Posts Tagged ‘orthopedics’

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.

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.

Improved Joint Capsule Reconstruction Results in Fewer Dislocated Hips

James Roberson, MDDislocation of the ball from the joint has always been a possible complication following hip replacement surgery. However, at Emory Orthopaedics, a couple of developments have significantly reduced, if not eliminated, those concerns.

One of these developments is the use of alternative bearing surfaces such as highly cross-linked polyethylene—a super-wear-resistant plastic—which enables surgeons to use larger-diameter balls (femoral heads) in the hip joint. The new, thinner bearing surfaces allow for larger-diameter femoral heads, making the hip intrinsically more stable.

Another development that has significantly increased hip stability is recognition of the importance of reconstructing the ligamentous capsule of the hip joint to its appropriate anatomic position at the completion of the hip replacement. The hip is held in place by the soft tissue around the hip—the capsule, the ligaments, and the tendons. If these are not put back in an anatomic position (i.e., where they came from), the hip will have a greater chance of dislocation.

At Emory Orthopaedics, what these developments mean is that we have become more comfortable allowing our patients to resume natural activities earlier after surgery. Traditionally, patients were told they shouldn’t bend their hip more than 90 degrees, shouldn’t cross their legs, should use an elevated toilet seat, etc. for up to three months following surgery. Patients were apprehensive about dislocating their hip. But with these new materials and improved methods, for most patients we’ve stopped using those restrictions in the early post-op period. Now we feel confident telling patients that they can sit however they’d like to, bend their hips, and so on. They can go straight to enjoying their new and improved hip.

Have you had or are you going to have joint capsule reconstruction surgery? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About Dr. Roberson

James R. Roberson, MD, chairman of the Department of Orthopaedics and professor of Orthopaedic Surgery, specializes in treating hip and knee arthritis and has performed more than 10,000 hip and knee replacements over the course of his career. Dr. Roberson has practiced at Emory since 1982.

New Biomaterials Mean Fewer Hip and Knee Replacement Reoperations

James Roberson, MDIn Emory Orthopaedics, we perform hundreds of hip and knee replacement operations every year. Most of these operations are highly successful, but occasionally, a reoperation is necessary. In these cases, it’s usually because the materials originally used in the knee or hip have worn down over time.

At Emory, we’ve been testing new and improved biomaterials for use in hip and knee replacements for more than a decade, and we’ve found that a new generation of biomaterials is making a significant difference in the longevity of these replacements. This means fewer patients will need reoperations down the road.

The failure rate in a knee replacement operation is directly related to how fast the knee wears, which is affected by how well the knee was put in, the patient’s activity level, the patient’s weight, and the wear resistant properties of the materials used. Think of the tires on a car. The stronger the tire material, the longer it lasts. What if, instead of getting 30,000 miles on a set of tires, you could get 100,000 miles? In essence, that order of magnitude difference is similar to the improved wear resistance of new biomaterials used in hip and knee replacement.

I’ve been using alternative bearing surface materials in hip replacements for about 12 years, starting with metal on metal, then ceramic on ceramic, and now highly cross-linked polyethylene. All three materials have dramatically improved wear resistance and have worked very well for several thousand patients, with no measurable wear on any patient visible through x-rays. But while metal on metal and ceramic on ceramic are useful in hip replacements, they aren’t an option in knee replacements. Until recently, this was also true of cross-linked polyethylene. However, the more recent second generation techniques for cross-linking now make this a viable option for knee replacement also.

Polyethylene, simply put, is a plastic formed from long molecular chains made of carbon and hydrogen atoms linked together. Prior to cross-linking manufacturing techniques, these molecular chains consisted of carbon atoms linked to other carbon atoms in single long chains with the remainder of the molecular bonding sites filled with hydrogen atoms. On a molecular level, cross-linking simply means that the single chains now are cross bonded together to, in essence, create a woven structure. This results in a material that looks identical but is actually a more wear-resistant form of plastic.

Over the past three to five years, we’ve performed approximately 1,000 knee replacement surgeries using cross-linked polyethylene. While all three materials—metal, ceramic, and polyethylene—appear to perform fairly evenly in hip replacement surgery, cross-linked polyethylene is less expensive than ceramic on ceramic. Although the individual patient does not experience a cost difference, this is a benefit to the industry as a whole. Our goal is to develop improved materials that will result in better outcomes and be cost-effective.

If you’re having knee or hip surgery, you can trust your doctor to choose the most effective material for you. Regardless of whether it’s metal on metal, ceramic on ceramic, or cross-linked polyethylene, with all of these new biomaterials, we are cautiously optimistic that wear may no longer be a problem.

Have you had or are you going to have hip or knee replacement surgery? Have you had experience with any of the new biomaterials? We’d like to hear from you. Please take a moment to give us feedback in the comments section below.

About James R. Roberson, MD:

James R. Roberson, MD, chairman of the Department of Orthopaedics and professor of Orthopaedic Surgery, specializes in treating hip and knee arthritis and has performed more than 10,000 hip and knee replacements over the course of his career. Dr. Roberson has practiced at Emory since 1982.

