Keeping You Moving: Foot & Ankle Fractures

Story by Randolph Sealey, M.D.
Foot & Ankle Surgeon, OrthoConnecticut | Danbury Orthopedics

Dr. SealeyOne of the injuries that I see increase in frequency during the winter months are foot and ankle fractures. The slippery conditions can trigger a fall, which is the usual cause of these injuries.

Not only do falls occur during snowstorms or ice storms, but the snow or ice that gets left behind on sidewalks and parking lots will often result in twisting injuries around the foot and ankle that can lead to fractures. Winter sports such as skiing, snowboarding, and ice skating also predispose patients to foot and ankle fractures. In fact, something called a “snowboarder’s fracture” is a specific injury that happens because of the position of the foot and ankle on a snowboard.

Foot and ankle fractures are some of the most debilitating injuries that we see in orthopedics.  These injuries have both immediate and long-term effects.  The majority of patients who sustain an ankle fracture will go on to develop ankle arthritis.  The term arthritis means that there has been some damage or injury to the normal smooth cartilage in the joint.  There are many conditions that can damage the joint surface, including an inflammatory problem (rheumatoid arthritis) or the long-term wear and tear of the joint (osteoarthritis).  In the case of an ankle fracture, there is an acute and immediate traumatic event that leads to post-traumatic arthritis.  This means that the patient will have some permanent mobility limitation and also some level of discomfort or achiness.  While standing, the forces that ankles and feet experience can be up to 10 times the patient’s body weight and this can lead to severe discomfort if arthritis develops in those joints.

There are many unique features about foot and ankle fractures that make them very different from fractures in other parts of the body. One very important thing to consider is which foot or ankle is fractured, because if it is your right side you will unable to drive for 2 to 3 months after the injury. Swelling can be a significant problem that may take up to a year to completely resolve.  This not only leads to discomfort but may create some practical problems such as fitting into a normal shoe.  Swelling can also lead to severe blisters that traumatize the skin around foot and ankle fractures. The blisters indicate that there has been severe injury to the skin, which can sometimes take several weeks to heal.  Bruising is another feature that is very common around foot and ankle fractures—the result of bleeding from the bone that makes its way to the surface.

Seeing a specialist with experience in foot and ankle trauma is extremely important in order to have the best possible outcome after a serious injury. Any individual’s treatment will depend on the severity and stability of his or her specific foot and ankle fracture.  Most stable fractures are treated with a rigid cast, boot, or shoe, and patients can begin walking immediately with some assistance.  Some patients will need crutches, a walker, or a cane first, until most of the pain resolves, and then the treatment can continue in a fracture boot or shoe.  Patients will usually benefit from physical therapy or a home exercise program after their fracture has healed since the period of immobilization will create atrophy.

If the fracture is unstable, however, it will require surgical treatment with orthopedic implants, such as plates and screws.  A cast or splint will not be enough to keep an unstable fracture in the proper position for it to heal appropriately.  Patients are often upset by the idea of surgery, but it will provide immediate stability to the bone and may allow for a more predictable recovery.  Bones, on average, will take 6 to 8 weeks to heal; the timeframe for healing does not change with surgery but quicker movement is possible because of the stability provided by the hardware.  Two emergencies that require surgery are an “open fracture” (in which there is an open wound or break in the skin near the site) and a joint that is dislocated along with a fracture.  Open fractures lead to a high risk of infection and they need to be cleaned and stabilized immediately in the operating room.  Patients also will need to take antibiotics to prevent infection.  A dislocated joint must be put back in place, or “reduced,” immediately and this is usually followed by surgery to keep the joint in position.

It is often important to wait for swelling to decrease before proceeding to foot and ankle surgery.  It can be dangerous to operate on swollen tissues because this may lead to an infection around the incisions after surgery.  It is not uncommon for a patient to have to wait 10 to 14 days after a fracture has occurred for the actual surgery to take place.  Many times x-rays are the only studies that we need before surgery, but occasionally a CT or MRI is necessary to plan the procedure.

Although foot and ankle fractures can have devastating implications on a patient’s immediate quality of life, it is possible to return to many of the activities he or she enjoyed once the injury is healed.  There may be a “new normal” in terms of comfort level during weight-bearing activities, and it may be necessary to use an orthotic insert or an ankle brace for some activities.

