases, immobilization of the foot should relieve that inflammation,” Dr. Suttle said.
Other types of overuse injuries are Achilles tendonitis and plantar fasciitis (heel pain caused by inflammation of the tissue extending from the heel to the toes).
Quick, out-of-nowhere ankle sprains are also common to soccer. “Ankle sprains should be evaluated by a physician to assess the extent of the injury,” said Dr. Suttle. “If the ankle stays swollen for days and is painful to walk or even stand on, it could be a fracture."
Collisions between soccer players take their toll on toes. “When two feet are coming at the ball simultaneously, that ball turns into cement block and goes nowhere. The weakest point in that transaction is usually a foot, with broken toes the outcome,” he/she explained. “The toes swell up so much the player can’t get a shoe on, which is a good sign for young athletes and their parents: If they are having trouble just getting a shoe on, they shouldn’t play.”
For further information about various foot conditions, contact one of the doctors at Academy Foot and Ankle Specialists at (817-424-3668 or visit www.texasfootdoctor.org.
Thickened yellow toenails are most commonly a result of a condition called onychomycosis, or fungal toenails. Onychomycosis is most commonly caused by the fungus trichophyton rubrum, T. Rubrum for short, but can also be caused my several other types of fungus. The types of fungus that affect the skin and nails are called dermatophytes. Onychomycosis can also be caused by yeast caused candida as well as several types of molds.
Can Nails become thickened and yellow for reasons other than onychomycosis?
Nails can also become naturally thickened as we get older, and sometimes due to any trauma from running, playing sports, or just simply stubbing your toe. This trauma causes the nail to lift off its attachment underneath, the nail bed, which causes skin cells to start to accumulate underneath the nail bed. The nail bed is normally protected from “shedding” skin cells by the nail plate. This shedding of skin cells happens on the exposed skin of our body and is called keratinization. The skin under the nail does not keratinize in a healthy nail. However, when the nail lifts off the nail bed the nail bed can then start shedding its skin cells through keratinization, causing the nail to appear thick. In this instance, the thick nail is actually not a thick nail. The keratinizing skin underneath the detached nail is causing the nail to appear thick. This is why when you visit the doctors of Academy Foot and Ankle Specialists we will take a section of this nail to send to a pathologist and help us determine if the nail in fact has fungus in it.
So my nails are thickened by trauma or thickened by fungus?
Almost, but that doesn’t completely summarize it. If you’re interested, Dr. Bradley Bakotic, a podiatric dermatopathologist organizes nail unit dystrophy into four different types:
Type 1- Non-mycotic, non-keratinizing nail unit dystrophy
• Traumatic (matrical): median nail dystrophy
• Metabolic: Beau’s lines, diabetes mellitus/peripheral vascular disease
• Inflammatory: psoriatic pitting
• Genetic: some forms of ectodermal dysplasia
Type 2- Non-mycotic, hyperkeratotic nail unit dystrophy
• Trauma/microtrauma (nail bed): traumatic keratinizing nail unit dystrophy, onycholysis
• Metabolic: diabetes mellitus
• Inflammatory: psoriatic keratinizing nail unit dystrophy
Type 3- Primary mycotic nail unit dystrophy
• Keratinizing Dermatophytic (T. rubrum) Saprophytic (S. brevicaulis) Yeasts (rare Candida sp.)
• Non-keratinizing Dermatophytes (T. mentagrophytes) Saprophytic molds (rare Fusarium sp.) Yeasts (Candida sp.)
Type 4- Secondary mycotic nail unit dystrophy
• Any form of type 2 nail unit dystrophy complicated by dermatophytic or non-dermatophytic onychomycosis.
So what can Academy Foot & Ankle specialists offer me for treatment?
Now that we understand that there is more to thickened nails than a simple fungal infection we can discuss treatment. The first thing we will likely do to determine proper course of treatment is to take a small sample of your nail to send to a podiatric dermatopathologist who will then perform special tests on your nail and look at it under a microscope to help pinpoint what is responsible for this thick nail. We will then discuss options for treatment including topical, oral, and laser therapy. You should also eliminate any microtrauma by possibly changing shoegear and keeping nails trim. Unfortunately, there is not one simple cure-all for thickened fungal toenails, but working with the team at Academy Foot & Ankle Specialists we will fight this condition and find a solution together using the most scientifically advanced techniques available.
Come visit Academy Foot & Ankle Specialists at any of our four locations in Southlake, Flower Mound, Hurst, or Keller to for all your foot and ankle with our physicians Dr. Paul Marciano, Dr. Sara Suttle, Dr. Brady Mallory, Dr. Greg Amelung, Dr. Joel Dacus or Dr. Philip Parr.