Pronation: What Runners Need to Know

Many runners have probably heard the word pronation thrown around. But what exactly is pronation? Follow along to learn more about pronation and what you need to know as a runner!

Pronation

In a running context, pronation simply refers to the inward rolling motion of the foot as it strikes the ground during walking or running. Pronation is a natural movement that allows feet to absorb shock and keep ankles and legs aligned during motion. The normal amount of pronation tends to be about 15 degrees. This means the foot rolls inward (towards the body center) about 15 degrees during activity.

Here’s how it works normally. As you push off with your foot, all of your toes are involved in helping this happen. The biggest two toes do the majority of the work, while the other toes provide support. The sole of the foot is in a neutral, flat position during this motion (not tilted inward or outward). The foot begins to roll outward a bit as you push off, and the arch stiffens and rises to to give some stability. Then, as the heel strikes the ground, the foot arch begins to flatten again (rolling inward).

However, many people may pronate (roll inward) more or less than normal. This can lead to issues for runners in particular, who are often repeating foot strikes thousands of times per run. Next, we will take a look at overpronation and underpronation.

Overpronation

Overpronation occurs when your feet roll inwards more than 15 degrees. The ankle continues to roll inward on push off (instead of starting to roll out), meaning the biggest two toes do all of the work and have no support from the other toes. People with flatter feet may be more likely to overpronate. Overpronation can cause issues with your knees, shin splints, and strain on the two big toes.

Underpronation

Underpronation (also called supination) is the opposite of overpronation. Here, the foot is not rolling in (pronating) enough during the toeing off part of motion. The outside edge of the foot and smaller toes end up doing a lot more work than normal. People with high arches may be more likely to underpronate. Some injuries associated with this include plantar fasciitis, ankle sprains, IT band syndrome, and achilles tendonitis.
Avoiding Injury

It’s crucial to get a professional opinion on your movement patterns if you believe you are not pronating correctly. While many people believe particular types of running shoes will help fix under or over pronation, this isn’t really shown consistently by studies. You should consult with a medical professional to get a diagnosis of your gait. They can help you with any therapeutic treatment or custom orthotics you may need to help treat and avoid injury.

Knowing your gait and what adjustments you may need to make is important when you are a runner. Fortunately, Orthopaedic Specialists can help! You should seek diagnosis and treatment from a qualified medical professional like Dr. Stacie Grossfeld if you are injured and want to get back to the activities you love. To schedule an appointment with Dr. Grossfeld, call Orthopaedic Specialists at 502-212-2663 today.

Patient of the Month Kelsey Evans

Meet this month’s patient in the spotlight, Kelsey Evans!

kelsey evans

Having recently suffered a fractured radial head, Kelsey is a brand new patient of Dr. Grossfeld’s. “Even with limited activity, I feel a sense of “freedom” simply due to not needing a cast and because Dr. Grossfeld encouraged movement for faster healing. I’m hopeful that I’ll have no long term issues or restrictions due to the positive outlook I was given since the start of my injury.”

Kelsey and her family show cattle, specifically Chiangus. “We travel across the country competing and promoting our livestock. It’s a project that takes commitment and dedication every single day.”

“Having grown up within the livestock and Agriculture industry, I couldn’t imagine doing anything else as I’ve gotten older and had a family of my own. As you can imagine, the physical demand to achieve this is somewhat large which is why the biggest fear I have is not making a full recovery with my arm.”

So far, Kelsey has been able to maintain a somewhat normal life during recovery. Please join us in wishing her nothing but health and healing in 2021!

Platelet Rich Plasma: A Treatment for Osteoarthritis and Inflammation

Platelet Rich Plasma Is Used to Treat Osteoarthritis and Inflammation

Platelet Rich Plasma is used to treat osteoarthritis and inflammation . PRP is short for platelet rich plasma. Treatment of inflammation and osteoarthritis involves using PRP. This is a new area of orthopaedics called orthobiologics. This is an area of medicine where we use the body to treat the body. PRP is generated by drawing blood from your arm.

Educational image

The patient is having their blood drawn to use for a PRP injection

The blood next goes into a special tube. Then, the tube with the blood is placed in a centrifuge. The centrifuge spins at a rapid rate for 20 minutes. In conclusion, this process separates the platelets and plasma. This combination of blood products is called platelet rich plasma.