There are some simple things that you can do to avoid foot and ankle fractures.  Wearing appropriate footwear, such as winter boots with strong grip and ankle support, is a simple measure that can help you avoid injuries… avoiding unpaved walkways and surfaces without salt can also prevent slip-and-fall events… and looking out for black ice during extremely cold temperatures is another step you can take to avoid injury.

About Dr. Randolph Sealey
Dr. Randolph Sealey, who is fluent in Spanish, specializes in the field of Foot & Ankle surgery and is the only fellowship trained orthopedic foot and ankle subspecialist in the greater Danbury area. He completed his fellowship training and gained his ankle reconstructive surgery expertise at the world-renowned Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore, Maryland. In 2008, he became the recipient of the prestigious Roger A. Mann Award, the highest clinical research honor given by the American Orthopaedic Foot and Ankle Society. He is Board-certified by the American Board of Orthopedic Surgery.

About OrthoConnecticut | Danbury Orthopedics
OrthoConnecticut I Danbury Orthopedics is the premier provider of orthopedic care in the region. Thirty-one fellowship-trained, Board-certified physicians provide care in nine office locations. The goal of the practice is to help patients regain mobility, lead active lives, and attain optimal health. Offices are located in Danbury, Darien, New Canaan, New Milford, Norwalk, Ridgefield, Sharon, Southbury, and Westport. To schedule an appointment with Dr. Sealey, or any of the physicians at OrthoConnecticut, please visit myorthoct.com or call 203.797.1500.

Preventing Shoulder Injuries

Story by Dr. Albert Diaz, Sports Medicine Specialist at Danbury Orthopedics

Many of the patients I see with shoulder pain have injured themselves as the result of strenuous, weight-bearing exercise.

As high impact, strength-related exercise programs have increased in popularity, many people are putting too much weight on their shoulder joints. While the benefits of exercise are indisputable, it is important to understand how the shoulder works and how best to avoid injuring this delicate joint.

The shoulder is built for range of motion rather than stability. It is a ball-and-socket joint held in place by a thin sleeve of muscles and tendons called the rotator cuff. Excessive weight on the shoulder can damage the cuff as well as other soft tissues around the joint. Exercise programs that work the large chest and back muscles should also include exercises with light weight or elastic bands for the smaller rotator cuff muscles.

If you feel shoulder pain when exercising or playing sports, DO NOT WORK THROUGH THE PAIN. Rest your shoulder for two weeks and take over-the-counter anti-inflammatory medication such as ibuprofen, if necessary. If, after two weeks, you return to your activity and still feel pain, you should consult an orthopedist.

Repetitive or continuous use of the shoulder at a young age can lead to injury. Children under the age of 16 should avoid playing any single sport for more than 8 months of the year, especially swimming, baseball or tennis, to prevent shoulder overuse. Heavy weight training is also a potential cause of injury.

Danbury Orthopedics, a member practice of OrthoConnecticut, offers an expert group of orthopedic specialists, including a team of sports medicine doctors who work with sports-related injuries and conditions of all kinds. The practice has its own x-ray, MRI and on-site physical therapy specialists, allowing patients to recover in one single, integrated location. All the practice’s physicians are fellowship-trained, and experts in their specialty area.

Danbury Orthopedics’ areas of expertise include five Centers of Excellence where you will find integrated comprehensive treatment for bone or joint pain injury and subspecialized orthopedic surgery to get you back to leading a healthy active life.  These include:

All of Danbury Orthopedics’ services are available at our new state-of-the-art location at 2 Riverview Drive in the Berkshire Corporate Park in Danbury.  For more information, go to: myorthoct.com

Dr. Albert Diaz, who is a fluent Spanish speaker, specializes in the field of sports medicine, minimally invasive arthroscopic shoulder and knee surgery. He completed his sports medicine fellowship at the Minneapolis Sports Medicine Center where he served as Assistant Team Physician to the Minnesota Vikings and Timberwolves. He currently serves as Team Physician for Joel Barlow High School in Redding.  He is board certified by the American Board of Orthopedic Surgery and is a member of the American Orthopedic Society for Sports Medicine, the American Academy of Orthopedic Surgeons, and the Arthroscopy Association of North America.

Should I Be Worried About Flat Feet?

Story By Randolph Sealey M.D., Foot and Ankle Specialist at the Foot and Ankle Center at Danbury Orthopedics

Flat FeetOne of the most common patient consultations to my foot and ankle practice is a parent bringing their child in for evaluation of “Flat Feet.”

