One of the great things is you can see how shoe styles have changed.\u00a0 One of the best things for me is these open back shoes.\u00a0 When I first went into medicine, nobody wore those.\u00a0 They were odd clogs, and nobody wore them.\u00a0 Now, they\u2019re all over the place, and if you have this problem, you can get a varying heel height.\u00a0 You can get an open back shoe that doesn\u2019t rub on the area, and a lot of times, that will give you symptomatic relief.<\/p>\n
We use cortisone injections for a lot of different things.\u00a0 This is definitely one where you do not want a cortisone injection in your Achilles tendon.\u00a0 It increases the chance of rupturing the tendon.\u00a0 So, stay awake from injections.\u00a0 I had two people come in last month that had cortisone injection in there, and they ruptured them.\u00a0 So, cortisone wipes out the inflammatory response, and whatever healing response that you have is wiped out.\u00a0 Then, it also weakens the tendon.\u00a0 Cortisone injection is okay for painful joints like the knee joint if you have arthritis in your knee.\u00a0 A lot people will get them in their shoulders, but you need to use them judiciously.<\/p>\n
So, we don\u2019t need to get too into the classification, but what we\u2019re saying about tendon is here\u2019s normal tendon as it attaches on to your heel.\u00a0 Sometimes, it can be involved in the mid portion of your tendon.\u00a0 The tendon can just degenerate, and what I usually tell patients it\u2019s like a rope that starts fraying.\u00a0 When you think of a rope, when it starts fraying, it gets wider.\u00a0 That\u2019s what happens to the tendon.\u00a0 You have these longitudinal fibers in the tendon, and as they get inflamed and start breaking down, they usually get wider.\u00a0 That\u2019s what you feel when you feel the nodules or the bumps in your tendon.<\/p>\n
There\u2019s an area of the tendon that has a poorer vascular supply, and it\u2019s right here, usually about an inch to two inches above your heel.\u00a0 That area doesn\u2019t repair itself well, and you see this.\u00a0 People get tendon problems in their middle age, and there\u2019s several tendons in the body that tend to fail.\u00a0 It tends to be in areas where the tendon doesn\u2019t have a good blood supply.\u00a0 So, all our tissues need nourishment from the blood.\u00a0 When they get as good a blood supply or nourishment, they don\u2019t repair themselves as well. Again, this is 2 to 6 centimeters above the heel.\u00a0 There\u2019s fewer blood vessels so there\u2019s less capacity for it to heal.\u00a0 Again, people with tendinosis tends to be the up in the tendon.\u00a0 They tend to be runners, oftentimes, with a gradual onset.\u00a0 They\u2019re tender throughout the length of the tendon.<\/p>\n
Usually, we don\u2019t need a lot of diagnostic studies.\u00a0 The MRI doesn\u2019t give me a lot of information.\u00a0 As long as the tendon is working doesn\u2019t give me a lot of information on how to treat it.\u00a0 The MRI, they\u2019re very sensitive, and it will tell you the full extent of the involvement of the tendon.\u00a0 Usually, the MRI will make the tendon look much worse than what it is.\u00a0 So, you have to be careful with what you take away from it because it\u2019s such a sensitive test that it makes the condition look worse than it probably really is.<\/p>\n
The surgery for it is just debriding the bad part of the tendon.\u00a0 In a nutshell, the more that you take out, sometimes you have to reconstruct the tendon defect that is created by taking out the bad tendon.\u00a0 We easily do a longitudinal section and remove what looks bad and repair the rest.\u00a0 Occasionally, we\u2019ll take another tendon from the area to reconstruct it or reinforce it.\u00a0 This is an MRI, and it shows you some of the diseased tendon.\u00a0 Then, this is looking at it in surgery.\u00a0 You see the tendon here.\u00a0 We made an incision along the medial side of the tendon, and you cut the bad portion of the tendon.\u00a0 If you take out more than 50% of the tendon, we usually reconstruct it with something.\u00a0 If we take out less than 50%, we can usually just sow it up.<\/p>\n
