• What Are Orthotics including Custom Orthotics?

    Posted by Orthopaedic Specialists

    Custom orthoticsAn orthotic is a device that is placed inside your shoe to help correct foot malalignment. An orthotic, including custom orthotics, is a supportive insert that fits into your shoe.

    Orthotics can help people with foot pain and common foot conditions such as: plantar fascitiis, foot pronation, patella femoral pain, bunion deformities, metatarsalgia, posterior tibialis tendinitis, posterior tibialis tendon ruptures / tears, stress fractures and Achilles tendinitis, just to name a few.

    3 Different Types of Orthotics including Custom Orthotics

    There are three different types of orthotics: 1) custom, 2) semi-custom and 3) off the shelf.

    Custom orthotics are the best type of orthotic. Custom orthotics fit your foot perfectly and are specifically designed for your foot type and alignment. A healthcare provider who is certified in making custom orthotics will measure your foot. This typically involves creating some type of cast of your foot to get precise measurements.

    The different type of healthcare providers that can make orthotics are: physical therapists, orthotists, and podiatrists. Typically after the custom orthotics are made there will need to be minor adjustments completed once you have tried the orthotic on inside your shoe.

    How to Buy Custom Orthotics?

    Most insurance plans will pay for custom orthotics. Another option if your healthcare provider does not include orthotics as a benefit is an off-the-shelf orthotic that is heated in the store and molded to your foot. These typically run about $30 to $50 dollars a pair.  A large percentage of running shoe stores will carry this option.

    Be careful of “Foot” stores that claim to make custom orthotics and are actually pulling an off-the-shelf device and just molding it to your foot. These places sometimes charge hundreds of dollars and your money is best spent with a true pair of custom orthotics (more…)

    Foot Bones Quiz

    Posted by Orthopaedic Specialists

    Foot BonesHow Much Do You Know About The Bones In Your Feet? Take this quiz about foot bones and find out!

    Q 1. How many bones are in your foot?

    A. 26

    Q 2. Can you name all the bones in the foot?

    A. Calcaneus, talus, navicular, cuneiforms, cuboid , metatarsals, proximal phalanx, middle phalanx and distal phalanx (also known as phalanges)

    Q 3.  Can you be born with an extra bone in your foot?

    A. Yes, it is called an accessory navicular. Most of the time they do not cause any problems. It it does become problematic it can be removed.

    Q 4. Does your foot have any bones encased in a tendon?

    A. Yes, you have two on each foot. They are called sesomoids. They are located under the great toe joints they can become fractured in runner.

    Q 5. Can your shoe size get larger after you have stopped growing taller?

    A. Yes, however it is not from the foot bones growing longer. It typically has to do with bunion formations or tendon ruptures that can change the shape of the foot and make a larger shoe size needed. (more…)

    Do You Have Foot Pain? It’s “Be Good To Your Feet Month” At Orthopaedic Specialists

    Posted by Orthopaedic Specialists

    Foot Pain and Foot CareLouisville’s Orthopaedic Specialists is celebrating “Be Good To Your Feet Month” to offer some relief to those suffering from foot pain. Board certified orthopedic surgeon and sports medicine physician Dr. Stacie Grossfeld is focusing on the importance of healthy feet and foot care to eliminate foot pain during the month of October.

    With 26 bones in each foot, 33 joints, over 100 ligaments, and around 125,000 sweat glands, the team at Orthopaedic Specialists emphasizes that caring for your feet is an important part of health and wellness.

    As an orthopedic surgeon and sports medicine doctor with a private practice in Louisville, Kentucky, Dr. Grossfeld is accustomed to seeing patients with foot pain and a wide range of foot injuries and problems. This month Orthopaedic Specialists is focused on offering educational information and preventive tips to help people treat their feet a little better. Some upcoming blog topics include: plantar fasciitis, bunions, orthotics, the best footwear, and much more.

    While people of all ages suffer from some type of foot pain or injury, foot problems tend to become increasingly common as people get older.  Many seniors experience some type of foot injury or problem, and this can cause pain and disability, paired with problems with mobility and independence.

    Some common foot conditions that Dr. Grossfeld sees at her Louisville orthopedic and sports medicine practice include: osteoarthritis, bunions, plantar fasciitis, blisters, toe deformities, bone fractures, heel spurs, stress fractures, and tendinitis.

    While basic foot care is important to everyone, certain athletes may be prone to specific types of foot injuries and problems. For example, football players may be more likely to suffer from turf toe, while some long distance runners may be prone to plantar fasciitis and ballet dancers may be more likely to experience pain under their big toe caused by sesamoiditis.

    If you are suffering from some type of foot pain that is not going away, you may need to seek help from a qualified medical provider like orthopedic surgeon Dr. Stacie Grossfeld at Orthopaedic Specialists. (more…)

    Rotator Cuff Surgery and Risk for Recurrent Tearing

    Posted by Orthopaedic Specialists

    Rotator cuff surgery and repairFactors Predicting Rotator Cuff Tears that are at Risk for Recurrence Tearing at the Time of Surgery

    Once the rotator cuff is repaired what are the chances of a tear recurring? There have been multiple studies completed to verify risk factors for recurrence of re-tearing of the surgically repaired tendon.