The referrals for this common condition come from a range of sources; pediatricians, family members, coaches, shoe salesmen, dance instructors, military recruiters and worried parents.

Although flat feet used to be a disqualifier for military duty, as it turns out, flat feet or pes planus is a normal variation in the spectrum of foot alignment. Most babies and toddlers will outgrow flat foot alignment. Like all things in life there is a normal distribution where a “normal” arch is in the middle and then flat and high arches are on the extremes. A flat foot is one of the most common foot variations or deformities that I treat.

More importantly, most people with flat feet have absolutely no pain! A slight amount of flattening or pronation is probably good to have in your foot alignment versus more of a high or cavus arch. A foot with slight pronation almost has built in shock absorption versus a foot with a high arch which tends to be more stiff during impact.

The World’s Fastest Man has Flat Feet

One of my favorite examples for worried parents and patients is Usain Bolt – the fastest man in the world. Google images of Usain’s feet and you will see that he clearly has flat feet or pronates. This fact doesn’t seem to have slowed him down as he dominated three straight Olympic games!

When Flat Feet Becomes Problematic

Flat foot alignment becomes problematic when it is accompanied by pain and activity limitations. The exact location of the pain and the degree of flexibility in the foot are two key factors when evaluating flat feet. The age of the patient also plays a role in the diagnosis and ultimate treatment. Young children who are active may develop pain from a congenital problem. Adults may develop pain from undiagnosed problems they have been carrying their whole lives. Patients can also develop a new or acquired flat foot because of tearing a tendon or ligament in their foot. Patient symptoms may include swelling, pain along the arch or outer border of the foot, difficulty fitting shoes, and fatigue from long periods of standing or walking. Most patients can be diagnosed in the office thru a history, physical exam and X-rays.

Non-Surgical Treatment Always the First Step

The goal of treatment is to prevent the deformity or flat foot from getting worse. An orthotic shoe insert can be used for mild or moderate deformity. An ankle brace may be needed for moderate to severe deformity. To calm the pain, other recommendations include low impact activity, calf stretching, rest, ice and anti-inflammatory medications. If conservative non-surgical treatment fails after 3 to 6 months we consider surgical options.

Experience is Key to Successful Reconstruction Surgery

Surgery involves reconstruction of the arch by either preserving or eliminating the mobility of foot joints. Experience with flatfoot deformity is critical to appropriately individualize a patient’s treatment plan. Although the recovery process can be lengthy, flatfoot reconstruction surgery enjoys extremely high success rates.

If you are dealing with a painful flatfoot your next step should be an evaluation from our experienced team at the Foot & Ankle Center at Danbury Orthopedics.

Dr. Sealey is the only fellowship-trained, board certified foot and ankle specialist in the Danbury Region. For more information, go to: myorthoct.com, and read more about Dr. Sealey and the Foot and Ankle Center at Danbury Orthopedics.

Today’s Hip Replacements Have Shorter Recovery Times and Longer-Lasting Results

hip replacement photo_8in wide 1.3 megsIf you suffer from persistent hip pain due to osteoarthritis, rheumatoid arthritis, an injury, or joint deterioration, a hip replacement could both relieve pain and improve mobility.

During the procedure, your damaged hip joint is replaced with implants that recreate the ball and socket of a healthy hip. Most patients can return to an active lifestyle after hip replacement, often becoming more mobile than they had been for years while suffering from hip pain.

While it is not uncommon for your doctor to recommend a hip replacement to those suffering from chronic hip pain, many people still think of the procedure as the last step to treating hip problems.  They fear post-operative complications and months of recovery time. However, the procedure has made tremendous strides in the last few years.  “New technology and new approaches have made hip replacement surgery less invasive, with decreased recovery time,” says specialist Dr. Robert Deveney of the Total Joint Center at Danbury Orthopedics.  “In fact, some minimally invasive approaches, when medically appropriate, can have patients on their feet within days of surgery.”

New Approaches to Hip Replacement

The anterior approach gently pushes muscles and surrounding tissue apart, sparing the muscle tissue from trauma. This enables a much faster recovery and a quicker return to normal function after the operation. It also results in fewer post-operative restrictions than other types of hip replacement surgeries. Ask your orthopedist if you are a candidate for this procedure.

