Onycholysis

What is Onycholysis?

Onycholysis is the separation of a fingernail or toenail from its pink nail bed. The separation occurs gradually and is painless.

The most common cause of onycholysis is trauma. Even slight trauma can cause onycholysis when it happens repetitively — for example, the daily tapping of long fingernails on a keyboard or counter. Onycholysis also can be caused by manicure tools that are pushed beneath the nail to clear dirt or smooth the nail. Too much moisture also can cause the problem.

Some medical conditions can cause onycholysis, generally by changing the nail’s shape or the contour of the soft tissue bed beneath it. In these situations, the nail cannot attach smoothly to the nail bed.

  • Fungal infections of the nails thicken the tissue immediately underneath the nail plate and cause edge of the nail to lift.
  • The skin condition psoriasis is a common cause of onycholysis.
  • After exposure to some medicines the nail can react to sun exposure by lifting away from its bed.
  • An overactive thyroid gland can cause onycholysis.

Symptoms of Onycholysis?

A nail that has lifted from its bed at its end can have an irregular border between the pink portion of the nail and the white outside edge of the nail. A greater portion of the nail is opaque, either whitened or discolored to yellow or green. Depending on the cause of onycholysis, the nail may have collected thickened skin underneath the edge of its nail plate, and the nail plate may have a deformed shape with pits or indentations in the nail surface, a bent nail edge or coarse thickening of the nail.

Diagnosis of Onycholysis?

Your doctor will be able to confirm that you have onycholysis by examining your fingernails or toenails. If the cause of onycholysis is not obvious, your doctor will note additional characteristics of your nails, such as their shape and color, the presence of indentations in the nail surface, and the appearance of the skin under and around the nail. He or she also will examine you to check for evidence of skin rashes or thyroid problems.

If your doctor suspects that a fungal infection is the cause of nail changes, he or she might scrape a sample of tissue from beneath the nail plate. This sample can be tested in a laboratory to check for fungus.

Expected Duration:

Nails are slow to grow and take time to repair themselves. The portion of nail that has separated from the skin surface beneath it will not reattach. Onycholysis only goes away after new nail has replaced the affected area. It takes four to six months for a fingernail to fully regrow, and twice as long for toenails. Some nail problems are difficult to cure and may affect the nail appearance permanently.

Prevention of Onycholysis:

Some preventive measures will make onycholysis less likely to occur:

  • Cut nails to a comfortable length so that they will be less likely to endure repeated trauma from tapping in everyday use.
  • Wear rubber gloves to avoid repetitive immersion in water. Nails expand after they are exposed to moisture and then shrink while drying, a cycle that over time can make them brittle. Keeping your nails dry also will help prevent fungal infections.
  • Avoid frequent exposure to harsh chemicals, such as nail polish remover.

Treatment of Onycholysis:

Because the portion of nail that has lifted away from its bed may catch on edges when you move abruptly, it is a good idea to trim the nail close to the place where it separates from the nail bed. A physician can help you do this.

Treatment for onycholysis depends on the cause of the problem:

  • Treatment for hyperthyroidism can permit the nails to regrow normally.
  • Some treatments for psoriasis that are given by mouth may improve nail health.
  • Fungal nail infections sometimes can be treated with prescription medicines. However, the medicines required to treat the nail condition are expensive and can have side effects. You should discuss the pros and cons of treatment with your doctor.

Plantar Warts

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Plantar warts are hard, grainy growths that usually appear on the heels or balls of your feet, areas that feel the most pressure. This pressure also may cause plantar warts to grow inward beneath a hard, thick layer of skin (callus).

Plantar warts are caused by the human papillomavirus (HPV). The virus enters your body through tiny cuts, breaks or other weak spots on the bottom of your feet.

Most plantar warts aren’t a serious health concern and may not require treatment. But plantar warts can cause discomfort or pain. If self-care treatments for plantar warts don’t work, you may want to see your doctor to have them removed.

Symptoms of Plantar Warts

Plantar wart signs and symptoms include:

  • A small, fleshy, rough, grainy growth (lesion) on the bottom of your foot
  • Hard, thickened skin (callus) over a well-defined “spot” on the skin, where a wart has grown inward
  • Black pinpoints, which are commonly called wart seeds but are actually small, clotted blood vessels
  • A lesion that interrupts the normal lines and ridges in the skin of your foot
  • Pain or tenderness when walking or standing

Causes of Plantar Warts

Plantar warts are caused by an infection with the human papillomavirus (HPV) in the outer layer of skin on the soles of your feet.

More than 100 types of HPV exist, but only a few cause warts on your feet. Other types of HPV are more likely to cause warts on other areas of your skin or on mucous membranes.

Transmission of the virus
Each person’s immune system responds differently to HPV. Not everyone who comes in contact with it develops warts. Even people in the same family react to the virus differently.

The HPV strains that cause plantar warts aren’t highly contagious. So the virus isn’t easily transmitted by direct contact from one person to another. But it thrives in warm, moist environments. Consequently, you may contract the virus by walking barefoot around swimming pools or locker rooms. If the virus spreads from the first site of infection, more warts may appear.

The virus also needs to have a point of entry into the skin of the foot:

  • Cracks in dry skin
  • Cuts or scrapes
  • Wet, softened, fragile skin from being in the water a long time

Complications

When plantar warts cause pain, you may alter your normal posture or gait perhaps without realizing it. Eventually, this change in how you stand, walk or run can cause muscle or joint discomfort.

Treatments and Drugs

Most plantar warts go away without treatment, though it may take a year or two. If your warts are painful or spreading, you may want to try treating them with over-the-counter (nonprescription) medications or home remedies. You may need many repeated treatments before the warts go away, and they may return later.

If your self-care approaches haven’t helped, talk with your doctor about trying these treatments:

  • Stronger peeling medicine (salicylic acid). Prescription-strength wart medications with salicylic acid work by removing layers of a wart a little bit at a time. They may also stimulate your immune system’s ability to fight the wart.Your doctor will likely suggest you apply the medicine regularly at home, followed by occasional visits to the doctor’s office. Your doctor may pare away part of the wart or use freezing treatment (cryotherapy). Studies show that salicylic acid is more effective when combined with freezing.
  • Freezing medicine (cryotherapy). Freezing therapy done at a doctor’s office involves applying liquid nitrogen to your wart, either with a spray or a cotton swab. Your doctor may numb the area first because it can be painful when the liquid nitrogen is applied.The chemical causes a blister to form around your wart, and the dead tissue sloughs off within a week or so. It may also stimulate your immune system to fight viral warts. Usually, you’ll return to the doctor’s office for repeat treatments every three to four weeks until the wart disappears.

    Some studies show that this treatment is more effective when combined with salicylic acid treatments.

