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Knee Pain

10 Tips for Managing Knee Pain When You Travel

Close up of woman leg with pain - long driving on the way.Knee pain while traveling is common, but if you’re prepared you don’t have to be sidelined. Sitting in tight, no-room-to-stretch airline seats, bouncing trains or buses, and sitting in one position in a car for too long can exacerbate pre-existing knee conditions or create knee stiffness and muscular cramping.

Whether it’s arthritis, runner’s knee, kneecap, meniscus, ligament, or other knee conditions causing you discomfort, employing these helpful strategies can reduce or eliminate knee pain while traveling.

General Strategies

  • Dress comfortably in loose or stretchy clothing, wear supportive shoes and compression socks to increase circulation and help prevent blood clots.
  • Plan breaks in your schedule so you can minimize long stretches of travel. Shorter hops mean more walking and stretching – – and the breaks can enhance your explorations at different destinations along the way.
  • Don’t sit too long, move and stretch more. Get up and walk around to avoid stiffness or cramping and to relieve pain. Slide your feet/legs forward and back while seated to stretch your muscles and knee joints – be sure to repeat often.
  • Seat location can help. Reserving an aisle seat (preferably a bulkhead) on planes, trains and buses makes it easier to stretch legs (periodically) into the aisle.
  • Know your cars cruise control. If safe, periodically use cruise control while driving to stretch your legs out. Make frequent rest stops to stretch and move.

Tips to Prepare for Travel

  • Ask your Orthopedist about preventative treatment. Would a knee brace, assistance device, compression socks, corticosteroid or hyaluronic acid injection (to reduce pain or lubricate your joint), or anti-inflammatory medication be of help for your knee condition.
  • Keep all advised medications in a handy location and in the prescription or over-the-counter bottles for easy identification and safety instructions. Ask if premedicating 30 to 45 minutes before travel is helpful.
  • Be prepared for icing or heating your knees. Why not pack a reusable hot or cold bag for relieving sore knees. Ask your doctor which is appropriate for your condition.
  • Ask your Orthopedist for knee strengthening exercises. Some examples include:
    • Pull your heels. Strengthen your hamstrings by lifting your toes with your helps on the floor until you feel tension in your hamstrings. Hold for 10 seconds.
    • Lift your legs. Do straight leg lifts if room allows to strengthen your quadriceps (or front thigh)
    • Slow and careful backward walking to strengthen hamstrings and stabilize knees over time.

Tips Post Travel

  • Keep moving, if possible, to avoid stiffness. If in pain consider applying heat or ice as appropriate, rest and elevate your knee. Does your hotel have a hot tub? Go and enjoy for stiff muscles. Most importantly, enjoy your travels.

OrthoConnecticut Can Help

Our physicians and physician assistants are available for travel consults in advance of your journey. Contact us today for an appointment and enjoy a safe and wonderful trip!

Reference: thepointsguy

Today’s Youth Sports Injuries and How to Keep Up

By Dr. Joshua B. Frank, OrthoConnecticut, Coastal Orthopedics

Lacross-girlsOver the years we have learned a tremendous amount about sports, physiology, bio-mechanics, and technique. This advancement in knowledge has allowed athletes to become faster, stronger, quicker, and more efficient.

Sports medicine has advanced concurrently, and there has been a particular focus on youth athletes. Sports injures can be thought of in two categories: acute and sub-acute, or chronic injuries.

Acute injuries can cause immediate pain, are often quite obvious. In some cases, the initial injury is not very dramatic and may not cause a person to stop playing sports. These injuries should be addressed in a timely manner, as negligence and lingering pain can cause permanent disability. Children can sustain similar injuries as adults, and we have witnessed that the diagnosis of pediatric anterior cruciate ligament (ACL) and meniscal injuries is on the rise. This may be related to increased awareness and better diagnosis of these injuries. If left untreated, these injuries may lead to further damage to the knee and even the onset of early arthritis. Acute knee injuries should be evaluated by a physician on medical professional and may require x-rays or MRI.

Sub-acute or chronic injuries can also sideline a young athlete. While sports are great and teach children excellent life skills as well as improve physical condition, there is a point where overuse of specific joints and muscles can be problematic. The threshhold may be different among different athletes and may change as a child grows.

In an effort to improve athletic ability, children and adolescents are often specializing in one sport and participating in that sport year-round. Whether it be on a team, in camp, or even in the backyard, year-round sports can lead to fatigue and injury. Overuse injuries can occur all over the body. Thee are even names to associate injuries with certain sports. For example, a chronic, over-use injury to the growth plate of the proximal humerus (shoulder) is known as “Little Leaguer’s Shoulder.”

