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Plantar Fasciitis Symptoms and Risk Factors

ankle-painAre you one of the over 2 million Americans who is suffering from plantar fasciitis this year? If you have stabbing pain in your heel right after getting out of bed or after long periods of standing or sitting you could be suffering from plantar fasciitis.

Plantar fasciitis is one of the most common causes of heel pain and it is caused by inflammation in the thick band of tissue – plantar fascia – that stretches across the bottom of your feet, connecting your heel to your toes.

Plantar fasciitis affects some groups of people more than others. If you fit into any of the categories below, you may be at increased risk for plantar fasciitis:

• Middle – aged individuals: Plantar Fasciitis is most commonly experienced by people between 40-60 years of age
• Occupations that require standing: People who are on their feet a lot are more likely to develop plantar fasciitis. This could include teachers, factory workers, soldiers, nurses and anyone else who stands a good portion of the day.
• Overweight individuals: Individuals who carry extra weight are at an increased risk for plantar fasciitis because the additional pounds add stress to your plantar fascia
• Active individuals: Any exercise that puts lots of stress on your heel and the attached band of tissue can lead to early-onset Plantar Fasciitis. Ballet dancers, runners and dance aerobicizers commonly develop plantar fasciitis.
• Individuals with impaired foot mechanisms: High arches, flat feet, or an irregular walking pattern can lead to incorrect weight distribution while standing. This puts additional strain on the plantar fascia in your feet and can lead to extreme heel pain.

It is important not to ignore heel pain, especially if it is so extreme that it gets in the way of your daily activities. Brushing aside plantar fasciitis may cause you to adjust the way you walk to decrease pain, which can lead to foot, knee, hip or back problems over time.

If you think you may have plantar fasciitis a good first treatment is rest! Cut back on the activities that hurt your heel. You can also try stretching your calves, toes and quads in order to reduce the pressure on the heel. If these simple remedies do not work, it is important to talk to your doctor so he or she can suggest the best treatment plan for you.

Related Links:

Plantar Fasciitis

Plantar Fasciitis PDF

How to Prevent Plantar Fasciitis – A common Running Injury

Emory Doctors Relieve Chronic Heel Pain with New Shock Wave Therapy System – A First in Atlanta

Rami Calis, DPMAbout Rami Calis, DPM:

Rami Calis, DPM, is assistant professor in the Department of Orthopedics. He is board certified and a Diplomate, American Board of Podiatric Orthopedics and Primary Podiatric Medicine, with an interest in sports medicine of the lower extremity and foot and ankle biomechanics. Dr. Calis sees patients at Emory Orthopaedics & Spine Center at Executive Park and also in Sugarloaf, at our satellite office. Dr. Calis’ professional goal is to improve patient care and quality of life for patients with foot and ankle problems. Dr. Calis began practicing at Emory in 2003.

Hand and Upper Extremity Live Online Chat

hand-upper-caloutDo you have hand, wrist or elbow pain that is keeping you for your daily activities? If so, join Emory Orthopaedic Surgeon, Dr. Claudius Jarrett on Tuesday, July 23 for an online web chat to discuss various topics related to hand and upper extremity conditions in the hand, wrist and elbow such as:

  • What is the difference between a fracture and a sprain?
  • What are the most common injuries that occur from falling down on an outstretched hand?
  • What is carpal tunnel syndrome?
  • What types of hand and wrist problems need surgery?
  • How do you treat arthritis in the hand?
  • What does it mean if it have numbness and tingling in my hands at night?
  • Is Emory involved in any research regarding new treatments of hand and upper extremity conditions?

CHAT TRANSCRIPT

Takeaways from Dr. Bradbury’s Hip and Knee Replacements Chat

Thank you for participating in the online chat on Hip and Knee Replacements.  We had a lot of really great questions.  We received a few questions a couple times so we will highlight the answers to those questions here!

What is the longevity of knee replacements?

The lifespan of a knee replacement is related to the body weight and activity level of the individual who receives the replacement.  Individuals who are very active often reduce the longevity of their knee replacement because high activity can put extra stress on the implant leading to loosening of the implants from the bone or “wearing” of the parts used to replace the joint.  Being overweight increases the forces on implant and can also lead to early failure.  In general, 15 year survivorship of modern knee replacement designs used in  good candidate is around 90 percent.