Surgical or other procedures

If salicylic acid and freezing don’t work, our doctor may recommend one or more of the following treatments:

  • Warts Removal. Our doctor cuts away the wart or destroys it by using an electric needle (electrodesiccation and curettage). This procedure can be painful, so our doctor will numb your skin first.
  • Laser treatment. Pulsed-dye laser treatment burns closed (cauterizes) tiny blood vessels. The infected tissue eventually dies, and the wart falls off. The evidence for the effectiveness of this method is limited, and it can cause pain and scarring.

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Morton’s Neuroma

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Morton’s neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. Morton’s neuroma may feel as if you are standing on a pebble in your shoe or on a fold in your sock.

Morton’s neuroma involves a thickening of the tissue around one of the nerves leading to your toes. This can cause a sharp, burning pain in the ball of your foot. Your toes also may sting, burn or feel numb.

High-heeled shoes have been linked to the development of Morton’s neuroma. Many people experience relief by switching to lower heeled shoes with wider toe boxes. Sometimes corticosteroid injections or surgery may be necessary.

Symptoms of Morton’s Neuroma

Typically, there’s no outward sign of this condition, such as a lump. Instead, you may experience the following symptoms:

  • A feeling as if you’re standing on a pebble in your shoe
  • A burning pain in the ball of your foot that may radiate into your toes
  • Tingling or numbness in your toes

Causes of Morton’s Neuroma

Morton’s neuroma seems to occur in response to irritation, pressure or injury to one of the nerves that lead to your toes.

Risks Factors of Morton’s Neuroma

Factors that appear to contribute to Morton’s neuroma include:

  • High heels. Wearing high-heeled shoes or shoes that are tight or ill fitting can place extra pressure on your toes and the ball of your foot.
  • Certain sports. Participating in high-impact athletic activities such as jogging or running may subject your feet to repetitive trauma. Sports that feature tight shoes, such as snow skiing or rock climbing, can put pressure on your toes.
  • Foot deformities. People who have bunions, hammertoes, high arches or flatfeet are at higher risk of developing Morton’s neuroma.

Diagnosis of Morton’s Neuroma

During the exam, your doctor will press on your foot to feel for a mass or tender spot. There may also be a feeling of “clicking” between the bones of your foot.

Imaging tests
Some imaging tests are more useful than others in the diagnosis of Morton’s neuroma:

  • X-rays. Your doctor is likely to order X-rays of your foot, to rule out other causes of your pain — such as a stress fracture.
  • Ultrasound. This technology uses sound waves to create real-time images of internal structures. Ultrasound is particularly good at revealing soft tissue abnormalities, such as neuromas.
  • Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, an MRI also is good at visualizing soft tissues. But it’s an expensive test and often indicates neuromas in people who have no symptoms.

Treatment of Morton’s Neuroma

Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first.

Therapy
Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve. These can be purchased over-the-counter, or your doctor may prescribe a custom-made, individually designed shoe insert — molded to fit the exact contours of your foot.

Surgical and other procedures
If conservative treatments haven’t helped, your doctor might suggest:

  • Injections. Some people are helped by the injection of steroids into the painful area.
  • Decompression surgery. In some cases, surgeons can relieve the pressure on the nerve by cutting nearby structures, such as the ligament that binds together some of the bones in the front of the foot.
  • Removal of the nerve. Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes.

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Bunion

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A bunion is a bony bump that forms on the joint at the base of your big toe. A bunion forms when your big toe pushes against your next toe, forcing the joint of your big toe to get bigger and stick out. The skin over the bunion might be red and sore.

Wearing tight, narrow shoes might cause bunions or might make them worse. Bunions can also develop as a result of an inherited structural defect, stress on your foot or a medical condition, such as arthritis.

Smaller bunions (bunionettes) also can develop on the joint of your little toes.

Symptoms of Bunion

The signs and symptoms of a bunion include:

  • A bulging bump on the outside of the base of your big toe
  • Swelling, redness or soreness around your big toe joint
  • Thickening of the skin at the base of your big toe
  • Corns or calluses — these often develop where the first and second toes overlap
  • Persistent or intermittent pain
  • Restricted movement of your big toe

When to see a Doctor

Although bunions often require no medical treatment, see your doctor or a doctor who specializes in treating foot disorders (podiatrist or orthopedic foot specialist) if you have:

  • Persistent big toe or foot pain
  • A visible bump on your big toe joint
  • Decreased movement of your big toe or foot
  • Difficulty finding shoes that fit properly because of a bunion

Causes of Bunion

Bunions develop when the pressures of bearing and shifting your weight fall unevenly on the joints and tendons in your feet. This imbalance in pressure makes your big toe joint unstable, eventually molding the parts of the joint into a hard knob that juts out beyond the normal shape of your foot.

Experts disagree on whether tight, high-heeled or too-narrow shoes cause bunions or whether footwear simply contributes to bunion development. Other causes include:

  • Inherited foot type
  • Foot injuries
  • Deformities present at birth (congenital)

Bunions may be associated with certain types of arthritis, particularly inflammatory types, such as rheumatoid arthritis. An occupation that puts extra stress on your feet or one that requires you to wear pointed shoes also can be a cause.

Risk Factors of Bunion

These factors may increase your risk of bunions:

  • High heels. Wearing high heels forces your toes into the front of your shoes, often crowding your toes.
  • Ill-fitting shoes. People who wear shoes that are too tight, too narrow or too pointed are more susceptible to bunions.
  • Arthritis. Pain from arthritis may change the way you walk, making you more susceptible to bunions.
  • Heredity. The tendency to develop bunions may be present because of an inherited structural foot defect.

Complications of Bunion

Although they don’t always cause problems, bunions are permanent unless surgically corrected. Possible complications include:

  • Bursitis. This painful condition occurs when the small fluid-filled pads (bursae) that cushion bones, tendons and muscles near your joints become inflamed.
  • Hammertoe. An abnormal bend that occurs in the middle joint of a toe, usually the toe next to your big toe, can cause pain and pressure.
  • Metatarsalgia. This condition causes pain and inflammation in the ball of your foot.

Treatments of Bunion

Treatment options vary depending on the severity of your bunion and the amount of pain it causes.

Conservative treatment
Nonsurgical treatments that may relieve the pain and pressure of a bunion include:

  • Changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes.
  • Padding and taping or splinting. Your doctor can help you tape and pad your foot in a normal position. This can reduce stress on the bunion and alleviate your pain.
  • Medications.
  • Shoe inserts. Padded shoe inserts can help distribute pressure evenly when you move your feet, reducing your symptoms and preventing your bunion from getting worse. Over-the-counter arch supports can provide relief for some people, although others may require prescription orthotic devices.
  • Applying ice. Icing your bunion after you’ve been on your feet too long can help relieve soreness and inflammation.

Surgical options
If conservative treatment doesn’t provide relief from your symptoms, you may need surgery. The goal of bunion surgery is to relieve discomfort by returning your toe to the correct position.

There are a number of surgical procedures for bunions, and no one technique is best for every problem.

