Months of anticipation and planning were successful in the installation of our new Open Bore MRI. We are happy to report that it is up and running. Installing this sophisticated piece of equipment was an event in itself! Thank you to everyone involved in the planning and installation of our new MRI!
Treatment of Cavus Foot Deformity
Cavus Foot Deformity
Now that it’s summer, we spend more time at the beach or swimming pool enjoying the warm weather. As an orthopedic surgeon that specializes in conditions of the foot and ankle, I tend to notice wet footprints across the pool deck or in the sand and cannot help but analyze the health of the individual’s feet. One of the conditions that I notice is the high arched foot, medically termed pes cavus. This is noticeable by a footprint that is pronounced in the heel and forefoot, with very minimal or even absent impression in the middle part of the foot.
Causes of Cavus Foot Deformity
Pes Cavus is caused by muscle imbalances in the lower leg and foot that draws the front of the foot, or sometimes draws the heel downward, making the arch higher than normal. It usually begins during childhood and may be associated with neurological conditions such as muscular dystrophy or spina bifida, but not always. In many cases the muscles of the feet become tighter or weaker for unknown reasons. As with many medical conditions, genetics play a role in who will become afflicted with high arches.
Symptoms of Cavus Foot Deformity
High arches can cause a number of symptoms, ranging from mild to severe. Pain in the forefoot is a common occurrence due to increased weight bearing in this area. Excessive callus buildup at the ball of the foot behind the great toe as well as just behind the fifth toe is common, as these become high-pressure areas during standing and walking. Tightness in the calf muscles is often present, and the individual may also suffer from recurring ankle sprains due to the inwardly rolled ankles associated with the deformity.
Diagnosis of Cavus Foot Deformity
Identifying pes cavus is a straightforward process. The high arched foot is noticeable to anyone, but an orthopedic surgeon should evaluate the individual in order to identify some of the nuances of the condition. Diagnosing which muscles are tight or weak and assessing their potential to be stretched or strengthened is important for initiating an effective treatment plan.
Also, the cavus foot causes increased body weight to be distributed through areas of the foot that are not designed for this purpose. Evaluation by the surgeon will aid in a proper prescription of orthotics, if deemed necessary.
Treatment of Cavus Foot Deformity
Conservative intervention is generally the rule when starting to treat high arches. Often times if the feet have become painful, orthotic inserts are prescribed. As opposed to pes planus (flat feet), which is often a flexible disorder of the foot that we try to correct with orthotics (i.e., push back into the correct position), pes cavus is usually a rigid deformity,meaning that the shape of the foot cannot be changed.
In this case, the goal of orthotics is to accommodate the shape of the foot and to redistribute body weight over a larger area. Because of the rigidity, the cavus foot is not able to flex and absorb impact as the individual walks. For this reason, orthotics are usually constructed of softer materials to act as a shock absorber.
Physical therapy may also be prescribed to stretch and strengthen the muscles of the lower leg. Tight calf muscles and weak muscles along the outside of the lower leg (peroneal muscles) are often present in pes cavus. While therapy cannot change the shape of the foot, it may be able to help with pain control and function. Because the foot is usually rolled inward along with the high arch, the individual is susceptible to chronic ankle sprains and some reactive muscle strengthening may be beneficial, along with ankle bracing.
If conservative treatment fails to achieve the desired result, then surgical correction maybe necessary. There are many types or surgeries that the physician can perform based on individual need:
- Tendon lengthening: This procedure involves making precision cuts in the tight tendons of the lower leg to allow better alignment of the foot. Following surgery,there is a period of immobilization for several weeks to allow the tendons to heal.
- Osteotomy (bone cut/realignment): If the condition has been present since childhood and the bony structure of the foot has grown abnormally, then small sections of bone may need to be removed in order to restore proper position of the foot. The first metatarsal, located in the midfoot behind the great toe, is often treated with an osteotomy. The metatarsal often is positioned at a downward angle that is greater than normal, which in turn rolls the ankle toward the outside of the foot as the person bears weight.
The osteotomy procedure seeks to normalize that angle and place the foot in a neutral position that is perpendicular to the ground. Many times, this osteotomy is performed in conjunction with soft tissue surgery such as tendon lengthening. Also, the calcaneus (heel bone) tends to be oriented toward the midline in pes cavus, as opposed to away from the midline in the normal foot, and sometimes an osteotomy is required to correct this.
- Arthrodesis: Also known as a joint fusion, this procedure permanently locks the affected joint into a fixed position. It is a last resort option, but sometimes necessary when the cavus foot deformity is severe or when arthritis is present.
Volleyball Injuries Caused by Repetitive Motion
Karch Kiraly, Misty Mae Traenor, Logan Tom, Kerri Walsh and Steve Timmons dominated the sport of volleyball both on the court and in the sand. It’s no surprise that over their years as either and Olympic gold medalist or a top professional athlete, they have had their share of injuries over the years. From shoulder injuries to foot and ankle injuries, these athletes have battled the pain and recovered through extensive orthopedic protocols and treatments.