Surgical recovery is similar to Achilles tendon rupture.\u00a0 If you don\u2019t have to take out more than 50% of the tendon, usually recovery is a little bit faster than a rupture.\u00a0 We usually have you in one of those protective boot and open-back shoe for about 3 months.\u00a0 Then, usually, it takes you about 8 to 12 months to really get all your strength back.\u00a0 The worse part of the surgery is the first 2 months.\u00a0 You\u2019re kind of limping around for the first 2 months.\u00a0 After that, from month two up to a year, you\u2019re basically just gaining strength.\u00a0 For people who run or do heavy exercise, usually you\u2019re back to jogging around 2.5, 3 months, but you\u2019re not up to the point where if you\u2019re a 10-mile runner, you\u2019re not doing that for a good 8 to 12 months.<\/p>\n
So, the treatment that\u2019s in between the newer, we\u2019ve been doing a study on it, is this stuff called PRP.\u00a0 PRP is platelet rich plasma.\u00a0 Basically, the appealing thing about is it\u2019s your own tissue so you don\u2019t have to get anything from anybody else.\u00a0 Basically, they draw blood from you as if you were doing routing blood work.\u00a0 You take your blood, and you put it in one of these centrifuges.\u00a0 The centrifuge spins it down, and it isolates the platelets.\u00a0 The platelets are cells in your blood, and the way it works is there\u2019s a lot of growth factors inside the platelets.\u00a0 So, we take that concentrated part that concentrates down to about 3 to 4 cc, and we inject it directly into the tendon.\u00a0 So, you\u2019re putting the growth factors on the bad part of the tendon trying to incite the healing response with the growth factors, and the tendon will somewhat repair itself.<\/p>\n
We think that it works well.\u00a0 Platelet rich plasma has been used well in a lot of the areas of the body and in a lot of soft tissue and places that haven\u2019t typically healed well.\u00a0 So far, our results have been pretty good, and out of all the people that we\u2019ve done, we haven\u2019t done surgery on any of them.\u00a0 So, it has prevented people from taking the step to saving surgery.\u00a0 Obviously, the advantage of this is there is essentially no recovery time.\u00a0 So, you come in.\u00a0 We usually do them on Fridays, and you put ice on it over the weekend.\u00a0 Then, the next week, you\u2019re walking on it again, and you can go back to your regular exercise program.\u00a0 So, I usually tell people this is something that\u2019s very low risk, and probably the worst-case scenario is it doesn\u2019t work.\u00a0 There\u2019s really no risk of getting any infection.\u00a0 You don\u2019t have any implant on your body or anything like that.\u00a0 So, oftentimes, it helps and gets them to the point where they don\u2019t need surgery.<\/p>\n
Platelet rich plasma is still investigational.\u00a0 Again, very low risk, very limited recovery time.\u00a0 So, you don\u2019t really have to stay off work or anything like that.\u00a0 This is generally not covered by insurance, but the nice thing about it is that it\u2019s not very expensive.\u00a0 So, again, it\u2019s probably less expensive than buying a pair of orthotics.<\/p>\n
Any questions about Achilles tendonitis?\u00a0 Yes, ma\u2019am?<\/p>\n
[38:09]<\/p>\n
What else have we used the PRP for?\u00a0 When it first came out in orthopedics, they used in fractures that didn\u2019t heal, but it\u2019s been used extensively in rotator cuff surgery because rotator cuffs are typically a tendon that is necessary.\u00a0 So, usually you don\u2019t want to cut the tendon out, and it\u2019s one that has a very poor blood supply.\u00a0 In rotator cuff surgery, in general, it\u2019s very hard to get the tendon to heal.\u00a0 Sometimes your symptoms will go away, but what my shoulder partners work on is trying to figure out better ways to make the tendon heal.\u00a0 So, it\u2019s used more extensively there.<\/p>\n
It\u2019s been used now, when people are injecting, in tennis elbow, in soft tissue tendons.\u00a0 The other big application of it that people were putting it in knee replacements, trying to decrease the blood loss, and those are probably the biggest orthopedic applications of it, but really, anywhere that you do surgery.\u00a0 Plastic surgery uses it, too, where you\u2019re trying to get soft tissue tendon or some type of soft tissue to try and heal.\u00a0 A lot of people have used it to augment the healing.<\/p>\n
