Wednesday, March 30, 2011

Another Professional Athlete Ankle Injury...TIM DUNCAN San Antonio Spurs.

Last week, Tim Duncan, Ace player of the San Antonio Spurs,  suffered an ankle injury after landing on the left foot/ankle awkwardly coming down from a jumper.  His absence from play is 'indefinite,' as no one from the NBA is willing to comment on the Truth of his injury and extent of damage.
The public has been made aware that there has been no bone damage and that the MRI was negative for anything specific,  and Duncan was diagnosed with a Grade I or II ankle sprain. 
WHAT IS AN ANKLE SPRAIN??
An ankle sprain is secondary to a forcible turning in , or a forcible turning out of the ankle joint.  There are ligaments (soft tissue structures that attach from one bone to another, to stablilize a joint and keep the joint together) on the inside/medial side, and outside/lateral side of the ankle joint.  When these ankle ligaments are disrupted, usually by a twisting injury, an ankle sprain results. 
There are 3 major type of ankle sprains.
Type 1 -- the ankle joint ligaments are stretched. 
Type 2-- the ankle joint ligaments stretch and tear, much like a a piece of silly putty tears in the middle when stretched too far.
Type 3-- the ankle joint ligaments are stretched so far that they pull off of the bone, and sometimes pull off a piece of bone with them, and can become so damaged that they shred into nothing.
Often times with ankle sprains, other areas of the foot and ankle can become damaged, even fractured!
Moral of the story is, Tim Duncan is on crutches.  The injury could be minor or major.  NBA playoffs could be at stake!
Any questions and/or comments welcomed.

Visit Dr. Malinoski via her website at www.podiatristofnaples.com

Saturday, March 26, 2011

Tom Brady Navicular Stress Fracture Foot Surgery.....

NFL superstar quarterback (and hunk) Tom Brady, of the New England Patriots, had foot surgery on January 20th of this year.
Tom had a lingering stress fracture of the navicular bone. 
The WHAT??!?
The navicular bone!
The navicular bone is a "boat-shaped" bone in the foot, also in the hand, and Also in a Horse's foot/hoof!
The navicular bone is one of 26 bones in the human foot, and is, surprisingly, commonly injured in athletes.
The navicular bone is a player in 3-4 joints of the foot, and supports the arch, so you can imagine its role in a professional athlete's foot with every forceful step taken!
Tom had a screw surigcally placed across the body of the navicular bone to stabilize the stress fracture, and to decrease the chance of it propagating across the body of the bone, just as a small crack in your windshield continues to spider across the glass. 
As a fracture grows, it becomes larger and less stable, and the liklihood of the bone displacing or dislocating increases, and major problems can follow.
In Tom's case, he was out of options.  He played with the stress fracture for weeks and months during the season, despite conservative treatments.

It has been 9 weeks since the surgery.....
It generally takes bones approximately 6-8 weeks to heal.
I would bet that Tom has begun a formal physical therapy program and will continue to rehab to strengthen the soft tissues the foot for at least another 3 weeks. 
The public will be hearing an update on Tom's status any day or week now....

Check back Here for Tom's update As Soon As It Is Released!!!!

Do you think the screw will need to be removed?
Place your bets here...  :o)

Visit us at www.podiatristofnaples.com

Did Serena Williams' foot surgery cause her life-threatening clot!?!?!

 Myth Buster #2.   "If I decide to have foot surgery, my risk of developing a life-threatening blood clot increases, just like professional tennis player Serena Williams! "
FALSE!!  And Whoa, whoa, whoa!  There are Many risk factors associated with blood clots!  Not Just foot surgery!  Genetics, birth control, a sedentary lifestyle, smoking, trauma, females of child-bearing age, prolonged durations of sitting (like being on an airplane or a long drive for many hours), again I repeat GENETICS!
Surgery is NOT the only cause of blood clots!  SURGERY IS NOT THE ONLY CAUSE OF BLOOD CLOTS!!
The public only knows what the media tells us.  The public thinks they know that Serena Williams had one or two foot surgeries which caused her to develop a clot in her lung and stomach that required emergent surgery.  Well, is there a History of blood clots in Serena's family?  We don't know.   Does Serena herself has a history of blood clots?  We don't know. Does Serena smoke?  Probably not, but we don't know!  Has Serena been on an extended airplane ride, YES!!  Is Serena of child-bearing age? YES again!!  Yes, Serena had a recent foot surgery, but this does not necessarily tell us that foot surgery caused Serena's clot.   As you can see from above, there is a combination of risk factors that may or may not have predisposed Serena to a clot. 
Unfortunately for Serena Williams and many Americans, blood clots happen.  It is the responsiblity of your medical doctor and surgical specialist to identify the potential risk factors that you as a patient may have, and to decrease the liklihood that you'll develop a clot.
Dr. Kelly Malinoski, DPM works very closely with your primary care physicians to have a complete patient history of medical conditions, medications, allergies, surgical history, and family history.  If we are discussing elective foot/ankle surgery, and there is a high-risk of blood clot, the surgery will not be done.  As with any surgery, there IS ALWAYS the risk of clotting.  There are specific precautions that are taken to significantly decrease this potential risk, i.e, oral drugs to decrease the chance of blood clotting, early physical therapy and range of motion exercises to get your body and your legs in motion, and sometimes cuffs place around the legs that regularly inflate and deflate with air compression to get your blood moving when you yourself cannot!
The moral of the story is, foot surgery is not the sole culprit in one's chance of developing a blood clot.  The most important factor in blood clot development are the risk factors that you individually possess, that IN COMBINATION, can increase your liklihood of developing a clot.  Yes, Serena Willaims had foot surgery, but she also had RISK FACTORS.