Surgical procedures for bunions might involve:

  • Removing the swollen tissue from around your big toe joint
  • Straightening your big toe by removing part of the bone
  • Realigning the long bone between the back part of your foot and your big toe, to straighten out the abnormal angle in your big toe joint
  • Joining the bones of your affected joint permanently

It’s possible you may be able to walk on your foot immediately after a bunion procedure. However, full recovery can take weeks to months. To prevent a recurrence, you’ll need to wear proper shoes after recovery. It’s unlikely that you’ll be able to wear narrower shoes after surgery.

Surgery isn’t recommended unless a bunion causes you frequent pain or interferes with your daily activities. Talk to your doctor about what you can expect after bunion surgery.

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Haglund’s Deformity

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Haglund’s deformity is a bony enlargement on the back of the heel that most often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone). In Haglund’s deformity, the soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes.

Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking.

Symptoms of Haglund’s Deformity

Haglund’s deformity can occur in one or both feet. The signs and symptoms include:

  • A noticeable bump on the back of heel.
  • Pain in the area where the Achilles tendon attaches to the heel.
  • Swelling in the back of the heel.
  • Redness near the inflamed tissue.

Causes of Haglund’s Deformity

To some extent, heredity plays a role in Haglund’s deformity. People can inherit a type of foot structure that makes them prone to developing this condition.

For example, high arches can contribute to Haglund’s deformity. The Achilles tendon attaches to the back of the heel bone, and in a person with high arches, the heel bone is tilted backward into the Achilles tendon. This causes the uppermost portion of the back of the heel bone to rub against the tendon. Eventually, due to this constant irritation, a bony protrusion develops and the bursa becomes inflamed. It is the inflamed bursa that produces the redness and swelling associated with Haglund’s deformity.

A tight Achilles tendon can also play a role in Haglund’s deformity, causing pain by compressing the tender and inflamed bursa. In contrast, a tendon that is more flexible results in less pressure against the painful bursa.

Another possible contributor to Haglund’s deformity is a tendency to walk on the outside of the heel. This tendency, which produces wear on the outer edge of the sole of the shoe, causes the heel to rotate inward, resulting in a grinding of the heel bone against the tendon. The tendon protects itself by forming a bursa, which eventually becomes inflamed and tender.

Diagnosis of Haglund’s Deformity

After evaluating the patient’s symptoms, the foot and ankle surgeon will examine the foot. In addition, x-rays will be requested to help the surgeon evaluate the structure of the heel bone.

Treatment of Haglund’s Deformity

Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the bursitis, they will not shrink the bony protrusion. Non-surgical treatment can include one or more of the following:

  • Removal of the problem: Walking without shoes takes the pressure completely off the affected area.
  • Medication. Anti-inflammatory medications may help reduce the pain and inflammation. Some patients also find that a topical pain reliever, which is applied directly to the inflamed area, is beneficial.
  • Ice. To reduce swelling, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
  • Exercises. Stretching exercises help relieve tension from the Achilles tendon. These exercises are especially important for the patient who has a tight heel cord.
  • Heel lifts. Patients with high arches may find that heel lifts placed inside the shoe decrease the pressure on the heel.
  • Heel pads. Placing pads inside the shoe cushions the heel and may help reduce irritation when walking.
  • Shoe modification. Wearing shoes that are backless or have soft backs will avoid or minimize irritation.
  • Physical therapy. A physical therapist can help identify biomechanical abnormalities that may be contributing to inflammation and recommend appropriate strengthening and stretching exercises to help decrease discomfort and prevent the need for surgery.
  • Orthotic devices. These custom arch supports are helpful because they control the motion in the foot, which can aggravate symptoms.
  • Immobilization. In some cases, casting may be necessary to reduce symptoms.

If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. surgical treatment: Debridement of affected tendon and excision of retrocalcaneal bursa and haglund deformity. A central approach facilitates such debridement but necessitates detachment of 50% of the tendo achilies from calcaneus which is usually sutered back using bone anchors. In severe cases after debridement of substantial portion of the tendo achilies, augmentation may be done with the transfer of the flexor hallusis longus muscle.

Prevention of Haglund’s Deformity

A recurrence of Haglund’s deformity may be prevented by:

  • Wearing appropriate shoes; avoid pumps and high-heeled shoes.
  • Using arch supports or orthotic devices.
  • Performing stretching exercises to prevent the Achilles tendon from tightening.
  • Avoiding running on hard surfaces and running uphill.

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Ankle Sprain

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What is Ankle Sprain?

An ankle sprain refers to tearing of the ligaments of the ankle. The most common ankle sprain occurs on the lateral or outside part of the ankle. This is an extremely common injury which affects many people during a wide variety of activities. It can happen in the setting of an ankle fracture (i.e. when the bones of the ankle also break). Most commonly, however, it occurs in isolation.

 

What are the symptoms of Ankle Sprain?

Patients report pain after having twisted an ankle. This usually occurs due to an inversion injury, which means the foot rolls underneath the ankle or leg. It commonly occurs during sports. Patients will complain of pain on the outside of their ankle and various degrees of swelling and bleeding under the skin (i.e. bruising). Technically, this bruising is referred to as ecchymosis. Depending on the severity of the sprain, a person may or may not be able to put weight on the foot.

What are the risk factors for Ankle Sprain?
As noted above, these injuries occur when the ankle is twisted underneath the leg, called inversion. Risk factors are those activities, such as basketball and jumping sports, in which an athlete can come down on and turn the ankle or step on an opponent’s foot.

Some people are predisposed to ankle sprains. In people with a hindfoot varus, which means that the general nature or posture of the heels is slightly turned toward the inside, these injuries are more common. This is because it is easier to turn on the ankle.

In those who have had a severe sprain in the past, it is also easier to turn the ankle and cause a new sprain. Therefore, one of the risk factors of spraining the ankle is having instability. Those who have weak muscles, especially those called the peroneals which run along the outside of the ankle, may be more predisposed.

The anatomy of Ankle Ligaments:

There are multiple ligaments in the ankle. Ligaments in general are those structures that connect bone-to-bone. Tendons, on the other hand, connect muscle-to-bone and allow those muscles to exert their force. In the case of an ankle sprain, there are several commonly sprained ligaments. The two most important are the following:

1.The ATFL or anterior talofibular ligament, which connects the talus to the fibula on the outside of the ankle.
2.The CFL or calcaneal fibular ligament, which connects the fibula to the calcaneus below.
3. Finally, there is a third ligament which is not as commonly torn. It runs more in the back of the ankle and is called the PTFL or posterior talofibular ligament. These must be differentiated from the so-called high ankle sprain ligaments, which are completely different and located higher up the leg.