    Surgical reconstructed is recommended on symptomatic patients that have full thickness tears and have partial thickness tears that involve over 50% of the tendon. One of the most common postoperative complications in reference to rotator cuff surgery is a recurrent tear.

    Even after surgical reconstruction the rotator cuff can re-tear. There have been studies reporting recurrent tear rates from 11 to 94%. What are the risk factors that would indicate a surgically repaired rotator cuff could re-tear? Risk factors  that have been identified in prior studies are: large tear size measuring from anterior to posterior  in addition to medial and lateral tear size ( retraction distance) , surface area of the tear size, older age of the patient, the existence of fatty replacement of muscle  , presence of muscle atrophy and quality of the torn tendon.

    The above factors have been reported in smaller sized studies typically under 200 patients. The biggest study to date with the most amount of patients was reported in the May, 2014  issue of the American Journal of Sports Medicine. The study was led by Brian Le MD from the University of South Wales, Sydney, Australia.  Their study included 1,000 consecutive patients who it undergone a primary rotator cuff repair by a single surgeon using arthroscopic technique.

    Six months after the rotator cuff surgery an ultrasound was completed to assess the repair integrity. The authors found that the most important factor in predicting recurrent tearing of the rotator cuff was the size of the rotator cuff tear at the index surgery. The research team also found a strong relationship between recurrence rates in patients who had poor tissue quality, poor intra operative tendon immobility and had a second surgical procedure performed in the shoulder at the time of the rotator cuff tear.

    In addition, the researchers found that a patient’s age at the time of rotator cuff surgery was a strong independent predictor of recurrent tear rates, with increasing age linked to increasing likelihood. When comparing the rotator cuff tear size from side to side versus the distance the tear was retracted, they found that the side to side tear size was more (more…)

    Nineteen Key Facts About Anterior Traumatic Shoulder Dislocation

    Posted by Orthopaedic Specialists

    shoulder dislocation1. Almost half of the people suffering from a shoulder dislocation are between 15 and 29 years of age.

    2. Males dislocate their shoulders three times more than females.

    3. A quarter of the people who have an anterior shoulder dislocation will require surgical stabilization secondary to persistent instability.

    4. Half of the patients who sustain a first episode of shoulder dislocation will most likely experience two more episodes.

    5. Moderate to severe osteoarthritis has been reported in 18% of patients with a first time dislocation, and up to 40% of patients who have more than one shoulder dislocation.

    6. Recurrence rate following nonsurgical management of traumatic shoulder dislocation ranges from 30% to 67%. This rate increases to 55% up to 82% in young male athletes.

    7. The biggest risk factors for recurrent instability after shoulder dislocation includes: young age, athletic activity, male gender, and the presence of a bony Bankart lesion. There are some studies that have concluded that males, that play contact sports, under age 20 are the highest risk for recurrence of anterior shoulder instability after first time this location.

    8. Nonsurgical management is the initial treatment of choice for first time dislocators. It is recommended that the athletes be in a sling for up to 1 to 4 weeks. Range of motion is typically started at one week post injury.

    9. Stabilizing structures at risk after dislocation: the glenoid labrum, the bony glenoid rim, the anterior capsule and the anterior band of the inferior glenohumeral ligament

    10. The shoulder is at risk for dislocation because of its wide range of motion, a shallow glenoid articulating with a nearly spherical humeral head. This makes an inherently unstable configuration relying on other structures to prevent instability, including static structures such as the glenoid labrum, joint capsule, and the glenohumeral ligaments.

    11. The glenoid is pear-shaped and measures 5 cm in its position from top to bottom and 2.5 cm and it’s inferior anterior posterior dimension. It is relatively shallow with a concave any measuring 2.5 mm deep.

    12. The labrum increases the depth of the glenoid by 2.5–5 mm. The capsule provide the negative hydrostatic pressure between the humeral head and glenoid making it more stable.

    13. The anterior inferior rim of the glenoid is important to anterior inferior glenohumeral stability. During an anterior shoulder dislocation, the glenoid rim may have avulsed at the bony attachment of the anterioinferior capsulolabral complex. (more…)

    Dancing and ACL Tear

    Posted by Orthopaedic Specialists

    Ballet dancers less likely to experience ACL injuryWhy do dancers (ballet and modern) have a lower incidence of ACL injury compared to other athletes?

    A great study conducted at the Harkness Center for Dance injuries in New York City in conjunction with the Langone Medical Center Hospital for Joint Diseases looked at the biomechanics of landing from a jump between the two groups. It was a two part study published in the American Journal of Sports Medicine in May of 2014. The research group was headed by Dr. Marijeanne Liederbach.

