So, that’s the three most common tendon problems around the ankle that I see.  Does anybody have any questions about that?  Yes, sir?

[44:03]

He asked what we think about the rocker sole shoe.  In general, I like them for some specific problems.  For people with ankle arthritis where they’ve had arthritis in the middle of the foot or anything that decreases the up and down motion of your foot.  Having a rocker sole helps you substitute for the motion that you’ve lost.  In those situations, it’s very useful.

They got marketed a lot, the Skechers was the real popular brand initially, and it had a pretty severe rocker.  So, they marketed it quite a bit, and did you ever try them on?  Of the Skechers?  So, the thing about the Skechers is the middle part of it was really soft and squishy.  So, some people like having that extra cushion.  In the hospital, for a while, it seems like the nurses go through different fads because they’re on their feet all the time.  So, they were pretty popular for a while, just for people with heel pain, and I think it worked for some people.

The reason they got into trouble, they took them off the market, was they were promoting them as a way to lose weight and change the tone of your legs and doing these things that I’m not sure people agree with.  So, they pulled it off the market, but just the concept of rocker sole is very helpful.  If you go to a shoe store, you’ll find a lot of different brands had those rocker soles.  So, you can still find them, and they’re pretty popular for a lot of different problems.

Yes, ma’am?

[46:08]

No, I don’t think so.  I think probably the only place where it may be harmful is if you have balance problems.  You probably don’t want a real severe rocker.  So, just a little bit in the front and the back is okay, but otherwise, just a little bit in the front and the back is okay.

Yes?

[46:30]

Clogs?  I think they’re comfortable.  They’re fine.  In a simple way, I had a teacher one time, when people come in with sore feet, tell them to go walk a lot and get your feet really sore.   Then, go try on shoes.  So, you find what’s comfortable on your feet, but the clogs are, in the open back sense, really helpful for Achilles tendon.

Yes, ma’am?

[47:03]

Again, I think if they’re comfortable, they’re fine. I think the problem with the whole barefoot running craze and everything is it came out of this book that this guy wrote about barefoot running.  These people live in the mountains, and they run barefoot their entire life.  So, they’re adapted to it so if someone like me decided to take up running, I’d been wearing shoes for the last 50 years.  If I start running barefoot, my feet are probably going to hurt.  So, I think the whole theory is if you’re barefoot, you use all the intrinsic muscles of your foot, and it helps maintain the general alignment of your foot because you’re working all those muscles.  I think, in general, a good supportive shoe is probably good.  I would enter into the barefoot part with some caution.

Yes?

[48:20]

Most of the studies, as long as the baby is otherwise normal, putting them in an arch support is not going to give them an arch if they weren’t going to have an arch to begin with. As far as wearing shoes, I think you put them in shoes when they start walking just to protect their feet so they don’t step on things, but I’m not sure if I’m answer your question all way.

[49:04]

I think there might be one, but realistically speaking, we live in a society that wears shoes.  So, kids are probably going to wear shoes at some point.

Yes, ma’am?

[49:37]

For posterior tibial reconstruction?  Usually for the first six to eight week, you’re in some type of boot, and you’re really not putting much weight on it.  So, the first two months is probably the toughest.  After the second month, you start putting weight on it.  Hopefully, by the third month, you’re putting a shoe on, and then, most people that have it are usually adults so they work.

Your biggest restriction is in the first couple of months.  Depending on what your job is, I mean if you’re in a job where you’re in an office and you sit all the time, it’s not a big deal.  If you’re a nurse or you work on an assembly line where you’re on your feet for 10 or 12 hours a day, it could be four to six months before you’re ready to do anything like that.  Usually, you’re pretty functional and starting to get in a shoe by 2.5 to three months, and hopefully, you’re crutches and cane are gone by three months.  The only other point and I don’t to scare anybody away if you’re thinking of having surgery, but it takes a while to get used to the realignment of your foot.  Usually, what I tell my patients is you’re going to change the realignment of your foot, and the whole goal of the surgery is keep the deformity from getting any worse.

Second, it takes a while when you realign those bones.  Your bones have realigned over time, and it took you a while to get there.  After you change the alignment to go all the way back, but I usually use my wife’s grandmother as an example.  She had a terrible flatfeet.  I remember, I’ve been married 20 years now, but back when I was dating my wife and I was doing my training, she said, “Come look at my grandma.  She had bad flatfeet, and I ought to get it fixed.”  She’s had knee replacements, and she didn’t want to go in.  Well, she’s still alive.  She’s 90 years old now, and she can’t walk because her feet have completely come off her legs.  So, the deformities do tend to get worse if you don’t do anything about them.