Typically for younger patients,  if x-rays do not show complete loss of cartilage, “bone on bone”, I recommend waiting as long as possible to have the knee replacement surgery.  However, if there is “bone on bone” arthritis, knee replacement is the most effective treatment, but the risks of early failure are increased.

What exercises can I do for a total knee replacement?

Low impact aerobic conditioning 4-5 times per week for 4-6 weeks prior to surgery is best.  Low impact activities include swimming, elliptical, or stationary  bike.

“Prehabilitation” is rehabilitation to get your body ready for the surgery so you can recovery as quickly as possible after surgery.  Instruction during this period should be focused on strengthening the muscles around the joint.  The prehabilitation period should last for several weeks before surgery.

How long is recovery after hip/knee replacement?

It is best to think of how long it takes to reach recovery milestones -

• For hip replacement, pain is typically better than what it was prior to surgery in 2-3 weeks, normal walking typically occurs by 6-8 weeks and full recovery typically occurs within 3-4 months.

• For knee replacement, pain is typically better than what it was prior to surgery by 4-6 weeks, normal walking typically occurs by 8-10 weeks and full recovery typically occurs within 4-5 months.

Thank you again for attending the chat. I hope you found the information useful!  If you have questions or would like to schedule an appointment with an Emory Orthopedic Surgeon about hip or knee replacements please call 404-778-7777.

>>Read the full transcript from the online chat here!<<

About Dr. Bradbury

Dr. Bradbury is an Assistant Professor of Orthopaedic Surgery at Emory. He specializes in hip and knee arthroplasty. He really enjoys this area of orthopaedic surgery because of the consistency of success in the properly selected patient. Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems.

His research interests center around infections involving hip and knee replacements which are rare, but difficult problems. Dr. Bradbury is researching the success rate of current treatment methods for hip and knee replacement infections caused by resistant bacteria (MRSA). Through his research, he hopes to find better way to both prevent and treat periprosthetic hip and knee infections.

Related Links

8 Types of Low Back Pain that Mean You Should Visit Your Doctor

Back pain warning signOver 80% of the population will suffer from lower back pain at some point in their lives. Low back pain is a common complaint in medical offices and is a common issue causing many people to miss work and be unable to participate in daily life activities. Sometimes back pain is due to a pulled or strained muscle and many times will not require a trip to your doctor’s office. Other issues such as fractures, tumors and infections of the spine are very serious and need to be evaluated by a physician promptly.

Patients should see a doctor immediately if they experience low back pain as a result of severe trauma. Patients should also make an appointment with a doctor if low back pain is accompanied by any of the following: fever, loss of bowel or bladder control, serious trauma, numbness, unplanned weight loss, personal history of cancer, back pain that persists more than 6 weeks, or severe night pain.

Fever and Back Pain
Fever combined with back pain can indicate an infection in your kidneys or back. A primary care physician can determine if you need antibiotics to eliminate the infection.

Loss of control of your bowel or bladder and Back Pain
If you have back pain along with new incontinence, you could have a serious back condition causing pressure on the nerves that requires immediate medical care.

Serious Trauma and Back Pain
Trauma such as a car accident or falling down a flight of stairs can cause a fracture in your back. Seek immediate care from your physician or the emergency department.

Numbness or Tingling in Leg and Back Pain
Numbness on tingling in your leg and back pain could indicate nerve irritation or nerve damage. You could have a herniated disc or spinal stenosis. A doctor can prescribe medications, treatments or even surgery to help relieve the pressure on the nerves.

Unexplained weight loss and Back Pain
If you lose a lot of weight without changing your diet or activity level and have back pain, a doctor should order imaging and blood work to check for cancers or hormonal disorders.

History of Cancer and New Back Pain
If you have had cancer, onset of back pain could be a sign that cancer has spread to you spine. You should visit your physician for further evaluation.

Back Pain at Night
Pain in your back that causes you to lose sleep should not be dismissed. This could be a sign of spinal tumors or even cancer.

Back pain that lasts more than 6 weeks
Any pain that lasts more than a month or two should be evaluated more fully.