How is an Ankle Sprain Diagnosed?
Ankle sprains can be diagnosed fairly easily given that they are common injuries. The location of pain on the outside of the ankle with tenderness and swelling in a patient who has an ankle with inversion is very suggestive. In these patients, normal X-rays also suggest that the bone has not been broken and instead the ankle ligaments have been torn or sprained.

It is very important, however, not to simply regard any injury as an ankle sprain because other injuries can occur as well. For example, the peroneal tendons mentioned above can be torn. There can also be fractures in other bones around the ankle including the fifth metatarsal and the anterior process of the calcaneus. In very severe cases, an MRI may be warranted to rule out other problems in the ankle such as damage to the cartilage. An MRI typically is not necessary to diagnose a sprain.

What are the treatment options of Ankle Sprain?

Surgery is not required in the vast majority of ankle sprains. Even in severe sprains, these ligaments will heal without surgery. The grade of the sprain will dictate treatment. Sprains are traditionally classified into several grades. Perhaps more important, however, is the patient’s ability to bear weight. Those that can bear weight even after the injury are likely to return very quickly to play. Those who cannot walk may need to be immobilized.

In general, treatment in the first 48 to 72 hours consists of resting the ankle, icing 20 minutes every two to three hours, compressing with an ACE wrap, and elevating, which means positioning the leg and ankle so that the toes are above the level of patient’s nose. Those patients who cannot bear weight are better treated in a removable walking boot until they can comfortably bear weight.

Physical therapy is a mainstay. Patients should learn to strengthen the muscles around the ankle, particularly the peroneals. An ankle brace can be used in an athlete until a therapist believes that the ankle is strong enough to return to play without it. Surgery is rarely indicated but may be needed in a patient who has cartilage damage or other related injuries. Ligaments are only repaired or strengthened in cases of chronic instability in which the ligaments have healed but not in a strong fashion.

How long is the Recovery of Ankle Sprain?

Recovery depends on the severity of the injury. As noted above, for those minor injuries, people can return to their activities in sports within several days. For very severe sprains, it may take longer and up to several weeks. It should be noted that high ankle sprains take considerably longer to heal.

Outcomes for ankle sprains are generally quite good. Most patients heal from an ankle sprain and are able to get back to their normal lives, sports and activities. Some people, however, who do not properly rehab their ankle and have a rather severe sprain may go on to have ankle instability. Chronic instability occurs in patients repeatedly spraining the ankle. Such repeated episodes can be dangerous because they can lead to damage within the ankle. These patients should be identified and considered for repair.

Frequently Asked Questions
What is a high ankle sprain and is that different from a regular ankle sprain?

A high ankle sprain refers to tearing of the ligaments that connect the tibia to the fibula (this connection is also called the syndesmosis). These are different and much less common than the standard lateral ankle sprains, meaning those that occur on the side of the ankle.

Do ankle sprains ever need to be repaired acutely?
Ankle sprains rarely, if ever, needed to be treated with surgery. The vast majority simply need to be treated with rest, ice, compression and elevation followed by physical therapy and temporary bracing.

I have sprained my ankle many times. Should I be concerned?
Yes. The more you sprain an ankle, the greater the chance that problems will develop. For example, turning the ankle can lead to damage to the cartilage inside the ankle joint. You should see your doctor if this is occurring.

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Achilles Tendinitis

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Achilles tendinitis is a common condition that causes pain along the back of the leg near the heel.

The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump.

Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse and degeneration.

There are two types of Achilles tendinitis, based upon which part of the tendon is inflamed:

– Noninsertional Achilles Tendinitis
In noninsertional Achilles tendinitis, fibers in the middle portion of the tendon have begun to break down with tiny tears (degenerate), swell, and thicken.Tendinitis of the middle portion of the tendon more commonly affects younger, active people.
– Insertional Achilles Tendinitis
Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches (inserts) to the heel bone.In both noninsertional and insertional Achilles tendinitis, damaged tendon fibers may also calcify (harden). Bone spurs (extra bone growth) often form with insertional Achilles tendinitis.Tendinitis that affects the insertion of the tendon can occur at any time, even in patients who are not active.

 Causes of Achilles Tendinitis

Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis, including:

  • Sudden increase in the amount or intensity of exercise activity—for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance
  • Tight calf muscles—Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon
  • Bone spur—Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain

Symptoms of Achilles Tendinitis

Common symptoms of Achilles tendinitis include:

  • Pain and stiffness along the Achilles tendon in the morning
  • Pain along the tendon or back of the heel that worsens with activity
  • Severe pain the day after exercising
  • Thickening of the tendon
  • Bone spur (insertional tendinitis)
  • Swelling that is present all the time and gets worse throughout the day with activity

If you have experienced a sudden “pop” in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.

Radiologic Investigation for Achilles Tendinitis

X-rays
X-ray tests provide clear images of bones. X-rays can show whether the lower part of the Achilles tendon has calcified, or become hardened. This calcification indicates insertional Achilles tendinitis. In cases of severe noninsertional Achilles tendinitis, there can be calcification in the middle portion of the tendon, as well.
Magnetic Resonance Imaging (MRI)
Although magnetic resonance imaging (MRI) is not necessary to diagnose Achilles tendinitis, it is important for planning surgery. An MRI scan can show how severe the damage is in the tendon. If surgery is needed, your doctor will select the procedure based on the amount of tendon damage.Treatment of Achilles Tendinitis
Nonsurgical Treatment
In most cases, nonsurgical treatment options will provide pain relief, although it may take a few months for symptoms to completely subside. Even with early treatment, the pain may last longer than 3 months. If you have had pain for several months before seeking treatment, it may take 6 months before treatment methods take effect.

Rest. The first step in reducing pain is to decrease or even stop the activities that make the pain worse. If you regularly do high-impact exercises (such as running), switching to low-impact activities will put less stress on the Achilles tendon. Cross-training activities such as biking, elliptical exercise, and swimming are low-impact options to help you stay active.

Ice. Placing ice on the most painful area of the Achilles tendon is helpful and can be done as needed throughout the day. This can be done for up to 20 minutes and should be stopped earlier if the skin becomes numb. A foam cup filled with water and then frozen creates a simple, reusable ice pack. After the water has frozen in the cup, tear off the rim of the cup. Then rub the ice on the Achilles tendon. With repeated use, a groove that fits the Achilles tendon will appear, creating a “custom-fit” ice pack.

Non-steroidal anti-inflammatory medication. Drugs such as ibuprofen and naproxen reduce pain and swelling. They do not, however, reduce the thickening of the degenerated tendon. Using the medication for more than 1 month should be reviewed with your primary care doctor.

Exercise. The following exercise can help to strengthen the calf muscles and reduce stress on the Achilles tendon.

  • Calf stretch
    Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.

Physical Therapy. Physical therapy is very helpful in treating Achilles tendinitis. It has proven to work better for noninsertional tendinitis than for insertional tendinitis.