Now, the peroneal tendon, this is the last one.\u00a0 So, if everybody could try to stay awake, we will wrap it up in about five minutes.\u00a0 The peroneal tendons are on the other side of your ankle. This is a picture showing the peroneal tendon tear.\u00a0 So, this is the lateral of the outside of the ankle.\u00a0 So, this is the ankle up here.\u00a0 The foot\u2019s over here, and this, right here, is your ankle bone or what you feel on the outside of your ankle.\u00a0 The tendons are right behind.\u00a0 There\u2019s two tendons right behind your ankle, and these tendons, when you have trouble them, they do one of two things.\u00a0 They either tear, which is more common in middle aged people, or sometimes you can have a sprain, and they pop out of their sheath.\u00a0 So, you can have a click over the fibula.\u00a0 So, that\u2019s a popular thing.\u00a0 It happens a lot of teenagers.\u00a0 They drive their parents crazy by popping their knee.\u00a0 You see them moving it back and forth over the tendon.<\/p>\n
Again, the more common thing we is the middle aged people with the tendon tear.\u00a0 Usually, the pain is behind the lateral side or your ankle bone.\u00a0 In the first part, we spoke about flatfeet.\u00a0 One of the more common alignment things that you see is people with this side of the ankle tend to have a really high arch.\u00a0 So, they have a really high arch and walk on the outside of your foot.\u00a0 You\u2019re more likely to get ankle sprains and these tendon tears like this.<\/p>\n
This shows the two tendons.\u00a0 This is your ankle bone here, and the peroneus brevis is the one in the front, and the peroneus longus is the long one behind it.\u00a0 So, in the subluxation where the tendons dislocate over the bone, it\u2019s usually younger people.\u00a0 It\u2019s usually a traumatic event, and it\u2019s usually the peroneus longus.<\/p>\n
So, in the tendinosis where you get tendonitis or the tendon starts to tear, usually what we try to do, as with a lot of things, is change the alignment of the foot.\u00a0 So, you can put a lateral heel wedge in. Usually, there\u2019s physical therapy.\u00a0 The reason we use so much physical therapy on these tendon problems is that it helps mobilize the foot, but the physical therapists have a lot of modalities like ultrasound, heat and cold, and all these things that will often calm down the inflammation of the tendon.\u00a0 Oftentimes, if you get the inflammation to go away, your blood or your symptoms will go away.\u00a0 So, we use a lot of physical therapy and bracing it so that when you do physical activity, you\u2019re not stressing the tendon too much.<\/p>\n
In the treatment of the dislocated peroneal tendons, usually there\u2019s not a lot that you can do to fix that.\u00a0 I don\u2019t know if any of you are baseball fans, but back when the Red Sox were in the World Series and Curt Schilling had his ankle hurt and they took him over to the guys at Harvard.\u00a0 They put a big stich right through and his tendon.\u00a0 He had this dislocating peroneal tendons.\u00a0 They did that so he would make it through the World Series, and stop the popping.\u00a0 When the World Series was over, they went in and fixed it.\u00a0 So, that\u2019s usually a surgical problem.\u00a0 There\u2019s really not much you can do to make the tendon stop snapping other than fixing it with surgery.<\/p>\n
The other thing we do with the peroneal tendon tears is most them, if you catch them earlier, you can repair them.\u00a0 For the ones that are far gone, since there\u2019s two tendons there, you can repair it to the one next to it.\u00a0 So, this is one of the conditions in foot and ankle where an MRI is very helpful.\u00a0 So, for pain on the outside of your ankle, sometimes an MRI can help you, and it can make the diagnosis of these tears and makes your decision making a little bit easier.<\/p>\n","protected":false},"excerpt":{"rendered":"
One of the great things is you can see how shoe styles have changed.\u00a0 One of the best things for me is these open back shoes.\u00a0 When I first went into medicine, nobody wore those.\u00a0 They were odd clogs, and nobody wore them.\u00a0 Now, they\u2019re all over the place, and if you have this problem, […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts\/104"}],"collection":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/comments?post=104"}],"version-history":[{"count":1,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts\/104\/revisions"}],"predecessor-version":[{"id":105,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/posts\/104\/revisions\/105"}],"wp:attachment":[{"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/media?parent=104"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/categories?post=104"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/footdetox.org\/pads\/wp-json\/wp\/v2\/tags?post=104"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}