    It is documented that poor landing mechanics from a jump such as a rebound can lead to an ACL tear and injury. Poor biomechanics such as an increase in knee abduction, hip adduction, low flexion angle when landing, increase use of quadricep muscles compared to hamstring muscles, and excessive truck tilt results in a higher incidence of ACL injury.

    The study looked at 4 groups of athletes: male and female, dancers and team sport athletes. They had the athletes do a single leg drop jump from a 30 cm platform. Joint kinematics and kinetics were compared between groups and genders using multivariate analysis of variance and pair wise t tests.

    They found that the male team sport group was similar to both the male and female dancers. They found that the team sport females exhibited poor landing techniques which would place their knee at increased risk of an ACL tear or injury.

    The hypothesis from the authors as to the reason the female dancers had excellent landing techniques was that dancers spend hours working on jumping and landing techniques which start at an early age in their training and continue throughout their career.

    The second part of the study looked at the 4 groups and what happened to their landing technique when they were fatigued. The study found that the dancers took typically a longer period of time before they became fatigued. Once they did become fatigued they start exhibiting signs of poor landing techniques.

    This study shows how it is important to focus on strengthening the muscles around the hip and knee in addition to making sure that the athletes have excellent landing techniques if an ACL tear is going to be prevented. (more…)

    Hip Survey

    Posted by Orthopaedic Specialists

    Are you a cyclist who has experienced a hip injury while biking? If yes, please consider participating in a survey Dr. Grossfeld is doing to better understand hip injuries for cyclists. For more info, see: Hip Injury Survey. Thank you for your participation!

     

     

    Rotator Cuff Pain

    Posted by Orthopaedic Specialists

    Woman with shoulder painWhy do rotator cuff tears and rotator cuff tendinitis hurt so much?

    As a shoulder specialist, one of the most frustrating situations is trying to control a patient’s pain, when they present with a rotator cuff tear or rotator cuff tendinitis. Rotator cuff pain, after rotator cuff surgery, can be significant. Rotator cuff pain often tends to intensify at night, especially if a person is sleeping on their injured side.

    As physicians, we are unsure as to why rotator cuff pathology causes so much rotator cuff pain and have not been very good at controlling it.

    High dose pain medications such as Percocet, hydrocodone, or even oral Dilaudid, have been used without great success.

    A scientific break through in identification of one of the sources of rotator cuff pain has been identified in a study conducted at the University of Oxford published in the August 2014 American Journal of Sports Medicine. Authors Sarah Franklin PhD et al. looked at the role of glutamate and the glutaminergic system.  (more…)

    Posterior Shoulder Dislocation

    Posted by Orthopaedic Specialists

    Posterior Shoulder DislocationPosterior Dislocations of the Shoulder

    There are several types of shoulder dislocations. They are named based on the direction of the dislocation.

    The most common type is the anterior dislocation where the shoulder comes out the front. Another type of shoulder dislocation is posterior: this is where the shoulder dislocates out the back.

    A posterior shoulder dislocation is rare.  Anterior shoulder dislocations occur 15-21 times more often than a posterior shoulder dislocation but the etiology of the posterior dislocations are consistent. We see this in people who have had seizures,  high energy trauma such as an auto accident, or have been electrocuted.

    The posterior  shoulder dislocation gets missed or has a delay in diagnosis up to 79 percent of the time.

    The orthopedic doctor should be suspicious of additional injuries associated with a posterior shoulder dislocation. Up to 55 percent of the time there is an associated neck injury and 23 to 42 percent of the time a fracture involving the shoulder bone (greater and lesser tuberosity) occurs at the time of the posterior shoulder dislocation.

    If the dislocation is caught early after the injury, a closed reduction can be performed in the emergency department. This is performed with a light anesthetic. (more…)

    Knee Surgery Among College Athletes

    Posted by Orthopaedic Specialists

    knee surgery and college athletesEffects of knee surgery on a subsequent injury and surgery among NCAA college athletes

    Dr. Sharon Hume et al. published a very interesting article in the April 2014 issue of the American Journal  of Sports Medicine. She and her colleagues studied 456 Division 1 athletes at UCLA who had a history of an orthopaedic surgery procedure.

    They identified a 6.8 fold increased chance of sustaining another knee injury if the athlete had a history of prior knee surgery. There was a staggering 14.4 fold chance that the athletes with a history of a prior knee surgery would end up undergoing another knee surgery.

    ACL Reconstruction May Increase Risk Of Additional Knee Surgery for College Athletes

    The group of college student athletes that was at extreme risk of an additional knee surgery were the student athletes that had undergone an ACL reconstruction prior to starting their collegiate career.

    If a student had an ACL reconstruction before starting college, there was an 892 fold increased risk that they would undergo a second knee surgery during college while playing D-1 sports. There was a 19.6 fold chance that those athletes would experience an additional knee injury.

    These research findings suggest that teaching young athletes about ACL injury prevention is more important than ever to reduce the risk of knee injuries (more…)