Eccentric Strengthening Protocol. Eccentric strengthening is defined as contracting (tightening) a muscle while it is getting longer. Eccentric strengthening exercises can cause damage to the Achilles tendon if they are not done correctly. At first, they should be performed under the supervision of a physical therapist. Once mastered with a therapist, the exercises can then be done at home. These exercises may cause some discomfort, however, it should not be unbearable.

    • Bilateral heel drop
      Stand at the edge of a stair, or a raised platform that is stable, with just the front half of your foot on the stair. This position will allow your heel to move up and down without hitting the stair. Care must be taken to ensure that you are balanced correctly to prevent falling and injury. Be sure to hold onto a railing to help you balance.

Lift your heels off the ground then slowly lower your heels to the lowest point possible. Repeat this step 20 times. This exercise should be done in a slow, controlled fashion. Rapid movement can create the risk of damage to the tendon. As the pain improves, you can increase the difficulty level of the exercise by holding a small weight in each hand.

  • Single leg heel drop
    This exercise is performed similarly to the bilateral heel drop, except that all your weight is focused on one leg. This should be done only after the bilateral heel drop has been mastered.

Cortisone injections. Cortisone, a type of steroid, is a powerful anti-inflammatory medication. Cortisone injections into the Achilles tendon are rarely recommended because they can cause the tendon to rupture (tear).

Supportive shoes and orthotics. Pain from insertional Achilles tendinitis is often helped by certain shoes, as well as orthotic devices. For example, shoes that are softer at the back of the heel can reduce irritation of the tendon. In addition, heel lifts can take some strain off the tendon.

Heel lifts are also very helpful for patients with insertional tendinitis because they can move the heel away from the back of the shoe, where rubbing can occur. They also take some strain off the tendon. Like a heel lift, a silicone Achilles sleeve can reduce irritation from the back of a shoe.

If your pain is severe, your doctor may recommend a walking boot for a short time. This gives the tendon a chance to rest before any therapy is begun. Extended use of a boot is discouraged, though, because it can weaken your calf muscle.

Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave impulses stimulate the healing process in damaged tendon tissue. ESWT has not shown consistent results and, therefore, is not commonly performed.

ESWT is noninvasive—it does not require a surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before surgery is considered.

Surgical Treatment

Surgery should be considered to relieve Achilles tendinitis only if the pain does not improve after 6 months of nonsurgical treatment. The specific type of surgery depends on the location of the tendinitis and the amount of damage to the tendon.

Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the Achilles tendon, this procedure is useful for patients who still have difficulty flexing their feet, despite consistent stretching.

In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope—an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs.

Complication rates for gastrocnemius recession are low, but can include nerve damage.

Gastrocnemius recession can be performed with or without débridement, which is removal of damaged tissue.

Debridement and repair (tendon has less than 50% damage). The goal of this operation is to remove the damaged part of the Achilles tendon. Once the unhealthy portion of the tendon has been removed, the remaining tendon is repaired with sutures, or stitches to complete the repair.

In insertional tendinitis, the bone spur is also removed. Repair of the tendon in these instances may require the use of metal or plastic anchors to help hold the Achilles tendon to the heel bone, where it attaches.

After débridement and repair, most patients are allowed to walk in a removable boot or cast within 2 weeks, although this period depends upon the amount of damage to the tendon.

Debridement with tendon transfer (tendon has greater than 50% damage). In cases where more than 50% of the Achilles tendon is not healthy and requires removal, the remaining portion of the tendon is not strong enough to function alone. To prevent the remaining tendon from rupturing with activity, an Achilles tendon transfer is performed. The tendon that helps the big toe point down is moved to the heel bone to add strength to the damaged tendon. Although this sounds severe, the big toe will still be able to move, and most patients will not notice a change in the way they walk or run.

Depending on the extent of damage to the tendon, some patients may not be able to return to competitive sports or running.

Recovery. Most patients have good results from surgery. The main factor in surgical recovery is the amount of damage to the tendon. The greater the amount of tendon involved, the longer the recovery period, and the less likely a patient will be able to return to sports activity.

Physical therapy is an important part of recovery. Many patients require 12 months of rehabilitation before they are pain-free.

Complications. Moderate to severe pain after surgery is noted in 20% to 30% of patients and is the most common complication. In addition, a wound infection can occur and the infection is very difficult to treat in this location.

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Achilles Tendon Rupture

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Achilles tendon rupture is an injury that affects the back of your lower leg. It most commonly occurs in people playing recreational sports.

The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture) completely or just partially.

If your Achilles tendon ruptures, you might feel a pop or snap, followed by an immediate sharp pain in the back of your ankle and lower leg that is likely to affect your ability to walk properly. Surgery is often the best option to repair an Achilles tendon rupture. For many people, however, nonsurgical treatment works just as well.

Symptoms of Achilles Tendon Rupture

Although it’s possible to have no signs or symptoms with an Achilles tendon rupture, most people experience:

  • Pain, possibly severe, and swelling near your heel
  • An inability to bend your foot downward or “push off” the injured leg when you walk
  • An inability to stand on your toes on the injured leg
  • A popping or snapping sound when the injury occurs

Causes of Achilles Tendon Rupture

Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot.

Rupture usually occurs in the section of the tendon located within 2 1/2 inches (about 6 centimeters) of the point where it attaches to the heel bone. This section may be predisposed to rupture because it gets less blood flow, which also may impair its ability to heal.

Ruptures often are caused by a sudden increase in the amount of stress on your Achilles tendon. Common examples include:

  • Increasing the intensity of sports participation, especially in sports that involve jumping
  • Falling from a height
  • Stepping into a hole

Test and Diagnosis of Achilles Tendon Rupture

During the physical exam, our doctor will inspect your lower leg for tenderness and swelling. In many cases, doctors can feel a gap in your tendon if it has ruptured completely.

The doctor may also ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the exam table. He may then squeeze your calf muscle to see if your foot will automatically flex. If it doesn’t, you probably have ruptured your Achilles tendon.

If there’s a question about the extent of your Achilles tendon injury whether it’s completely or only partially ruptured, our doctor may order an ultrasound or MRI scan. These painless procedures create images of the tissues of your body.

Treatments of Achilles Tendon Rupture

Treatment for a ruptured Achilles tendon often depends on your age, activity level and the severity of your injury. In general, younger and more active people often choose surgery to repair a completely ruptured Achilles tendon, while older people are more likely to opt for nonsurgical treatment. Recent studies, however, have shown fairly equal effectiveness of both operative and nonoperative management.

Nonsurgical treatment
This approach typically involves wearing a cast or walking boot with wedges to elevate your heel, which allows your torn tendon to heal. This method avoids the risks associated with surgery, such as infection. However, the likelihood of re-rupture may be higher with a nonsurgical approach, and recovery can take longer. If re-rupture occurs, surgical repair may be more difficult.

Surgery
The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair may be reinforced with other tendons. Surgical complications can include infection and nerve damage. Infection rates are reduced in surgeries that employ smaller incisions.