Educational for PRP use

The image shows a vial of PRP after the blood has been centrifuged

What is Platelet Rich Plasma’s Indications?

Doctors inject PRP in the area of the body where inflammation and or osteoarthritis is located. The platelets are full of natural anti-inflammatory factors. This reduces inflammation from the injection.

Who is a Candidate for PRP

Good candidates for PRP are people who have osteoarthritis or inflammation. Common diagnosis treated with PRP include tennis elbow, plantar fasciitis, Achilles’ tendonitis, golfers elbow and rotator cuff tendinitis.

People that have a disease process related to platelets are not good candidates. Especially if they  are on medication for their platelet disease. Most people will try other treatment options prior to PRP. The reason being is that most insurance companies to not cover the injection therapy. The treatment becomes an out of pocket cost.

How Quick Does PRP Work?

Most patients will have good to excellent relief of their symptoms within 2 weeks when used for osteoarthritis. It may take 6 weeks before you feel the feel effect of the PRP if it is for an inflammatory condition such as tennis elbow or plantar fasciitis .

Patient of the Month Sam Shaheen

Meet this month’s patient in the spotlight, Sam Shaheen!

Sam owns and operates Shaheen’s, a 4th generation department store located in The Springs Store on Breckenridge Lane in Louisville, KY. Established in 1922, Shaheen’s has continued to serve the Louisville community with their clothing needs by offering custom in-house embroidery and work apparel. Throughout the pandemic, they have been deemed essential because of the work they do for area hospitals.

sam shaheen

Recently, Sam suffered from a large Achilles tendon tear. While he can’t point to the exact cause of the injury, Sam suspects it is due in part to the many years he used to compete in road races, (racking up 60 miles a week) as well as a fractured leg from his time in the Army.

Luckily, Sam is recovering nicely after receiving a stem cell injection from Dr. Grossfeld. At the age of 68, Sam enjoys keeping up with his yard and playing a round of golf in his spare time.

Working from Home: Ergonomics

Working from home has become a new norm for many people during the coronavirus pandemic. There are a few challenges that come with setting up a workspace at home. Here’s an overview of what you should consider related to ergonomics in a home office.

Physical Setup

The physical layout of your workspace is a great place to start. If you sit while working, the chair you use is important. It should be supportive for your spine, and should allow you to rest your feet flat on the floor. You can also use a footrest to keep your feet flat if that works better for you. Additionally, if your chair has armrests, they should keep your arms in a neutral position. If you are using a desk, it should have room for your legs beneath it and should be compatible with your chair to create an ergonomic position.

If you are using a monitor or laptop, the screen should be about an arms length away from you and should be at or just below eye level. A keyboard and mouse can also be helpful, and can be set up to allow your arms to rest parallel to the floor. Last, any other accessories you need, from paper to pens and phones, should be within easy reach on the desk and should not require reaching.

Of course, some people prefer standing desks, which are a great option as well. If you use a standing desk, make sure you wear supportive shoes and stand in an upright position. A footrest or pad can help alleviate pressure from the floor as well. Otherwise, the same principals for sitting desk setups apply.

Body Positioning for Ergonomics

You also need to pair good body positioning with your layout for ergonomics. As alluded to before, your arm positioning is crucial. Your elbows should rest flat with the desk surface. This helps create the best wrist alignment. Additionally, you should not hunch over your work. Keep your back and neck straight whether you are using a chair or standing. Your monitor setup should allow you to keep your eyeline parallel to the floor, or at a slight downward angle.

Good Movement Practices

There are a few movement-related practices you should consider for ergonomics as well. For one, it can be easy to stay in the same position for long periods of time at home. There may be fewer opportunities for movement and interaction than in the office. Make sure you get moving regularly, every 30 minutes or so. This helps you break up static body positioning and avoid injuries that can develop from poor body positioning and movements. Even just a short break or walk can be helpful. Eye strain can be an issue as well. To avoid this, make sure you take an eye break from work every 20 minutes or so. You can simply look away from your work and focus on something farther away for about 20 seconds. This gives your eyes a needed break.