Obviously, these types of injuries are not limited to baseball. We do not yet know how much time is too much time in gymnastics practice, or ice-skating or even playing basketball outside. We do believe that performing multiple sports over the course of a year allows for different muscles to be used and rested. Also, periods of rest and time without any major sports participation is also beneficial.

Another important recommendation is to prepare for the upcoming season well in advance. A period of limited activity followed by a sudden onset of intense training can easily lead to aggravation of growth plates, tendons, and apophyses. In general, a graduated schedule of increased activity with appropriate stretching may help prevent these conditions. Even though training camp often begins in August, young athletes should be preparing on their own, well in advance of these intense training periods.

We are delighted to see so many youth engaged in fitness and athletic activities, especially as obesity rates grow in the country. With the increased prevalence of childhood obesity, it has become even more evident that many children are not nearly active enough. With appropriate training, rest, and conditioning we hope to prevent many injuries and keep our young athletes safer.

Skiing Injury Prevention

Preparing for injuries can help prevent or minimize common snow skiing-related injuries and help you to avoid hospital, doctor’s offices and emergency room visits and costs.

  • Common Ski injuries include:
    • Knee injuries such as injuries of the anterior cruciate ligament
    • Arm or shoulder injuries, breaks, dislocations and sprains
    • Shoulder and lower leg fractures
    • Skier’s thumb
    • Head injuries should always be checked out as they can be serious, even life-threatening
  • A few tips can help prevent ski injuries:
    • Get assistance selecting appropriate equipment
    • Match the ski run to your ability level
    • Taking a ski lesson to learn how to fall correctly and to brush up on your skills helps reduce risk of injuring

For more tips on proper preparation, appropriate equipment, a safe environment and preparing for injuries from the American Academy of Orthopaedic Surgeons learn more here.

Accidents happen, we’re here to help. Visit our board certified orthopedic surgeons specialists at OrthoConnecticut and OrthoCare Express where our goal is to help our patients regain mobility, lead active lives and attain optimal well-being.

What You Should Know – Running Right to Avoid Common Injuries

By Ross Henshaw, M.D., Sports Medicine Specialist, OrthoConnecticut

RUNNING-1024x576Running is a wonderfully efficient way to improve your health, except when it produces chronic injuries. The best way to safely enjoy a running program is to gradually build the intensity of your workouts.


Typically, a running coach or trainer will recommend increasing distances no more than 10 percent a week. If you have an underlying health condition or are new to exercise, make your first step a consultation with your physician. If you have a history of orthopedic injury or joint pain, seek the advice of an orthopedic surgeon.


Hip Bursitis – This is an overuse injury caused by friction between the iliotibial 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 reduce this friction, but if they have not had time to adapt they can swell and hurt, causing pain in the front of the knee. This condition is common among runners.

Kneecap Pain and Patella Tendonitis – This results in pain in 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. 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 – This can occur on one or both shins, but most commonly on the dominant leg. 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. Treatment for this overuse is rest and cross training.

Achilles Tendonitis – The strong Achilles tendon is prone to inflammation when starting a running program. 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 is rest, stretching, strengthening, cross-training and as the pain dissipates, a gradual return to running with limited hills.

Plantar Fasciitis – The most common early symptom of this comes with 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. The best treatment is to recognize it early and rest.


Most of us can enjoy running without ever suffering from these common maladies. My best advice is to cross train and to recognize symptoms early and not ignore the pain. If you pay attention to symptoms, you can help avoid painful injuries and stay active.

About OrthoConnecticut
OrthoConnecticut is the region’s premier, multi-specialty orthopedic and pain management practice. Thirty-one fellowship- trained, board-certified physicians offer patient care at nine offices in Danbury, Darien, New Canaan, New Milford, Norwalk, Ridgefield, Sharon, Southbury and Westport. The practice’s urgent care service, OrthoCare Express, is open 7 days a week for emergencies and is available in Danbury, Darien, Norwalk and Westport. To make an appointment with Dr Henshaw, or to learn more about OrthoCare Express, please visit, or call 1.833.ORTHOCT (1.833.678.4628).