If you experience significant trauma and back pain, an evaluation in the Emergency Department is indicated. In most other cases, your primary care physician can evaluate your condition and begin treatment. . If he or she is unable to help with your condition he can refer you to a spine specialist.

For more information about low back pain, visit Spine-Health.com. Our spine physicians at Emory regularly contribute content to this website for not only our own patients, but for anyone searching for spine information.

Dr. Susan DreyerAbout Susan Dreyer, MD
Dr. Dreyer is an Associate Professor in the departments of Orthopaedics and Physical Medicine & Rehabilitation at Emory University School of Medicine. Dr. Dreyer specializes in non-operative spine care and focuses on helping patients achieve their best functional level. She has taught many national and international courses on spine care and spinal injections for sciatica and other causes of back and neck problems. She is also active in several professional societies. Dr. Dreyer started practicing at Emory in 1992.

 

Related Resources:

Did you know that July is Juvenile Arthritis Awareness Month?

We are all painfully aware that arthritis affects many older adults, but did you know that kids can develop juvenile arthritis?

Approximately 294,000 children age 16 or younger are affected by pediatric arthritis and rheumatologic conditions.
In adults, arthritis typically affects the joints. While juvenile arthritis can cause bone and joint growth problems, it also can affect the eyes, skin, and gastrointestinal tract.

The most common symptoms of juvenile arthritis are joint swelling, pain, and stiffness that won’t go away, particularly in the knees, hands, and feet. Symptoms are generally worse in the morning and after naps. Other signs of juvenile arthritis include:

•    Limping due to a stiff knee

•    Excessive clumsiness

•    High fever and skin rash

•    Swelling in the lymph nodes

The most common type of juvenile arthritis is juvenile idiopathic arthritis. (Idiopathic means “from unknown causes.”) You may have heard this referred to as juvenile rheumatoid arthritis. This type of arthritis is diagnosed when a child has swelling in one or more joints for at least six weeks.

There are several different types of juvenile idiopathic arthritis. The type is usually determined by the number of joints affected as well as by the results of a rheumatoid factor blood test. While children may have a genetic predisposition that makes them more likely to develop the disease, at this point, researchers have not determined a direct cause, and there’s no evidence that toxins, foods, or allergies can cause it. Most children with juvenile arthritis experience remission, when the symptoms get better or go away, and times when symptoms flare, or get worse.

If your child has juvenile arthritis symptoms, the first thing to do is get an accurate diagnosis. Your child’s pediatrician can run tests that will rule out other potential causes, but if the signs point to juvenile arthritis, he or she may suggest you make an appointment with a pediatric rheumatologist.

There is no cure for juvenile arthritis; however, a number of treatments can improve your child’s quality of life, including:

•    Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and analgesics to help relieve inflammation and control pain

•    Disease-modifying anti-rheumatic drugs (DMARDs) and a biologic response modifiers (biologics), which can alter the course of the disease, put it into remission, and prevent joint damage

•    Splints to help keep joints in the correct position and to relieve pain and orthopedics or shoe inserts to compensate for any difference in leg length or to improve balance

•    Physical therapy to help restore motion and flexibility in joints that have become stiff and occupational therapy to help children learn how to do basic activities without aggravating their arthritis

And, of course, it’s super important for kids with juvenile arthritis to eat healthy foods and get regular moderate exercise, to keep joints strong and flexible.

Does your child have juvenile arthritis? How does your family cope? We welcome your questions and feedback in the comments section below.

Emory Plays a Key Role in Accelerated Bone Healing

Dr. Scott Boden Emory HealthcareAt Emory Healthcare, we’re always looking for new and better ways to treat patients. Bone healing, particularly after spine fusion surgery, is one of the many areas in which we’ve pioneered research that can significantly improve our patients’ quality of life. For more than two decades, the Emory Orthopaedics & Spine Center has been instrumental in developing technology to improve bone healing, accelerate the speed of healing, and prevent the need to “borrow” bone graft.