Rehabilitation
After treatment, whether surgical or nonsurgical, you’ll go through a rehabilitation program involving physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within four to six months.

Prevention of Achilles Tendon Rupture

To reduce your chance of developing Achilles tendon problems, follow these tips:

  • Stretch and strengthen calf muscles. Stretch your calf to the point at which you feel a noticeable pull but not pain. Don’t bounce during a stretch. Calf-strengthening exercises can also help the muscle and tendon absorb more force and prevent injury.
  • Vary your exercises. Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming. Avoid activities that place excessive stress on your Achilles tendons, such as hill running and jumping activities.
  • Choose running surfaces carefully. Avoid or limit running on hard or slippery surfaces. Dress properly for cold-weather training and wear well-fitting athletic shoes with proper cushioning in the heels.
  • Increase training intensity slowly. Achilles tendon injuries commonly occur after abruptly increasing training intensity. Increase the distance, duration and frequency of your training by no more than 10 percent each week.

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Plantar Fasciitis (Heel Pain)

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Plantar fasciitis  is one of the most common causes of heel pain. It involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes.

Plantar fasciitis commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

Plantar fasciitis is particularly common in runners. In addition, people who are overweight and those who wear shoes with inadequate support are at risk of plantar fasciitis.

Symptoms of Plantar Fasciitis
Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually worst with the first few steps after awakening, although it can also be triggered by long periods of standing or getting up from a seated position.
Causes of Plantar Fasciitis
Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually worst with the first few steps after awakening, although it can also be triggered by long periods of standing or getting up from a seated position.
Complications of Plantar Fasciitis
Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. If you change the way you walk to minimize plantar fasciitis pain, you might also develop foot, knee, hip or back problems.
Test and Diagnosis of Plantar Fasciitis

During the physical exam, our doctor checks for points of tenderness in your foot. The location of your pain can help determine its cause.

Imaging Tests:

Usually no tests are necessary. The diagnosis is made based on the history and physical examination. Occasionally your doctor may suggest an X-ray or magnetic resonance imaging (MRI) to make sure your pain isn’t being caused by another problem, such as a stress fracture or a pinched nerve.

Sometimes an X-ray shows a spur of bone projecting forward from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.

Treatment of Plantar Fasciitis

Most people who have plantar fasciitis recover with conservative treatments in just a few months.

Medications
NSAIDs (Non Steroid Anti-Inflammatory Drugs) may ease the pain and inflammation associated with plantar fasciitis.

Therapies
Stretching and strengthening exercises or use of specialized devices may provide symptom relief. These include:

  • Physical therapy. A physical therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist may also teach you to apply athletic taping to support the bottom of your foot.
  • Night splints. Your physical therapist or doctor may recommend wearing a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching.
  • Orthotics. Your doctor may prescribe off-the-shelf heel cups, cushions or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

Surgical or other procedures
When more-conservative measures aren’t working, your doctor might recommend:

  • Steroid shots. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple injections aren’t recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone.
  • Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic plantar fasciitis that hasn’t responded to more-conservative treatments. This procedure may cause bruises, swelling, pain, numbness or tingling and has not been shown to be consistently effective.
  • Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It’s generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.

Cure your Heel Pain today. Orthopaedic Specialist Clinic for Heel Pain. Fast, Safe and Effective treatment is available. Call us +65 97731458 for appointment today.

Ingrown Toenail

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Ingrown toenail is toenail having its free tip or edges embedded in the surrounding flesh or nails whose corners or sides dig painfully into the skin of the toe.

Definition of Ingrown Toenail:

An ingrown toe nail is a painful condition of the toe. It occurs when a sharp corner of the toenail digs into the skin at the end or side of the toe. Pain and inflammation at the spot where the nail curls into the skin occurs first. The inflamed area then starts to grow extra tissue or drain yellowish fluid.

Ingrown Toenail

What are the causes of Ingrown Toenail?

Ingrown toe nail can be caused by tight-fitting shoes or high heels causing the toes to be compressed together and pressurize the nail to grow abnormally. Improper trimming of toenails can also cause the corners of the nail to dig into the skin. Disorders such as fungal infections of the nail can also cause a thickened or widened toenail to develop.

How to prevent Ingrown Toenail?

The best method of prevention is careful clipping of the toenails. Toenails should be clipped straight across and taking care to keep the end longer than the skin edge. This prevents the corners from digging into the skin. They should not be rounded or cut too short. Wearing well-fitting shoes helps as well.

What are the treatments for Ingrown Toenail?

Mild ingrown toenails may be treated with conservative measures like warm daily soaks, topical antibiotics, and gently pushing back the piece of overgrown skin away from the nail. More advanced ingrown toenails may require treatment with oral antibiotics. Resistant or recurrent cases of ingrown toenails may require a minor in-office procedure. Surgical procedures aim to remove the nail’s matrix so that this will be permanent solution for Ingrown Toe Nail.

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Plantar Fasciitis (Heel Pain)

Heel pain is sometimes associated directly with plantar fasciitis, an inflammation of the plantar fascia at the bottom of the foot.

Plantar fasciitis is the most common cause of heel pain. It is caused by repeated strain on the plantar fascia, the ligament that connects the heel bone to the toes, supporting the arch of the foot. A strained plantar fascia causes weakness, swelling, and inflammation, especially in one or both heels. Causes of plantar fasciitis include rolling the feet inward while walking; having high arches or flat feet; and running, walking, or standing for along periods of time. Symptoms include pain upon waking and pain while walking and climbing stairs.

Definition of Plantar Fasciitis:
Plantar fasciitis is one of the most common causes of heel pain. It is due to inflammation of a thick band of tissue called the plantar fascia, which runs across the bottom of the foot, connecting the heel bone to the toes.

How is heel pain (plantar fasciitis) diagnosed?
The chief diagnostic sign of these problems is pain in the bottom of the heel or arch when first standing, which gradually improves with walking. This pain may later return with continued walking. The pain usually subsides after a period of rest.

What are the causes of Plantar Fasciitis?
Under normal circumstances, the plantar fascia acts like a shock-absorbing bowstring, supporting the arch of the foot. But when the tension on the bowstring becomes too great, it creates small tears in the fascia. Repetitive stretching and tearing causes the fascia to become irritated or inflamed.

How to prevent heel pain (plantar fasciitis)?
Maintaining a healthy weight minimizes the stress on the plantar fascia and choosing supportive shoes by avoiding high heels and buy shoes with a low to moderate heel, good arch support and shock absorbency. Do not go barefoot, especially on hard surfaces.

What are the treatment options available for plantar fasciitis?
About 90 percent of people who suffer from plantar fasciitis recover with conservative treatments in just a few months. Anti-inflammatory drugs will be able to reduce pain and inflammation, although they do not treat the underlying problem. Anti-inflammatory injection will help to reduce the inflammation of the soft tissue. If the symptom persisted, Shockwave therapy or Platelet Rich Plasma (PRP) therapy may be performed to treat the plantar fasciitis.