You should seek diagnosis and treatment from a qualified medical professional like Dr. Stacie Grossfeld if you are injured and want to get back to the activities you love. To schedule an appointment with Dr. Grossfeld, call Orthopaedic Specialists at 502-212-2663 today.

Patient of the Month Miranda Der Ohanian

Meet this month’s patient in the spotlight (and newlywed) Miranda Der Ohanian!

Miranda Der Ohanian

When asked what it was like to plan a wedding during the pandemic, she said, “Planning a wedding during a pandemic meant throwing all our plans out the window. Thankfully my husband and I wanted a small wedding and our church was equipped to accommodate the number of guests for both the ceremony and reception with social distancing measures. With the help of family and friends we made all the decorations and made the main dishes for the reception. To support our local community we purchased sides from our favorite restaurants. We were thankful to have help from friends at church to serve food and keep everyone safe and healthy. In the end, we had a perfect day sharing our love before God and our family and friends.

In addition to her wedding, Miranda recently endured several foot fractures.

“Having never broken a bone before, living through 6 fractures in my foot has been a learning experience. The first few weeks I lived in a recliner. Most days were counted in hours from pain meds, ice, heat, repeat. The knee scooter was an unexpected blessing. I felt a measure of independence having it. After 8 weeks of no walking and using the scooter, I was afraid to try to put weight on my foot, but did it anyway. After another month, I started PT. Even now, walking and going up and down stairs is difficult for me. PT continues and movement is slowly returning. The worst part of recovery for me was not being able to help my family. We had just moved into a new house and instead of helping, my parents and (then) fiance now had to care for me AND unpack. I am blessed to have a loving family who helped me through this process and made our home beautiful in the process.”

Dr. Grossfeld and Angel have been instrumental in my recovery. Without their medical care and encouragement, I would not have been able to make such progress. They communicated all the possibilities to me along the way and kept me safe so I could heal properly. When it was time they allowed me to work, then add light pressure to my foot and eventually walk. They knew I was getting married and did what they could to make sure I would walk down the aisle to my husband and do so without a boot on my foot. I am eternally grateful to them for the progress I have made and that my bones have healed!”

Pandemic Injuries

The pandemic has changed the way we live, work, and play. Because of this, there are a multitude of emerging injuries due to changes in how we move and position our bodies. Let’s take a look at some of the most common non-coronavirus related pandemic injuries.

Injuries Working from Home

Many workers have found themselves working from home due to the pandemic. Our homes may not be the best setups for office work, and this can lead to several different injuries. Makeshift home workspaces have replaced office setups. This can mean less supportive chairs, weird table heights, and more. Unsurprisingly, back pain, neck pain, and other musculoskeletal injuries are on the rise.

For many people, un-ergonomic setups have led to overuse injuries as the pandemic stretches on. If your chair or table is an improper height, you may be looking up or down too much to view a computer screen or positioning your arms awkwardly while you write, type, or create.

Additionally, you might find yourself moving around less during the day than you did at the office. This means longer stretches of time in the same position, which can be devastating if it’s a harmful one.

To avoid issues, try your best to create an ergonomic setup. Avoid leaning over or hunching and try to have a table height that matches where your elbows fall. Try to use an office chair if you are sitting too. Also, try to work in some movement throughout the day to break up long bouts of being stationary.

Exercising Too Much, Too Fast

Being cooped up inside has led to an increase in people trying new (or long-forgotten) activities. While this can be a healthy decision, doing too much too quickly can easily lead to overuse injuries. Many people have experienced injuries from doing just that during the pandemic. As a general rule of thumb, always ease yourself into a new activity and gradually build up your intensity and time. Your body takes a long time to get used to the strain of a new activity. Too much new exercise too quickly can cause undue musculoskeletal stress. You should also focus on proper form early on- developing good form from the start can help you avoid overuse injuries.

Trauma Injuries on the Rise

There have also been more of certain exercise-related trauma injuries during the pandemic. For example, with fall sports starting up in many places, injuries are more common than usual. Some of this is linked to higher rates of sedentary behavior throughout the pandemic. Starting back up with exercise all at once puts our bodies at risk.