While some broken bones heal quickly and easily, certain types of leg bone fractures and high energy traumatic fractures often need extra help. In some cases, bone graft has been used in the treatment of difficult fractures, segmental bone loss, and fusion of other joints in the body that may have severe arthritis (e.g., foot joints). At Emory, spine fusion represents 50% of the reason our surgeons would harvest bone graft in the past. Many spine operations involve getting bone to grow in the spine, where it normally doesn’t grow. Also, for certain types of long spine fusions, there’s often not enough bone. Traditionally, the surgeon would harvest bone graft from the patient’s hip (pelvis). This process, called an iliac crest bone graft harvest, often causes patients to complain of chronic pain at the bone donor site.

So how do we accelerate bone healing and avoid the use of bone graft? Emory has participated in laboratory studies and clinical trials to work out the details of how to use special proteins in humans. The first procedure was approved by the FDA in 2002. The approval is for only very specific indications, so work is ongoing to optimize these proteins for more broad use. Since we at Emory are very familiar with the science and development of these proteins, we’re able to use them safely in a variety of individual patient cases. In some situations, use of these proteins can prevent the need for bone graft harvest from the hip and result in better healing.

Some of the newer bone-healing technologies have only limited approval by the FDA and can be associated with some local side effects, so their use is not as broad unless they are being used by a very experienced surgeon or as part of a research trial—such as those conducted at Emory. Over the next five to 10 years, you can expect these new bone healing technologies to be more commonly used. If you’re having surgery at Emory that requires bone grafting or bone healing, ask your surgeon whether bone healing technology is a viable option for you.

Have you had a bone graft or surgery using new bone-healing technology? We welcome your questions and feedback about accelerated bone healing in the comments section below. For more information on accelerated bone healing technology at Emory, watch the short video below:

About Dr. Boden

Scott D. Boden, MD, Director of the Emory Orthopaedics & Spine Center and Professor of Orthopaedic Surgery, is an internationally renowned surgeon, lecturer, and teacher and the driving force behind the Emory University Orthopedics and Spine Hospital (EUOSH). Dr. Boden started practicing at Emory in 1992.

Orthop(a)edics 101

Orthopedics 101Is it “orthopaedic” or “orthopedic”? What does “musculoskeletal” really mean? What’s the difference between a ligament and a tendon? Today we’re going to answer some of the more pressing questions people have about this fascinating area of medicine.

First off, let’s discuss the use of orthopaedic v. orthopedic. Orthopaedic is derived from the Greek orthos, for correct or straight, and paideion, for child. Today, orthop(a)edics refers to the correction of spinal and bony deformities in both children and adults. In the U.S., we like to keep things simple, so “orthopedics” has become the standard spelling. In Great Britain and its other former (non-U.S.) colonies, orthopaedics is preferred. The academic world, like the Brits, enjoys fancying things up, so in most universities and other academic settings, orthpaedics stands. Microsoft Word prefers it without the “a.” Take your pick.

Simply put, orthopaedic (or orthopedic) surgery is the branch of surgery concerned with conditions of the musculoskeletal system. What’s the musculoskeletal system? Clearly, it’s a system that involves the muscles and the skeleton. Also called the “locomotor system,” the musculoskeletal system includes the parts of your body that help you move. And help you stay in one place. The bones provide stability, while the muscles help the bones stay in place and move. Joints allow motion, and cartilage keeps the bone ends from rubbing against one another. It’s all about how bones are connected to other bones and joints and muscles by connective tissues called tendons and ligaments.

What’s the difference between a tendon and a ligament, you ask? A tendon (or sinew) is a tough band of tissue that connects the muscle to the bone. A ligament connects bones to other bones. But wait—let’s not forget the fascia. The fascia is a layer of fibrous tissue that surrounds muscles and groups of muscles, as well as blood vessels and nerves, and binds all of these together. The layers of fascia include a superficial fascia (connected to the dermis, or skin), a deep fascia (surrounding the bones and muscles), and a subserous, or visceral, fascia (supporting the organs).

The surgeons and physiatrists at the Emory Orthpaedics & Spine Center are intimately familiar with every aspect of the musculoskeletal system and can diagnose and treat myriad ailments, both surgically and nonsurgically. So if you’re hurting, whether from a broken bone or a stretched or torn ligament or tendon, come see us. With or without the “a,” we know our orthop(a)edics.