At EUOSH, It’s All About the Patient

The Emory University Orthopaedics & Spine Hospital is known for its strong focus on patients and families, as well as its sharp attention to detail. It’s unlike any other facility in Georgia.

In fact, EUOSH is so focused on patient satisfaction and comfort, we call upon 75 various patient committees and have adopted listening practices to ensure that we fully understand the needs of the patient. Further, we make a point to avoid being married to any sort of protocol; for example, there’s no limit on patient visiting hours, and family members are welcome to sit with patients right up until the time of surgery. Our efforts have not gone unnoticed—I’m proud to say that we have over a 90% satisfaction rate among our patients.

EUOSH is focused on teaching and research, and all of our physicians are highly specialized within their particular areas of focus.

Every room is equipped with everything a patient could possibly need for a comfortable recovery, including an interactive television that offers hospital information, a “my education” feature, the patients’ chart, health notes, and of course, regular TV channels and movie options.

EUOSH truly strives to exceed patient expectations every day. Learn more about the facility in this video:

What to Do When It Hurts to Exercise

Exercising with pain can be a catch-22. Certain exercises can ease arthritis pain and keep stiffened joints limber. When you exercise, you strengthen muscles that help stabilize your joints. However, if you over-exercise, or go about it the wrong way, you can further damage the joints you’re trying to protect.

As a physiatrist at the Emory Orthopaedics & Spine Center, I work with athletes who make a living being active. When they’re hurt, they need to know when it’s best to exercise through the pain, or when they need to lay off for a while so that they don’t further injure themselves. So, how do you know when to exercise through the pain and when to give yourself a break?

My rule of thumb for exercising in pain: if the pain doesn’t get worse during exercise (and stays below a 3/10 on pain scale), and if you don’t feel increased pain later that night or the next day after exercising, then it was most likely a safe form of exercise.

On the other hand, if the pain becomes severe as you’re exercising, or you have an increase in pain after exercise, you probably shouldn’t continue with that particular activity. Additionally, if you experience any painful catching/locking (especially in the knee), don’t push through the pain. If these symptoms persist, or if the pain is present at night while you’re resting, it’s a good idea to schedule an appointment with a physician.

Low-impact, aerobic activity is the best way to get exercise and minimize pain from orthopedic conditions. Stationary or recumbent bicycling, elliptical trainers, and swimming are great examples of low-impact ways to get your heart rate up.

Are you dealing with pain when you exercise? Are you unsure whether to work through it, or stop until you feel better? Share your experience with us. We welcome your questions and feedback in the comments section below.

About Kenneth Mautner, MD


Dr. Mautner is an assistant professor of orthopedics, as well as an assistant professor of physical medicine and rehabilitation, serving both Spine and Sports Medicine. In addition to being a consulting physician for the Georgia Tech Athletics, he is head team physician for Agnes Scott College and team physician for Emory University Athletics. Dr. Mautner began practicing at Emory in 2004.

What is a Physiatrist, and Should I See One?

Have you injured your back, or do you have spine pain that just won’t get better? If so, your first visit at the Emory Spine Center should be with an Emory Physiatrist. Physiatrists are physicians who’ve earned medical degrees in Physical Medicine and Rehabilitation. We’re experts at diagnosing and treating pain, and we’re your first stop for back pain relief—and, in many cases, your last.

As Physiatrists, we focus on the whole person, not just the injury. Our first job is to find out where your pain is coming from so that we can address it, but we’ll also work with you to prevent future injuries.

Successful treatment requires the right diagnosis. At the Emory Orthopaedics & Spine Center, we have a variety of diagnostic tools and tests on site, including CT scans, X-Rays, and MRIs, that we use to locate the exact source of your pain so that we can treat it effectively. The good news is, more than 90% of spine cases can be treated without surgery.

Once we have determined the cause of your pain, we can provide you with non-operative and minimally invasive treatment options—also called interventional treatments—to ease your pain and get you back to good health. If spine surgery is called for, we’ll work with the Emory spine surgeons to coordinate the best treatment plan specific to your condition.

To recap, physiatrists…

  • Are experts at diagnosing and treating pain
  • Treat the whole person, not just the problem area
  • Provide nonsurgical treatments
  • Work not only on treatment but also prevention

If you’ve injured your back or have disabling back pain, make an appointment to see an Emory physiatrist. We’re here to help you feel better.

Have you seen a physiatrist for back pain? Do you have questions about nonsurgical spine treatments? We welcome your feedback in the comments section below.

About Jose Garcia-Corrada, MD:

Dr. Garcia-Corrada is an Assistant Professor of Physical Medicine and Rehabilitation. He joined the Emory faculty in 2001 and served as chief of Rehabilitation Medicine at Emory-Wesley Woods Center prior to joining the Emory Spine Center in 2005. Dr. Garcia is board certified in the specialties of Physiatry and Pain Medicine.