When does surgery for plantar fasciitis become a treatment option?
Surgery should be reserved for patients who have made every effort to fully participate in conservative treatments, but continue to have pain from plantar fasciitis. Patients should fit the following criteria:

  • Symptoms for at least 6 months of treatment
  • Participation in daily treatments (exercises, stretches, etc.)
  • Understanding of the potential risks and benefits of surgery

If you fit these criteria, then surgery may be an option in the treatment of your plantar fasciitis.

Platelet Rich Plasma (PRP)

Platelet Rich Plasma (PRP) therapy holds Great Promise to heal the Soft Tissue, Chronic Tendon Injury, Knee Osteoarthritis, Sports Injury, Acute Ligament and Muscle Injury. Get your PRP done with us today. Call us at +65 97731458 to schedule for an appointment

During the past several years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of injuries.

Many famous athletes Tiger Woods, tennis star Rafael Nadal, and several others have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.

Platelet Rich Plasma

What is Platelet Rich Plasma (PRP)?

Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries.

PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets and, thereby, the concentration of growth factors can be 5 to 10 times greater (or richer) than usual.

To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. Then the increased concentration of platelets is combined with the remaining blood.

How does Platelet Rich Plasma (PRP) works?

Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.

To speed healing, the injury site is treated with the PRP preparation. This can be done in one of two ways:

  • PRP can be carefully injected into the injured area. For example, in Achilles tendonitis, a condition commonly seen in runners and tennis players, the heel cord can become swollen, inflamed, and painful. A mixture of PRP and local anesthetic can be injected directly into this inflamed tissue. Afterwards, the pain at the area of injection may actually increase for the first week or two, and it may be several weeks before the patient feels a beneficial effect.
  • PRP may also be used to improve healing after surgery for some injuries. For example, an athlete with a completely torn heel cord may require surgery to repair the tendon. Healing of the torn tendon can possibly be improved by treating the injured area with PRP during surgery. This is done by preparing the PRP in a special way that allows it to actually be stitched into torn tissues.

What conditions are treated with Platelet Rich Plasma (PRP)?

Research studies are currently being conducted to evaluate the effectiveness of PRP treatment. At this time, the results of these studies are inconclusive because the effectiveness of PRP therapy can vary. Factors that can influence the effectiveness of PRP treatment include:

  • The area of the body being treated
  • The overall health of the patient
  • Whether the injury is acute (such as from a fall) or chronic (an injury developing over time)

– Chronic Tendon Injuries

According to the research studies currently reported, PRP is most effective in the treatment of chronic tendon injuries, especially tennis elbow, a very common injury of the tendons on the outside of the elbow.

The use of PRP for other chronic tendon injuries such as chronic Achilles tendonitis or inflammation of the patellar tendon at the knee (jumper’s knee) is promising. However, it is difficult to say at this time that PRP therapy is any more effective than traditional treatment of these problems.

– Acute Ligament and Muscle Injuries
Much of the publicity PRP therapy has received has been about the treatment of acute sports injuries, such as ligament and muscle injuries. PRP has been used to treat professional athletes with common sports injuries like pulled hamstring muscles in the thigh and knee sprains. There is no definitive scientific evidence, however, that PRP therapy actually improves the healing process in these types of injuries.

– Surgery
More recently, PRP has been used during certain types of surgery to help tissues heal. It was first thought to be beneficial in shoulder surgery to repair torn rotator cuff tendons. However, the results so far show little or no benefit when PRP is used in these types of surgical procedures.Surgery to repair torn knee ligaments, especially the anterior cruciate ligament (ACL) is another area where PRP has been applied. At this time, there appears to be little or no benefit from using PRP in this instance.
– Knee Arthritis
Some initial research is being done to evaluate the effectiveness of PRP in the treatment of the arthritic knee. It is still too soon to determine if this form of treatment will be any more effective than current treatment methods.
– Fractures
PRP has been used in a very limited way to speed the healing of broken bones. So far, it has shown no significant benefit.Treatment with platelet-rich plasma holds great promise. Currently, however, the research studies to back up the claims in the media are lacking. Although PRP does appear to be effective in the treatment of chronic tendon injuries about the elbow, the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions.Even though the success of PRP therapy is still questionable, the risks associated with it are minimal: There may be increased pain at the injection site, but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be no different from that associated with cortisone injections.

If you are considering treatment with PRP, be sure to check your eligibility with your health insurance carrier. Few insurance plans, including workers’ compensation plans, provide even partial reimbursement.

Platelet Rich Plasma (PRP) therapy holds Great Promise to heal the Soft Tissue, Chronic Tendon Injury, Knee Osteoarthritis, Sports Injury, Acute Ligament and Muscle Injury. Get your PRP done with us today. Call us at +65 97731458 to schedule for an appointment

Gouty Arthritis

Managed your Gout Attack today. Effective and Fast Relief Treatment by Orthopaedic Specialist. Call us +65 97731458 to schedule for an appointment.

Gout is a rheumatoid form of arthritis that causes the inflammation, joint pain and swelling especially in the toe, knee and ankle, also reducing their mobility. Gout usually appears in midlife and primarily in males. It can be hereditary or the secondary to some other disease process.

What are the causes of Gout?
Gout is mainly caused by the clustering of uric acid crystals in the arteries, obstructing normal blood flow and causing inflammation. Uric acid is a residual product that is excreted from the body through urine during synthesis of purine – a substance that presents in fat meats, fish, some dairy products and vegetables. The level of uric acid can be found and measured in the blood.

What are the first signs of gout attacks?
In most cases, the first gout signs appear at the level of the big toe. The skin around the affected regions turns yellow, appears to be stretched and bruised. The regions affected by gout become very sensitive. It even causes the sufferers can’t tolerate clothing or shoes. Gout attacks in the region of the big toe are referred to as podagra and they involve inflammation, swelling, pain and a sensation of burning. Podagra can also occur due to acquired injuries or intense physical effort that involves the lower limbs.

Apart from the region of the toes, recurrent attacks also involve pain and inflammation of the knees, elbows, shoulders, wrists and fingers. Most types of gout attacks can generate low to moderate fever and sweating.

And when gout becomes chronic, the damage to the joint is deforming and crippling. Chronic gout attacks are usually long-lasting and they occur in multiple regions of the body.

What are the main symptoms of Gout?
The main symptoms of gout are severe pain and swelling in joints. It’s the crystallized and lodged of uric acid in the joints that cause joint pain. The joint gets hot, swollen and tender. In most cases, the pain attacks seem to amplify at night causing sleeping difficulty to many patients. How long can gout pain remain? The pain may remain anywhere from a few minutes to a few hours and in some cases, even days. As the disease progresses, the duration of gout attacks can exceed 7-10 days.