As an Academic Medical Center, Emory Provides Superior Spine Care

Dr. Scott BodenI am often asked questions like “Will YOU actually be doing my surgery?” and “Does a teaching hospital mean someone will be practicing surgery on my back?” These questions made me realize that many patients don’t understand what it means to receive care in an academic medical center, so I thought I would try to explain this in more detail.

Most of the differences in a true academic medical center, especially for a spine center, represent benefits that the patient may not even realize. First, to be a physician at an academic medical center, the surgeon also must be a professor, usually in a School of Medicine. As part of the medical school faculty, these physicians, in addition to taking care of patients, are teaching surgical techniques to the future generation of surgeons and/or performing research that is allowing for new discoveries and advancements in the field. This means that patients are exposed to the latest advances in surgical techniques and technology.

In addition, because of the teaching process, the patient will likely have a second MD assisting (helping retract and hold tissues), rather than just one surgeon and a nurse or surgical assistant. I would liken it to a pilot and co-pilot flying an airplane. Spine surgery is serious business, with little room for error, so you can rest assured that at any reputable academic center (such as Emory), the key portions of the surgery will be performed by your surgeon.

A second benefit comes from the collaborative environment in a multidisciplinary spine center. At the Emory Spine Center, one of the largest in the U.S., there are physical medicine/rehabilitation, occupational medicine, psychology, orthopaedic surgery, and neurological surgery physicians all seeing patients side by side every day. This spectrum of physicians ensures that no matter what a patient’s spine problem may be, he or she is sure to find a true expert among the staff. This environment takes the worry away from the patient about which type of specialist to see.

All of the surgical and nonsurgical physicians working at the Emory Spine Center have been fellowship trained (which means they’ve received extra training to specialize in spine care) and spend the majority of their clinical practice diagnosing and treating only patients with spine problems. This level of sub-specialization is harder to find outside an academic center. In addition, academic medical centers usually have the resources to have the latest and highest quality imaging technology—which is also very helpful in spine care.

A third benefit comes from the fact that some of the toughest cases are referred to academic centers. As a result, these physicians have more experience with the toughest problems and rarest complications, so that in the unlikely event you do experience a complication, they are very comfortable diagnosing and managing it to minimize any long-term impact on your outcome.

Most of these and other advantages of an academic medical center typically go on behind the scenes, which is probably why so few people truly understand the difference.

How have you benefitted from spine treatment in an academic medical center? We welcome your questions and feedback in the comments section below.

About Dr. Boden
Scott D. Boden, MD, Director of the Emory Orthopaedics & Spine Center and Professor of Orthopaedic Surgery, is an internationally renowned surgeon, lecturer, and teacher and the driving force behind the Emory University Orthopedics and Spine Hospital (EUOSH). Dr. Boden started practicing at Emory in 1992.

Ironman Triathlete Back on Track after Lumbar Laminectomy

Dr. Tim YoonWhen it comes to spinal disorders, there’s good news for the weekend warrior who enjoys vigorous athletic training and competitive sports activities. Being in great physical shape plays a large role both in your recovery and getting you back to an active lifestyle.

Joann Pope, one of my current patients, has an impressive athletic resume. She completed the half Ironman in Panama City, Florida, 21 times straight. She qualified for the world-famous Hawaiian Ironman seven times and finished four times. But two years ago, at the age of 74, her back started hurting and she had to stop racing due to lumbar spinal stenosis.

Lumbar spinal stenosis is a degenerative condition that causes a narrowing of the spinal column in the lower back, known as the lumbar area. This narrowing occurs when the growth of bone or tissue or both reduces the size of the openings in the spinal bones. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord. It can also squeeze and irritate the spinal cord itself, causing pain, numbness, or weakness, most often in the legs, feet, and buttocks.

You might think that the physical stress of being a triathlete took its toll on Joann’s back, but that isn’t the case. In fact, if she hadn’t been in such great shape, her spine might have begun degenerating long before it did. For more than 20 years, Joann has been running, biking, and swimming. She was 47 when she started running, back in 1984. After she ran the Boston Marathon, her daughter talked her into doing a triathlon, the ultimate endurance test – a grueling three-part race with no stops.

So, thanks to her level of fitness, it’s as if Joann has the body of someone 20 years younger. Despite her active lifestyle , the lumbar stenosis progressed, and Joann’s pain, which came on slowly, continued to get worse.