There is also a new, minimally-invasive procedure called a Mini-Posterolateral total hip replacement, which allows for a small incision, no cutting of the abductor muscles aand full weight bearing immediately after surgery. Shorter recovery time and fewer post-operative complications are observed with this procedure.

New Materials Last Longer

In addition, hip sockets are now often being replaced with ceramic or plastic materials, instead of metal. These newer materials are significantly less corrosive and result in improved joint longevity. “State-of-the-art materials and leading edge technology have made hip replacement a very strong option for so many people these days,” says Dr. Deveney. “We are eager to inform patients about all the options so they can make the best decision for themselves and get back to their active lives.”

About Danbury Orthopedics

Danbury Orthopedics, founded in 1954, is a multi-specialty practice staffed by leaders in orthopedic care; the practice is a member of OrthoConnecticut, along with New Milford Orthopedics and Coastal Orthopedics, providing comprehensive care to the community. The practice’s Centers of Excellence provide integrated treatment, offering individualized and compassionate care by a team of specialists. The goal of the practice is to help patients regain mobility, lead active lives and attain optimal well-being. To make an appointment with any of the practice’s specialists, please visit myorthoct.com or call 203.797.1500.

How Do You Prevent Winter Sports Injuries? The Pros at Danbury Orthopedics Give Tips

iStock-153765931Winter is the time some sports enthusiasts look forward to enjoying skiing, ice skating, snowboarding and more.  However, winter is also when orthopedists see many injuries related to those very sports.

Most Common Winter Injuries Orthopedists See

According to Dr. Angelo Ciminiello, a Sports Medicine Specialist at Danbury Orthopedics, the most common injuries he sees this time of year are torn ACLs from skiers, broken or fractured wrists from snow boarders and skaters, and many concussions.

Proper Gear Can Prevent Common Injuries

He recommends always wearing a helmet for any of these winter sports, since this simple step can prevent a serious concussion.  To prevent against broken wrists, he suggests using a specialized glove with a wrist guard built-in, which can help prevent a fracture.  Wearing mouth guards and other protective equipment when playing hockey is also a must.

For skiers, be sure the bindings are appropriate for your weight and height so they will disengage when needed.  A torn ACL occurs when the foot is planted and the knee is turned.  If the bindings release your foot after a fall, you are less likely to tear the ACL.

How to Determine if the Injury is Serious

How do you know if you’ve torn your ACL? “You usually hear a pop in the knee, followed by swelling and pain when putting weight on the knee.  If that happens see an orthopedist immediately,” Dr. Ciminiello advises.  The same holds true for a broken wrist.  If you have swelling after a fall and are unable to use the hand properly, see an orthopedist.  “Do not take a wait and see attitude, since immediate treatment will result in a much more successful recovery,” he adds.

Stretching Really is Important for Injury Prevention

Stretching, too, is important for all winter sports. Athletes who play winter outdoor sports are often cold before they begin playing, so stretching your muscles helps warm them up and prevents hamstring pulls and other injuries.  This includes winter outdoor runners, too.

The Premiere Sports Injury Practice in the Region

Danbury Orthopedics treats more than 2,000 sports injury cases each year — from ACL and rotator cuff surgeries to complicated multi-ligament injuries to tendonitis. They are also at the forefront of concussion management.

With offices in Danbury, Ridgefield and Southbury, Danbury Orthopedics is the area’s premier multi-specialty orthopedic practice. The Sports Medicine Center at Danbury Orthopedics is dedicated to the complete care of the athlete — from professional, collegiate and high school athletes to recreational, youth players and weekend warriors. The Sports Medicine Center specializes in sports injury treatment and rehabilitation through both surgical and non-surgical techniques.  The team of four fellowship-trained Sports Medicine Specialty Physicians include: Dr. Michael G. Brand, Dr. Angelo Ciminiello, Dr. J. Albert Diaz and Dr. Ross Henshaw.  Walk-in orthopedic urgent care services for injuries are also available at the group’s OrthoCare Express location at 2 Riverview Drive at Berkshire Office Park in Danbury, open 8 a.m. to 8 p.m. weekdays and 10 a.m. to 3 p.m. on weekends.

Recent patients point to an attentive staff and immediate return to home as major advantages

surgical center prDANBURY, CT – For decades, word of mouth advice has been important in the health care field, where people advise family and friends on their personal experiences, both good and bad, about practitioners, procedures, and results. That communication has been a key influence for many years on how people choose their care. So when the Western Connecticut Orthopedic Surgical Center’s (WCOSC) Total Joint patients stepped forward to talk about WCOSC, their voices were especially audible and noteworthy.