Seattle Mariner, Mike Zunino Out for Six Weeks due to a Broken Hamate Bone
Seattle Mariner, Mike Zunino, injured his left hand during the game against the Minnesota Twins at the end of July. Zunino suffers from a broken hamate bone.
Wrist and Hand Injuries From Bike Falls
I have always enjoyed cycling. There is something about grinding your way up a steady incline for a mile or greater and then riding over the hillcrest to claim your reward. Turning all the responsibility of propelling the bike over to gravity is one of those great feelings that only vigorous exercise can produce.
Here in Seattle, we have great opportunities for cycling, whether for fitness or just getting around the city. Seattle offers numerous roadways with bicycle lanes as well as separate bike paths for those who wish to stay clear of automobile traffic. Because of the popularity with riding in and around the city as well as on mountain trails, I do tend to see numerous wrist and hand injuries during the warmer months from bicycle falls.
The natural reaction when one falls off of or is thrown from a bike is to break the fall with their arms, and is the most common mechanism of injury. The impact of falling on an outstretched hand can cause several different types of injury that we will discuss.
Fractures
The impact of falling on an outstretched hand can be several times an individual’s body weight, leading to broken bones. In fact, 20% of all upper extremity injuries caused by bicycle falls are fractures.
Wrist Fracture
One of the most common fractures is of the distal radius, the large bone of the forearm that articulates with the smaller carpal bones in the wrist. The break will often lead to pain in the forearm, approximately one inch away from the wrist.
More severe breaks could show some deformity if the bones are displaced, which will likely cause the rider to seek immediate medical attention; however, it is important to know that the blood vessels and nerves that supply the hand are funneled into a fairly compressed area in the wrist, and a fracture or the subsequent swelling that occurs could disrupt this neurovascular integrity.
These symptoms include numbness or tingling, discoloration, and temperature change in the hand. Most bike injuries happen over the weekend, when your doctor’s office is closed. If this is the case and you have any of the above symptoms, then you should go to the emergency room. Even without these symptoms, it is important to get evaluated by a hand surgeon soon after the injury occurs in order to initiate treatment.
Wrist fractures, if non-displaced, may be treated with immobilization in a cast; however, any misalignment may cause a loss of function in the wrist and is difficult to correct without surgical fixation. Screws and plates may be placed internally, or a device called an external fixator may be placed to hold the fracture in place.
Scaphoid Fracture
The scaphoid is a small bone located in the wrist, at the base of the thumb. When a bike rider falls on an outstretched hand, the scaphoid is compressed and could fracture. The primary symptoms are acute pain and tenderness on the thumb side of the wrist lasting longer than a few days, swelling, and limited thumb function. Diagnosis is usually confirmed with X-ray; however, this type of fracture often will not be visible on X-ray until a week after the injury. In this case, I will splint the patient’s hand and have them return in one week for a repeat exam.
If the fracture is located further toward the thumb, then the treatment may be immobilization in a short arm cast for several weeks. If the bone is fractured more toward the forearm, surgical treatment may be necessary as the scaphoid has poor blood supply in this area.
Surgical treatment consists of placing a small screw or wire through the bone fragments to create proper alignment. In some cases where the scaphoid has broken into several pieces, a bone graft taken from another part of the patient’s body may be used to stimulate healing. In all cases, there will be a period of immobilization and limited activity, followed by physical or occupational therapy by one of our therapists that specialize in hand rehabilitation.
Wrist and Finger Sprains
A sprain occurs when a ligament holding one bone to another bone at a joint is torn, either partially or completely. With a fall from a bike, the ligaments most likely to be torn are on the palm side of the wrist and where the fingers meet the hand. Again, this is due to the extreme backward bending (extension) of the wrist and fingers as one tries to break their fall with the arms. Pain and swelling in the affected joint are likely, but should start to subside after a few days. If pain is severe or persistent, you should see a doctor in order to rule out a fracture.
Treatment for wrist sprains could be as simple as careful observation over several weeks or splinting and activity modification to allow the ligament to heal. In severe cases, surgical reconstruction using tendon grafts may be necessary to restore optimal function.
Not all bike falls will be avoided, but there are a few things that we can do as riders to prevent injuring ourselves:
- Being aware of your surroundings is paramount, which includes being able to hear approaching vehicles from the rear. Avoid listening to music when sharing the road with motorists.
- When cycling with others, break up your party into groups of no more than 3 riders in line. This will help avoid a driver from squeezing you off the road in the presence of oncoming traffic.
- Mountain bikers may want to reconnoiter a new obstacle or downhill challenge prior to attempting it at full speed.
- Wear padded gloves to avoid skin abrasions on the hands if you fall. They also protect against nerve compression in the wrists.