Visit Dr. Malinoski at www.podiatristofnaples.com

Is Foot Surgery REALLY as painful as I hear???????

Myth Buster #1.  "I have always been told Never to have foot surgery because it is Incredibly painful, and the recovery is awful....Is this True??"
FALSE!!!  Medicine and surgery have come a long way.  In ancient times, brain surgery and amputations were performed on patients anesthesia-free, and/or with the only products available, such as wine or brandy!  Yes!  Doctors would literally pour wine or brandy on the surgical site for numbing purposes!  As one can imagine, this was not particularly comfortable!  Fortunately, we now live in an age where different types of anesthesia are readily-available to surgeons and specialists to supplement post-operative comfort levels during and after the necessary surgical procedures.
My patients report Minimal to No pain after surgery, and the majority do not need to take the prescribed pain medication.  This includes All types of foot surgeries, from minor elective procedures like bunions and hammertoes, to major procedures such as foot or ankle reconstruction and emergent trauma surgeries.   Why & how, you ask??
  Dr. Kelly Malinoski, DPM answers, "There is a combination of things I do before, during, and after the surgery to minimize patient discomfort.  Just prior to surgery, I give a local anesthetic block around the surgical site, that completely numbs a portion of the foot from 24 to sometimes 48 hours after surgery.  During the surgery, I am very careful in my dissection and in my handling of the tissues.  Afterall, the more delicate I handle the tissues, the less likely they are to respond as feeling "damaged," minimizing a lot of swelling that could ensue.  I prefer to close the skin with sutures/stitches that are absorbed by the body, and do not require uncomfortable removal in the office.  After the procedure, I give the patient an injection of medication that supplements in swelling-reduction and pain-reduction.  Most importantly, I bandage the foot/ankle in such a way that I feel is most comfortable for my patients, and again, aids in swelling and pain reduction.  Finally, my patients are given prescriptions of pain medication and special anti-inflammatory medications post-operatively for a specific time period.  Although the anti-inflammatory medications are required, the pain medications are not, and are usually sitting in the medicine cabinet unopened. "
Elective foot and ankle surgery is not what is once was, folks.  The pain is minimal, specifically controlled, and easily tolerable!
Recovery time is different for each patient, depending on the necessary procedure to correct the problem, and whether or not your situation requires a prolonged period of non-weight bearing, AKA, a cast or boot and crutches.  Dr. Malinoski says, "I've found that as long as the patients' pain levels are controlled, their recovery time is unremarkable.  Surprisingly, not every foot/ankle surgery requires crutches!" 

Visit Dr. Malinoski at www.podiatristofnaples.com

Thursday, March 17, 2011

Shockwave Therapy/ESWT For Heel Pain

Shockwave Therapy for my heel pain? What is all the hype about, & can it work for ME??

Shockwave therapy for the treatment of heel pain is a Non-invasive, PAINLESS procedure used to manage that nagging pain you feel that "you've tried everything for," and feel with every step you take!
That's right, no hospital, no operating room, no surgical blades, no bandages, no stitches, no PAIN!!

Shockwave therapy involves resting your heel on a machine that pounds high energy sound waves into your heel through the skin. These 'sound waves' penetrate the soft tissue structures and bone in your heel and break up some of the scar tissue that causes your discomfort. The special products in your body that heal tissue are attracted to the shockwaves, and a healing response occurs over time!

Dr. Kelly Malinoski specialized in this technique during her Fellowship training, and conducted a study following up with patients 9 years after having the procedure. 88% of patients were extremely satisfied after the procedure, 84% of patients had an improvement in heel pain, and ALL patients returned their regular activities in less than 4 weeks!

Heel pain is a common complaint among the patients presenting and treated in podiatrists' offices, particularly in the active population! Many patients, young and old, are competitive and/or leisurely tennis and golf players. These individuals typically complain of pain in the heel(s) most intense with the first few steps taken during the competition that ‘eases up’ as the game goes on. Sometimes the aching pain is felt in the arches, or even in the back of the heel. Eventually, the pain becomes aggravating enough that it is felt with every step attempting to return a serve, or with every long drive down the fairway. When arch supports, custom orthotics, and cortisone injections fail, that is when we introduce shockwave therapy!

So….you’re wondering what the recovery process is after shockwave therapy??
The procedure takes about ½ hour per foot, in the office. Patients walk in, have the procedure, and walk out with a walking boot worn for an unspecified time period at your doctor’s discretion, depending upon the origin of your heel pain (minimum of 24 hours, maximum of 2 weeks). Patients report NO pain during the procedure, and mild tenderness after the procedure for approximately 48-72 hours. You can walk, you can drive, you can go to the grocery store, sunbathe & swim, and go to dinner the evening of the procedure! Again, no hospitals, no operating room, no surgical blades, no bandages, no stitches, NO PAIN!!

How many treatments??
The number of treatments is dependent upon the type of shockwave therapy recommended for you, as well as your personal schedule and flexibility. To sum things up, there are two types of shockwave therapy—High energy and low energy. High energy shockwave therapy requires one treatment, and the sound waves are of a higher frequency level. Low energy is 3 treatments 7-10 days apart and the sound waves are of a lower frequency level. Our patients respond positively to both high and low energy shockwave therapy.

What are the disadvantages?
Unfortunately the majority of insurance companies do not cover the procedure despite shockwave’s impressive beneficial results in the medical literature. Therefore, shockwave therapy is an out-of-pocket expense. The medical community is hopeful that shockwave therapy will be compensable by insurance companies in the near future.

Why should I choose shockwave therapy over a surgical procedure?
Because shockwave therapy has been found to be equally beneficial to an open surgical procedure, without the risks that open surgeries introduce (pronounced pain, swelling, infection, & the need for another surgery/revision).


Visit Dr. Malinoski at www.podiatristofnaples.com