Opened in September of 2014, WCOSC is the first outpatient center of its kind in the region, offering patients a state-of-the-art facility, a highly trained and qualified staff, access to top surgeons, and, most importantly, the ability to go home to recover right after total joint surgery. “Our surgical center is specifically designed to meet the needs of patients who want to recuperate in their own homes,” says administrator Diane Heelan.

Today’s new healthcare model demands shorter hospital stays and cost-conscious care.  For patients who meet the qualifications to have total joint surgery on an outpatient basis, WCOSC is an important new offering in the Danbury area. The following patients were all part of the total joint replacement program at WCOSC, one of the only centers in our area providing this type of care.

Phil Ruckel had a total hip replacement at WCOSC in January and was amazed at the personal approach of the entire team at the center.  “I was most impressed that all of my questions were answered prior to surgery,” says Mr. Ruckel, a Brookfield resident. “The nurses, staff and my surgeon, total joint specialist Dr. John Dunleavy, motivated me with positive, encouraging attitude and an attentive style that built my own confidence which I believe really contributed to my quicker than expected progress.”

“WCOSC’s staff set up my home care through the Ridgefield Visiting Nurse Association (RVNA) which has also been a godsend,” he continues.  “Their Occupational Therapist came to the house the week before my surgery and evaluated what changes I would need to make in the house to make my recuperation easier.  Small daily things, like getting in and out of the bathtub, or getting my socks on or off, were planned out and practiced. Then, the visiting nurse arrived at my home about an hour after I did following my surgery.  That was such a comfort.  From that moment, I was on my way.”

Danbury resident, Bill Dempsey, a total shoulder replacement patient of Dr. Philip Mulieri’s, has recovered from more medical emergencies than he would like to mention.  “In 2001, I fell from a tree and broke 20 bones.  I am more knowledgeable than most people about healing from orthopedic trauma,” continued Mr. Dempsey.  “I absolutely loved going home after this replacement surgery at WCOSC.  The center’s staff makes you feel at home from the minute they are introduced and begin to plan out your surgery.”

However, one of the most significant comments Mr. Dempsey shared was about post-surgical medication. “After my fall from the tree, I went through an enormous amount of surgery, spent many nights in the hospital, and was on a crazy amount of pain medication.  Having my recent shoulder replacement done on an outpatient basis allowed me to have very minimal medication, and I felt so much better almost immediately after my surgery. I am a huge fan of the practice, these doctors, and now of the surgical center.  I won’t go anywhere else,” raves Mr. Dempsey.

Gary Furtak, of New Fairfield, was the very first total joint surgical patient at the center.  As a landscaper, Mr. Furtak depends on his musculoskeletal system to handle a wide range of tasks, counting on his muscle strength to use the larger equipment needed for his job. He refers to his full knee replacement, performed by Dr. Robert Deveney, as one of his smoothest medical experiences ever . “If I had to rate my experience at WCOSC, out of 5 I would give it a 5+,” says Mr. Furtak. “I am overwhelmed with the attention I received at WCOSC. The nurses, staff and Dr. Deveney’s office not only prepared me extremely well prior to surgery, they have responded promptly to any question I have had since.”

Mr. Furtak’s wife, Marilyn, has been a nurse for over 31 years and was equally impressed with the attention, information and follow up care. She explains, “Gary was cleared to return to work in 28 days, and I attribute his speedy recovery not only to Dr. Deveney’s skill level, but to the support system provided by the nursing staff, immediate post-surgical home visits by the RVNA, follow up phone calls and subsequent therapy with David Jewell of Danbury Orthopedics Physical Therapy.” Mr. Furtak, who is becoming emotional about his experience, says with a tear in his eye, “I wouldn’t have changed anything.”

Police officer Robin Montgomery underwent a right total shoulder with Dr. Ross Henshaw in February  in order to continue his active lifestyle. “I didn’t hesitate as I have utmost confidence in Dr. Henshaw, and was delighted to learn that I could do the surgery on an outpatient basis at the new state-of-the-art surgical center,” says Mr. Montgomery.  He adds, “At every turn, the staff has responded to what I needed. I can’t recommend them enough.”