Some are overuse injuries as alluded to before. Others, though, are trauma injuries like ankle sprains, torn ligaments, and fractures. This has some link to the same sedentary patterns: our bodies are less durable if we are not continuously performing an activity. Going back into a sport that involves quick movements, for example, can lead to a higher risk of ankle-related injuries. Muscles and tendons are not as developed, leading to less stability. With less stability comes that risk of injury.

You should seek diagnosis and treatment from a qualified medical professional like Dr. Stacie Grossfeld if you are injured and want to get back to the activities you love. To schedule an appointment with Dr. Grossfeld, call Orthopaedic Specialists at 502-212-2663 today.

Exercising Safely During the Pandemic

Keeping active during the pandemic is important for your health and wellness. It can be hard to evaluate what the level of risk is with different activities, though. You may have questions like: when do I need to wear a mask, what should I avoid doing, and is it safe to go to a gym? Let’s take a look at the facts to help you make the best decisions as you stay active.

General Considerations During the Pandemic

As with many decisions in the pandemic, a lot of your choices will have to be in context locally. Where you are has a huge impact on what sorts of activities are more or less safe. So, for starters, make sure you follow your state and local-level guidelines. If certain activities are temporarily halted, like going to a gym or gathering with a group to work out outside, heed the advice of your public health officials. If there’s a lot of disease spread in your area, you should be a bit more careful than if community transmission is largely under control where you live.

Additionally, you should take your own risk level into account when deciding between different activities. For one thing, the risk of severe illness from the coronavirus increases with age. A 70 year old is at a higher risk for severe illness than a 20 year old. Additionally, any existing medical conditions may increase your risk. There are several conditions that increase risk, from heart conditions to cancer and obesity. See the CDC’s guidelines here for more information.

With all of that in mind, you can start to think through your options. Now let’s take a look at some of the risks associated with different types of activity.

Outside Activities

In general, we know that interactions outside are much safer than those inside relative to coronavirus spread. Still, it’s important to think through how close you may need to get to other people outside during exercise. If you are running, walking, or cycling by yourself or with a small trusted group, that’s relatively low risk. However, a crowded walking path or park may be a higher risk if you have to be close to other people.

Plus, if you are going to exercise with others, there is a level of risk associated if you get too close with them. Depending on the activity, you may be able to distance or wear a mask to mitigate risk. Keeping any group sizes as small as possible, distancing, only exercising with people you trust, and masking if needed can all help you keep yourself and others safe.

Indoor Activities

Being inside with others is higher risk compared to outside during the pandemic. In many places, indoor spaces like gyms and studios have reopened with many precautions in place. You should consider the layout and precautions for the space you may exercise in. For example, some fitness businesses have been able to keep windows open, increase airflow, enforce good distancing, and require mask-wearing. If these precautions are in place, they create a safer space for exercising.

To conclude, any decision you make about exercising around others is very contextual during the pandemic. Your own risk factors, disease spread in your community, and the specifics of where and how you will be exercising around others all come into play. There is no one size fits all answer here- just make sure you take everything into account as you decide what’s best for you.

You should seek diagnosis and treatment from a qualified medical professional like Dr. Stacie Grossfeld if you are injured and want to get back to the activities you love. To schedule an appointment with Dr. Grossfeld, call Orthopaedic Specialists at 502-212-2663 today.

Broken Bone Versus Fracture: What is the Difference?

Broken Bone Versus Fracture

A broken bone versus a fracture: what is the difference?https://orthoinfo.aaos.org/en/diseases–conditions/fractures-broken-bones/ They both mean the same thing. You will probably hear doctors or health care providers use the word fracture more often than broken bone. https://louisvillebones.com/

For instance, different types of fractures or broken bones occur based on the degree of injury.

Stress fractures

Stress fractures are typically not seen on plain x-rays. They are best visualized on MRI scan. A stress fracture will show up on an MRI as a black line . In addition, a stress fracture will have fluid surrounding the fracture site on MRI. First of all , a plain xray is obtained in the doctor’s office . Secondly , if the fracture is not seen a MRI will be ordered. A stress fracture is typically from repetitive use and not a single traumatic event.

Education to show a stress reaction of a bone on a MRI scan

The image reveals a stress fracture in a calcaneous . The white arrow shows the stress fracture. The yellow circle surrounds the region of bone edema . Which is bleeding or swelling in the bone. The red circle is normal bone and normal appearance on a MRI scan.