So, in the greater scheme of things, you have to think.  People’s life expectancy and the length of time they’re staying active.  You can’t really just say, “You’re 68 years old.  You’re probably going to die in a year or two, and you don’t have to bother with it.” People are living much longer, and they’re much more active.  So, you want to try and make your activities pleasant.

Yes?  You, back there.

[52:45]

Plantar fasciitis is pain on the bottom of the heel as the surface is hitting the floor.  If I knew that cause I probably wouldn’t have to be here.  I would be rich.  I wouldn’t need to be working anymore.  The cause is the plantar fascia is not a tendon, but it’s a soft tissue.  It attaches on the bottom of your heel.  The plantar fascia attaches right there on the bottom of your heel.  So, there’s your Achilles tendon where it goes in, and the plantar fascia’s right there.  The plantar fascia also helps support your arch.

Again, the most common presentation is in middle age.  That attachment where it attaches to the heel start wearing out, and it starts breaking down.  I don’t have an answer as to why it’s so painful, but it’s painful if you have it.  The thing you have to keep telling yourself is that it naturally goes away.  Most of the treatments that you’re doing is to treat the symptoms until it goes away.  So, you have to be careful with the treatments that you use.  You don’t want to be the guy to get surgery on it, and then, you’re worse off than you were before.

You have to be a little careful with the cortisone shots. The studies that have been done on the cortisone injection shoes that it gives you a little bit of short-term relief.  It doesn’t change the time it takes to get over it.  So, the study that I quote to people is that the treatment is symptomatic.  So, you take Motrin® or Tylenol® for pain.  You use some type of cushion or arch in your shoe.  If you’re stretching, physical therapy is helpful because of the ultrasound.  Occasionally, people will try out night splints which keeps you stretched out at night.  If you do all that, the natural history is that 95% of people get over it within 11 months.  Now, 11 months is a long time.

[55:15]

It’s okay to have some pain when you’re doing things. You shouldn’t be miserable the next day.  So, to try and push through the pain, it’s probably okay, but I don’t think you want to push yourself to where you can’t do your normal activity.  The other part of stretching though that other people have shown makes a big difference when you go to a therapist.  Usually they have you stretching your calves, doing this. The other thing you need to do is, can I demonstrate on you?

Keep your foot up there.  Take your foot and put it on your knee.  Take your foot there, and then you grab your toes.  Then, you pull all your toes up so you’re really stretching the arch on your foot.  Then, you can take an ice cube or some type of ice massage and massage it there.  That’s been shown to make a difference better than just regular stretching.

[56:13]

Yeah. I think what you find with a lot of these tendon problems and massages and different types of physical therapy is that it just increases blood flow, and increase in the blood flow is good.

Yes?

[56:30]

Probably not, but I usually try and get people to do, if you’re a runner, try to get you to cross train on an elliptical or a rowing machine or something where you’re not doing impact.  So, it’s good to cross train a little bit.

Yes, ma’am?

[57:12]

Shin splints is a real generic term like back pain.  So, shin splint, one of the things that you want to make sure is that you don’t have stress fracture.  If you have that pain on the front of your leg, it probably warrants getting an X-ray and making sure you don’t have a stress fracture.  The causes of it, of posterior tibial tendonitis, we talked about it.  Sometimes, that’s the cause of it.  Sometimes, you get inflammation of the covering of the bone.  This is called periostitis.  It’s usually related to activity, and again, it seems like the people who complain about that the most are people who are big runners.

So, again, when you’re rehabbing them, the surface they’re running on, you might change their shoes.  People use elastic sleeves.  Get them to swim or bike or do other things so you don’t have the same pounding, but it’s generally an overuse syndrome.

You’re probably on crutches for four to six weeks.  Hopefully, back in the shoe by two to three months.  For all the Achilles tendon surgery, we have a regimented protocol where each week they give you a little bit more to do.  On the first couple of weeks, you might be on a stationary bike, and you build up.  Usually, by 2.5 to 3 months, you can do light jogging on a treatdmill.

Yes, ma’am?

[58:50]

She asked what happens if a tendon tears and winds up in your calf.  How can you get along without it because that’s what happened to my leg? It was a sharp pain, and there was a knot in my calf.  I went to a chiropractor and he said it broke down there, and it just rolled up.  I never did anything.  It just went away.  So, what happened to that tendon?  How can I get along without it?

Don’t eating anything tonight.  I’ll meet you tomorrow, and we’ll fix it.  So, people can walk without an Achilles tendon.  Where you would feel it the most is in fast walking.  If you do any type of sports or jumping things.  You probably notice that you can walk okay, but it definitely changed the way you walk.  Would that be true enough? Is one calf a little bit smaller than the other?