Download article as pdf:
pdf(English) Running Right to Avoid Common Injuries
pdf(Español) Correr Correctamente para Evitar Lesiones Comunes
pdf(Português) Correr Corretamente para Evitar Lesões Comuns

de Quervain’s Tendonitis

By Michael G. Soojian, MD
Hand & Upper Extremity Surgeon

Living in a digital worldIF YOU ARE experiencing a shooting pain from your wrist into your thumb, you may be suffering from a common form of tendonitis called de Quervain’s tendonitis. This condition gets its name from Dr Fritz de Quervain who first described it in 1895, and is often referred to by other names such as texting thumb, gamer’s thumb, and mother’s wrist. Anatomically, two separate tendons start in the forearm and pass through a small sheath or tunnel as they cross the wrist, before they attach to the thumb. Repetitive movements can cause these tendons to experience friction and lead to a build-up of inflammation within this sheath, which manifests as pain, swelling and a feeling of weakness with routine daily activities. This condition usually occurs as a result of repetitive gripping and lifting, and other activities such as swinging a hammer, using a cell phone, working in the yard or even carrying a baby. Less commonly, this problem can result from trauma, i.e. a direct blow or a sudden yank to the hand or wrist.

This condition usually occurs as a result of repetitive gripping and lifting, and other activities such as swinging a hammer, using a cell phone, working in the yard or even carrying a baby.

DeQuervain’s tendonitis can usually be diagnosed by physical examination which can detect swelling and tenderness over the tendon sheath. Many patients feel as though their “bone is sticking out” but in actuality it is a thickening of the soft tissue sheath they are feeling. X-rays can be taken to rule out other sources of pain, but in most cases end up being normal. In its early stages, DeQuervain’s tendonitis can often be successfully treated with bracing and oral anti-inflammatories such as ibuprofen. Occupational/Hand Therapy can also help some patients. When these simple treatment options fail to provide relief, cortisone injection is usually recommended and can cure this problem about 75% of the time. When all else fails, a minor surgery can decompress the tendons and definitively treat the problem. This surgery entails a brief trip to the operating room and is performed under local anesthesia that is usually combined with an intravenous sedative (“twilight anesthesia”). After the surgery, the hand and wrist are wrapped in a soft bandage for a few days and routine activities are encouraged. The majority of the symptoms usually resolve within two weeks, and most patients are pain free within four to six weeks.

Osteoarthritis (OA)

By Lisa M. Cyr, OTD, OTR/L, CHT
Occupational Therapist/Hand Therapist, OrthoConnecticut

Strong Male Hands Twisting a Stubborn Jar Lid (Close-Up)OSTEOARTHRITIS (OA) is one of the most common joint disorders and is one of the leading causes of disability in the United States. It affects as many as 12% of the American population over 25. One in 4 women and at least 1 in 12 men will suffer from the pain and loss of function caused by osteoarthritis (OA) of the carpometacarpal joint (CMC) of the thumb during their lifetimes. When the smooth cartilage covering the ends of the bones in the thumb wears away, the bones rub against each other, causing friction and damage to the bones and the CMC joint. This can cause severe pain, swelling, and decreased strength and range of motion, making it difficult to do simple daily tasks. This may lead to loss of function, depression and decreased quality of life, causing many people to ultimately seek surgical intervention for relief.

There are many potential causes for arthritis at the base of the thumb. Since the thumb is involved in at least 40% – 50% of every task that we do with our hands, it is subjected to many forces and strains throughout each day. Each time we pinch something between the fingertip and thumb tip, there is up to 25 times more force at the CMC joint than at the tip! Straining to open a new jar, holding a pen tightly when writing, buttoning tight buttons, pulling tight weeds, twisting a key in a stiff lock, trying to pull open a new bag of cereal or chips, holding pliers or other tools or overly large cups are all examples of ways we repeatedly strain our thumbs each day. Texting, with its repeated thumb motion, can irritate an already inflamed CMC joint.

These techniques are most effective when incorporated early in the disease when people first notice twinges of pain at the base of the thumb with pinching or gripping activities.

Research shows that the disabling effects of basal joint disease can be minimized with conservative interventions such as joint protection strategies, short term immobilization to rest the painful joint, and hand exercises.

A referral to a skilled Occupational Therapist/Hand Therapist for two or three sessions can help significantly decrease pain at the base of the thumb, and enable people to continue doing the activities most important for their quality of life. A skilled Occupational Therapist/Hand Therapist accomplishes this by educating the patient in joint protection techniques and adaptive equipment. Patients are either fitted with a custom thumb stabilizer or educated about an over the counter soft support to help rest the painful CMC joint. The patient is given a home exercise program to help delay the progression of the arthritis. These simple techniques have been shown to dramatically improve pain and function for many people with basal joint arthritis.