Stress Reaction

Stress reaction is a pre stress fracture. Therefore a MRI is also needed to visualize the pathology. A stress reaction is never seen on plain x-ray. In addition, stress reaction typically occurs from repetitive use.

Hairline Fracture

A hairline fracture is seen on plain x-ray. It is a simple line that can sometimes be difficult to identify .

Educational purpose to show a hairline fracture

The black arrow points to the hairline fracture in a tibia. The yellow circle outlines the location .

Occult Fracture

You cannot see an occult fracture on plain x-ray. This is typically from a traumatic event. In other words, if an occult fracture is suspected we treat it like it is broken. On the other hand, if you want to know for sure,  an MRI scan will show the occult fracture.  MRI is very sensitive when it comes to fracture identification.

Compound or Open Fracture

A compound or open fracture is when the bone has come through the skin. Therefore if the  trauma is so severe,  the bone tears through the skin at the time of the injury. A compound or open fracture is a surgical emergency. Surgery is used to clean out the wound and open fracture. In addition, there is a high infection rate with open or compound fractures.  Conversely,  a closed fracture is a broken bone that does not stick out through the skin.

Comminuted Fracture

A comminuted fracture has more than two pieces . These are typically high energy injuries. Because of this many comminuted fractures require surgery to realign the pieces of bone.

Education to show a comminuted fracture of a tibia

The image reveals a comminuted fracture of the tibia. The tibia is the shin bone. A comminuted fracture has more than two pieces

 

 

 

Injection Options for Knee Osteoarthritis

 

Injection Options for Knee Osteoarthritis

Different injections therapy used to treat knee arthritis range from cortisone, hyaluronic acid to PRP (platelet rich plasma ) . The injections do not replace the damaged cartilage in the knee. However , the injections work well to control the symptoms of knee arthritis. Therefore, they reduce swelling, decrease stiffness, reduce giving way, improve range of motion and reduce pain.https://louisvillebones.com/

To educate what an arthritis knee xray look like and the detail of bone on bone

A knee x-ray that shows advanced knee arthritis. The red circle shows the bone on bone area on the x-ray where the advanced osteoarthritis is located.

Cortisone Injections

Cortisone is a short acting injectable anti inflammatory medication. Because of this, cortisone  typically reduces systems of knee arthritis up to and sometime beyond three months. The medication is giving via an injection in the office. Above all, it is a very simple and almost painless procedure . Therefore getting a cortisone injection in the knee feels like a flu shot. First of all, the provider easily identifies the knee joint and the injection is preformed. Because the knee joint is very superficial it is easy to inject. A provider that is familiar with knee injections doesn’t need ultrasound guidance to accurately inject a knee joint. Cortisone typically takes 2-5 days to start reducing symptoms.

An image of different bottles of cortisone used for injection

Cortisone is an injectable to treat arthritic knees.

Hyaluronic Acid Injections

Hyaluronic Acid also know as the chicken injection or the chicken fat injection. My practice uses Gel one when insurance covers. The single shot injection only requires on office visit. It. Sodium hyaluronate (hyaluronan) is the active ingredient . Hyaluronan comes GelOne® comes from chicken combs and is highly purified. https://www.zimmerbiomet.com/medical-professionals/biologics/product/gel-one.htmlHyaluronan is  a natural substance in the human body and is present in very high amounts in healthy joints that do not have arthritis . This injection will typically  last 6 months to a year. Medicare covers 80% of the cost and the secondary insurance typically picks up the remaining 20%.

An image of a syringe with Gel one an injection that is used to help reduce the symptoms of knee arthritis . The photo is for education purposes

Gel-one is hyaluronic acid that is an injection used to reduce the symptoms of knee osteoarthritis

 

PRP Injections

PRP is Platelet Rich Plasma treats the symptoms of knee arthritis. It is experimental per some insurance carriers. Tricare , which is for active duty military personal will cover the cost. Most other carriers will not cover the cost. We use the patient’s own blood for the procedure . A centrifuge separates out the platelet rich plasma from the other blood components . After that, we inject the PRP into the knee joint. The whole process takes about 30 minutes. The PRP helps to reduce the inflammation in the arthritic knee joint . Therefore,  the patient has less symptoms .