 

About Western Connecticut Orthopedic Surgical Center:

Western Connecticut Orthopedic Surgical Center (WCOSC) opened in 2014 to offer the highest quality, state-of-the-art orthopedic surgery on an ambulatory basis to the community. The outpatient facility offers the most advanced technology to assist orthopedic surgeons with routine and complex procedures. The surgical team includes physicians from Danbury Orthopedics, New Milford Orthopedics and Connecticut Neck & Back Specialists. For more information about the center and the surgical team, please visit www.wcosc.org or call 203.791.9557.

 

 

J. Albert Diaz, M.D. Joins The Sports Medicine Center at Danbury Orthopedics

J. Albert DiazDiaz Brings Over 18 Years of Experience as Sports Medicine Specialist

DANBURY, CT – Danbury Orthopedics is pleased to announce that J. Albert Diaz, M.D., will join the practice as of June 1st. A specialist in the field of sports medicine, minimally invasive arthroscopic shoulder and knee surgery, Dr. Diaz completed his orthopedic residency training at The Hospital for Special Surgery in New York City, and his sports medicine fellowship at the Minneapolis Sports Medicine Center where he served as Assistant Team Physician to the Minnesota Vikings and Timberwolves. He attended Dartmouth College and the Tulane University School of Medicine, and currently serves as Team Physician for Joel Barlow High School in Redding.

“We are thrilled to have Dr. Diaz join our sports medicine team to work alongside Drs. Ciminiello, Henshaw and myself,” says Danbury Orthopedics’ President, Dr. Michael Brand. “Our patients will certainly benefit from his arthroscopic surgical expertise, and the eighteen years of experience he brings in this field.”

Dr. Diaz is board certified by the American Board of Orthopaedic Surgery and is a member of the American Orthopaedic Society for Sports Medicine, the American Academy of Orthopaedic Surgeons, and the Arthroscopy Association of North America. He maintains surgical privileges at Danbury Hospital, Danbury Surgical Center and Western Connecticut Orthopedic Surgical Center.

“I am delighted to bring my skills to the highly trained team at Danbury Orthopedics, and continue to care for patients in the greater Danbury area,” says Dr. Diaz. “This organization has made significant advancements to meet the needs of the modern orthopedic patient and I am excited to be a part of it,” adds Dr. Diaz. Danbury Orthopedics offers the full suite of orthopedic services, including the highest quality diagnostics, non-operative and surgical treatment solutions, integrated care by its physical therapy team, its own orthopedic-only outpatient surgical center, and OrthoCare Express, a walk-in orthopedic specific urgent care service, 7 days a week.

Running Right – to Avoid Common Injuries

Story by Ross Henshaw, MD, Sports Medicine Specialist, Danbury Orthopedics

family runnersDANBURY, CT – As any runner will tell you, this simple sport is one of the most rewarding and convenient exercise activities. It’s a wonderfully efficient way to improve your health, except when it produces chronic, nagging injuries. So what’s the best way to safely enjoy a running program? Start smart, with a progressive training schedule that gradually builds the intensity and duration of your workouts.

What the Pros Say

Typically, a running coach or trainer will recommend increasing distances no more than 10% a week. If you have never been a runner, seek advice from friends, trainers or your local athletic store. There are also great resources online and in print. But if you have an underlying health condition or are new to exercise, make your first step a consultation with your physician to be sure it’s OK to start running. Orthopedically, running is a safe exercise for most people but there are exceptions, even among athletes. So if you have a history of orthopedic injury or joint pains, particularly those involving the legs or spine, seek the advice of an orthopedic surgeon.

While any form of exercise can cause or aggravate a preexisting injury, endurance sports generate typical injury patterns. Endurance sports by definition involve prolonged repetitive motion. While a soccer player may run 3-7 miles in a game, depending on position, he or she is rarely only running straight ahead at the same speed. But runners go straight ahead at a maintained speed, which means your hip, knee, ankle and arm motions are roughly the same for the duration of the exercise. Hills change the degree of motion and add more jarring forces.

The longer the duration and hillier the terrain, the more our joints are cycling and the more our tendons and ligaments are pulling and rubbing around our joints. When we start an endurance sport like running and build up too quickly, the abrupt increase in joint motion can lead to ‘overuse’ injuries.