Other common gout symptoms include fever, discomfort, sourness, malaise, tachycardia, elevations in skin temperature, itching sensations, body aches, water retention, inflammation and intense pain of the affected area – gout in the knee cause joint pain in the knee whereas gout in the finger or toe cause pain in finger or toe. The skin in the affected regions often looks stretched. Gouty arthritis may also cause back pain since it affects the joints.

There are few therapies available for treating gout.  Fortunately gout attacks subside within a period of a week or so and gout attacks are less frequent.  There may be period ranging from months to even years between two gout attacks.

Managed your Gout Attack today. Effective and Fast Relief Treatment by Orthopaedic Specialist. Call us +65 97731458 to schedule for an appointment.

Foot and Ankle Pain

Dr Ambrose Yung Knee, Sports and Orthopaedic Centre Knee, Sports and Orthopaedic Clinic

Stop your Foot and Ankle Pain today. Effective Treatment, Non Surgery. Discuss with our Orthopaedic Specialist for the Diagnosis, Treatment and Prognosis of your Foot and Ankle Pain. Call us +65 97731458 to schedule for an appointment.

Refers to pain located in the foot. There are many things that can create foot pain including broken bones, muscle tears, nerve pain or other soft tissue pain. Our team and Specialist can work with you to decrease your foot pain and get you back on the road of life.

More and more people are facing common foot problems and more serious foot conditions everyday. The human foot is one of the best-engineered parts of the body. Each foot has 33 joints, eight arches, 26 bones, more than a hundred muscles, ligaments, and tendons that all work together to distribute body weight and allow movement. Unfortunately, many people pay no attention to their feet until they start to hurt.

Foot disorders must be diagnosed and treated early, before they become very painful and incapacitating. In some cases, some painful foot abnormalities are already warning signs of even more serious ailments such as diabetes, circulatory disorders, and nerve problems.

Foot and Ankle Pain

Common Ankle Problems:

  • PLANTAR FASCIITIS – Plantar fasciitis is one of the most common causes of heel pain. It is due to inflammation of a thick band of tissue called the plantar fascia, which runs across the bottom of the foot, connecting the heel bone to the toes.
  • ACHILLES TENDON RUPTURE – Achilles tendon rupture is where the large tendon in the back of the ankle ruptures.
  • ACHILLES TENDINITIS – Achilles tendinitis is a syndrome of irritation of the Achilles tendon in the ankle. The Achilles tendon is the large tendon in the back of the ankle that inserts into the heel bone.
  • ANKLE SPRAIN – The ankle joint, which connects the foot with the lower leg, is injured often. An unnatural twisting motion can happen when the foot is planted awkwardly, when the ground is uneven, or when an unusual amount of force is applied to the joint.
  • HAGLUND’S FOOT DEFORMITY – Haglund’s foot deformity is a protrusion of the upper posterolateral calcaneum.

Common Foot and Toes Problems:

  • BUNION / HALLUX VALGUS – Hallux valgus is a condition when the big toe of the foot called the hallux starts to deviate inward towards the direction of the little toe.
  • MORTON’S NEUROMA – Morton’s Neuroma is a benign soft tissue mass that forms on the nerve which runs between the metatarsals and the ball of the foot.
  • PLANTAR WARTS – A plantar warts (also known as “Verruca plantaris”) is a wart caused by the human papillomavirus occurring on the sole or toes of the foot.
  • INGROWN TOE NAIL – An ingrown toe nail is a painful condition of the toe. It occurs when a sharp corner of the toenail digs into the skin at the end or side of the toe.
  • ONYCHOLYSIS – Onycholysis is a diseases whose symptoms appear as the separation of the nail plate from the nail bed on your fingers and toes.
  • FOOT ARCH PAIN Arch pain, better known in the scientific community as plantar fasciitis, is the term used to describe the burning sensation under the long arches of the feet (arch strain).
  • CLAW TOE DEFORMITY – Claw toe is a result of the flexor digitorum brevis (attached to the middle bone, also called the middle phalanx) contracting and eventually overpowering all of the toe muscles.
  • FOOT ARTHRITIS– Foot arthritis is a disorder characterized by the swelling of the joints of the feet. Just like arthritis on another part of the body, it can be painful and debilitating.
  • FOOT CORNS – Known in the scientific community as ‘helomas,’ foot corns are actually thick skin areas that develop because of too much friction and pressure.
  • GANGLION CYST – Ganglion cysts are masses of tissues filled with fluid, usually jelly-like.

When do you need to call us about your Foot or Ankle problem?
If you are unsure of the cause of your discomfort, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of these conditions must be directed at the specific cause of your problem.

Stop your Foot and Ankle Pain today. Effective Treatment, Non Surgery. Discuss with our Orthopaedic Specialist for the Diagnosis, Treatment and Prognosis of your Foot and Ankle Pain. Call us +65 97731458 to schedule for an appointment.

Singapore Knee, Sports and Orthopaedic Centre

Dr Ambrose Yung Knee, Sports and Orthopaedic Centre Knee, Sports and Orthopaedic Clinic
Orthopaedics, specialising in degenerative, chronic orthopaedic condition and sports injuries to the musculoskeletal system with an exceptional record in orthopaedic treatment especially to the Knees, Hip, Elbow, Foot and Ankle, Wrist and Hand, and Shoulder joints; with special interest in Sports Medicines, Partial and Total Joint Replacement, and Minimal Invasive Trauma Surgery.

Orthopaedics is the area of medicine focusing specifically on the body’s musculo-skeletal system. This includes bones, ligaments, joints, muscles, tendons, and even nerves – essentially, all the parts of the body needed move, work and enjoy your life.

At Singapore Knee, Sports and Orthopaedic Centre, we aim to partner with you to maintain your health, allowing you to lead an enriched, fulfilling life. In-house Orthopaedic Surgeon, Dr Ambrose Yung Wai Yin is an established professional with a solid medical background and qualifications.

In addition to our specialism in sports injuries of the musculo-skeletal system, we can also help with orthopaedic problems of all different natures.

We have an exceptional record in treating sport injuries, especially to the knees, shoulder and ankle joints. We specialise in:

  • Complex knee ligamentous reconstruction, using soft tissue tendon allographs
  • Meniscus repair
  • Meniscus allograft transplantation
  • Autologous chondrocyte implantation, using stem cells
  • Double bundle anterior cruciate ligament reconstruction
  • Arthroscopy of knee, elbow, shoulder, ankle and hip joints
  • Ankle sprain treatment
  • Treatment of stiff and painful shoulders
  • Complex Partial and Total Joint Replacement
  • Minimal Invasive Trauma Surgery

As professionals, we treat your health with passion and care through 4 key aspects: Diagnosis, Treatment, Rehabilitation and Prevention.

READ MORE ABOUT COMMON ORTHOPAEDICS PROBLEM