Before Joann came to see me, she’d been experiencing lower back pain for a year. To address it, she’d been taking pain pills twice a day and was undergoing physical therapy, the first line of defense for lumbar stenosis. But when therapy didn’t ease her pain, her physical therapist told her she needed to see a surgeon. She chose to come to the Emory Orthopaedics & Spine Center.

In July of 2010, I performed a lumbar laminectomy and fusion on Joann. This procedure, also called a decompression, relieves pressure on the spinal cord or spinal nerve by widening the spinal canal. In Joann’s case, I removed the portion of the bony roof of the spine, or lamina, that was pressing on her lumbar nerves. Then I fused the two lowest lumbar vertebra, L4 and L5, with screws. When she woke up, the pain she had before surgery was gone.

Because Joann had been in such great physical shape before the surgery, she recovered rapidly and was swimming and walking again quickly. Now she’s walking two miles a day and is working up to getting back on her bike. Joann remains pain free and plans to go back to racing.

Have you had a lumbar laminectomy, or would you like to learn how spine surgery at Emory can get you back to the active life you enjoy? We welcome your questions and feedback in the comments section below.

About S. Tim Yoon, MD:
S. Tim Yoon, MD, PhD, specializes in minimally invasive surgery and cervical spine surgery. He is board certified in orthopedic surgery. Dr. Yoon started practicing at Emory in 2000.

Top Four Ways PRP Therapy is Different at Emory Sports Medicine

Dr. Amadeus MasonFootball fans are anticipating a competitive Super Bowl match-up between the Pittsburgh Steelers and Green Bay Packers this Sunday. Steelers’ fans might remember that the last time the Steelers were in the Super Bowl—in 2009— wide receiver Hines Ward was very close to being unable to play because of a sprained medial collateral ligament of his right knee. Fortunately, he was able to contribute to his team’s victory over the Arizona Cardinals with the help of a cutting-edge procedure called platelet-rich plasma (PRP) injections.

Since Ward’s high-profile recovery, PRP therapy has become a popular treatment for those suffering from ligament and tendon injuries—and Emory Sports Medicine has become a leader in the PRP therapy field.

Here’s how it works: PRP therapy is an outpatient procedure, in which blood is drawn and placed in a centrifuge for 15 minutes to separate out the platelets. The layer of platelet-rich plasma is then injected into the diseased portion of the tendon with the guidance of an ultrasound machine. Patients are then put on a program of relative rest followed by physical therapy for the first six weeks. After about 6 to 12 weeks, patients are re-evaluated for improvement. (Many patients require only one treatment.)

Sounds simple, right? It can be, but only if it’s performed properly and with the right expert guidance. Below we’ve outlined four factors that allow Emory Sports Medicine to excel at PRP therapy:

  1. We’ve been doing this since the beginning. PRP therapy is a fairly new procedure, and Emory has two doctors on staff who are skilled in performing it: Dr. Kenneth Mautner and myself. Both of us are dedicated to keeping up with the latest developments in the field.
  2. A vital step in the PRP process is the separating of platelets. We use only the most advanced centrifuge systems to ensure the highest concentration of platelets harvested from the process.
  3. We use ultrasound guidance to place the PRP into the affected tendon. Many other practices don’t use ultrasound—and the difference can be compared to dropping an atomic bomb vs. using a laser-guided missile. Although utilizing PRP in a generalized area can be helpful, placing it in a specific area will give the best chances at a positive result, proper healing, and full recovery.
  4. Emory Sports Medicine has developed a standardized post-injection protocol – a daily and weekly follow-up program designed to give patients the best chance at recovery.

While PRP therapy is still a relatively new procedure, when a skilled team of physicians does it properly, the results are remarkable. Just ask Hines Ward!

Are you considering PRP therapy? Do you have any questions regarding this procedure? If so, be sure to leave a comment here, or contact Emory Sports Medicine for an evaluation today.

About R. Amadeus Mason, MD:
Dr. Mason specializes in family practice and sports medicine. His areas of clinical interest include ankle, foot, shoulder, sports injuries, wrist, and ultrasound. Dr. Mason holds organizational leadership memberships with the American Academy of Family Physicians, the American College of Sports Medicine, and the Georgia State Medical Association.