The Top 5 Complaints

In my practice, the most common running injuries are hip bursitis, kneecap pain, shin splints, Achilles tendonitis and plantar fasciitis. Here’s a quick anatomy lesson:

Hip Bursitis – ‘Trochanteric Bursitis’ is an overuse injury caused by friction between the illiotibial tendon band and the hip bone. This large tendon travels over the bony prominence on the outside of the hip, goes all the way down to the leg and attaches just below the outer side of the knee. When we run, this band rubs back and forth over the outer hip bone; over time the friction creates inflammation. Our bodies have natural ‘cushions’ called ‘bursa’ that are designed to reduced this friction, but if they have not had time to adapt they can swell and hurt. (A related injury is ITB syndrome.)

Kneecap pain and Patella Tendonitis – Often grouped as ‘anterior knee pain’, this refers to pain in the front of the knee and is common among runners. The quadriceps muscle in the front of the thigh powers our ability to straighten the knee. It works by using the kneecap or ‘patella’ for leverage across the knee. This generates pressure and can cause the kneecap to become sore. It’s especially evident when people walk down stairs or inclines and is precipitated by excessive downhill running. The quadriceps muscle tapers to become a tendon that attaches to the kneecap and then to the shin bone (tibia) via the patella tendon. When strained, the quadriceps and patella tendons can also develop micro tears and become inflamed. Treatment includes rest, anti-inflammatories, strengthening exercises, cross training and progressing back to running while avoiding hills.

Shin Splints – Shin splints, or ‘posteromedial tibial stress syndrome’, can occur on one or both shins, but most commonly on the dominant leg depending on your stride. Pain originates at the lower third of the inner part of the shin just behind the bone. The pain is usually discrete and easily reproduced by pressing on the trigger point. This condition is caused by inflammation where the Soleus muscle in the calf attaches to the tibia. As the muscle helps runners with ‘pushing off’ it pulls on the attachment site, which may become inflamed and swollen. This pain usually hurts only when running, early or later in a run. Some people try to run through the pain, which worsens it so that even walking becomes painful. Treatment for this overuse is rest and cross training. Some people may be predisposed to shin splints because of running style or leg, ankle or foot alignment.

Achilles Tendonitis – The strong Achilles tendon is prone to inflammation when starting a running program, particularly on hilly terrain. Our calf muscle tapers off to become the Achilles tendon that inserts into the heel and powers the push-off of the running stride. Running uphill demands more stretch from the calf, forcing it to work harder. This can lead to micro tears of the small Achilles fibers. Micro tears do not become full tendon ruptures, but cause inflammation and swelling as the body tries to repair and regenerate the area. The usual treatment for this pain is rest, stretching, strengthening, cross-training and as the pain dissipates, a gradual return to running with limited hills.

Plantar Fasciitis – Dreaded heal pain! Its most common early symptom comes not with running, but with the morning’s first step. The plantar fascia is a tight band of tissue that supports the foot arch. It attaches to the heel and traverses across the sole, attaching broadly across the end of the foot. When we run the plantar fascia can become overstressed at the smaller attachment on the heel, especially in individuals with tight calf muscles. Initially, inflammation starts after the run and hurts upon standing after a period of inactivity. When the foot and ankle bend to stand flat, the fascia stretches and hurts. Best treatment is to recognize it early and rest, cross train and take an anti-inflammatory. More severe cases may require calf stretching, night splints that keep the plantar fascia stretched, and heel pads.

Pain is a warning!

While it sounds like a lot can go wrong, most of us can enjoy running without ever suffering from these common maladies. As a sports medicine specialist, my best advice is to recognize symptoms early and not ignore the pain. Early recognition and treatment generally lead to a quicker recovery. I also recommend cross training. Even if you prefer running as your primary aerobic exercise, you’ll benefit by incorporating other forms of conditioning such as biking, elliptical or swimming into your routine. If you pay attention to symptoms and mix it up, you can help avoid painful injuries due to repetitive overuse of the joints … and stay active.

Accidents happen

Should an unexpected injury occur, runners in the region can access the orthopedic urgent care service offered at Danbury Orthopedics. OrthoCare Express, the walk-in, orthopedic emergency treatment center, is open 7 days a week in the heart of downtown Danbury, CT at 226 White Street. The Center is staffed by fellowship trained orthopedic surgeons and highly trained Physician Assistants, and is open weekdays from 8 am – 8 pm, and on weekends from 10 am – 3 pm. No appointment is necessary and no referral is required. Visit orthocareexpress.com or call 203.702.6675 for more information.