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 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:

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:, and read more about Dr. Sealey and the Foot and Ankle Center at Danbury Orthopedics.

Tennis Elbow

By Paul D. Protomastro, M.D.
Hand & Upper Extremity Surgeon, OrthoConnecticut

Mixed race Woman Playing TennisTENNIS AND GOLFER’S elbow are common orthopaedic conditions that lead to pain, weakness and disfunction of the elbow. Both conditions actually represent tears of the forearm tendons off of the humerus bone at the elbow. A tear on the outside (lateral) part of the elbow is known as Tennis elbow. A tear on the inside is known as golfer’s elbow. The muscles involved in this condition help to extend (tennis) and flex (golfer’s) the wrist. With both disorders there is degeneration of the tendon attachment usually following repetitive grasp or lifting activities and subsequent weakening of the anchor site leading to tendon detachment. Patients usually experience the insidious onset of elbow pain associated with activities in which this muscle is active, such as lifting, gripping, and/or grasping. Sports such as tennis, golf and weight training are common causes. The problem can occur with many different types of activities such as home renovation and gardening.

A direct blow to the bony prominence of the elbow may result in an acute tear or swelling of the tendon that can lead to degeneration. A sudden extreme action, force, or activity, such as starting a lawn mower, can also injure the tendon. The most common age group that this condition affects is between 30 to 50 years old. It affects both men and women with equal frequency. Pain is the primary reason for patients to seek medical evaluation. With tennis elbow the pain is located over the outside aspect of the elbow, over the bone region known as the lateral epicondyle, and is exacerbated by overhand lifting or power grip activities. With golfer’s elbow the pain is on the inside part of the elbow (medial epicondyle) and exacerbated by resisted wrist flexing or underhand lifting. The bone and tendon insertion often becomes tender to touch. Pain is also produced by any activity which places stress on the tendon, such as gripping or lifting. With activity, the pain usually starts at the elbow and may travel down the forearm to the hand. Occasionally, any motion of the elbow can be painful.

The bone and tendon insertion often becomes tender to touch. Pain is also produced by any activity which places stress on the tendon, such as gripping or lifting. With activity, the pain usually starts at the elbow and may travel down the forearm to the hand.

There are several theories as to why the elbow is so prone to these tendon injuries. Firstly, these tendons are taut and under great stress with repetitive wrist and hand activity. Secondly, the tendon origin is very small relative to the muscles that attach to them which leads to high forces on a tiny insertion site. Thirdly, these tendons have a very poor blood supply and take a long time to heal. All these factors result in prolonged pain and dysfunction in most cases. On average a case of tennis or golfer’s elbow takes 12-18 months to fully heal. On rare occasions people can be pain free and return to their sports, work or hobbies in 2-3 months.


Activity modification
Initially, the activity causing the condition should be limited. Limiting the aggravating activity, not total rest, is recommended. Modifying grips or techniques, such as use of a different size racket and/or use of 2-handed backhands in tennis, may relieve the problem.

Anti-inflammatory medications may help alleviate the pain temporarily to make the tendon tear heal.

A tennis elbow brace, a band worn over the muscle of the forearm, just below the elbow, can reduce the tension on the tendon and decrease pain while using the arm and possibly allowing the tendon to heal.

Occupational Therapy
May be helpful, providing stretching and/or strengthening exercises. Ultrasound, lasers, deep friction massage and heat treatments may be helpful by increasing blood flow and decreasing pain.

Steroid injections
A steroid is a strong anti-inflammatory medication that can be injected into the area. These injections have been shown to temporarily decrease the pain of elbow tendonitis but do not help the tear heal. In fact, steroids may further harm the tendon and lead to chronic tendon damage. No more than (3) injections should be given.

Surgery is considered when the pain is incapacitating, has not responded to conservative care, and symptoms have lasted more than six months. Surgery involves removing the diseased, degenerated tendon tissue and then repairing healthy tendon back to the humerus bone. This 15-20 minute procedure is performed in the outpatient setting under sedation and local anesthesia.  Recovery from surgery requires physical therapy to first regain motion of the arm and then a strengthening program after 6 weeks. Most patients can return to usual activities by 3-4 months. Complete recovery, including a return to tennis, golf and high impact/repetition work, can be expected to take 4–6 months. The success rate of this surgery is over 90%.