Patriot's tight end, Rob Gronkowski, suffered from a high ankle sprain.  How effective will he be in the Super Bowl?  

Ankle sprains are very common injuries.  In the US alone, approximately 25,000 ankle sprains occur every day.  Not all of these individuals seek medical care.  Most walk it off and resume life with little or no consequences.  The question is when should you be concerned that you have a serious ankle sprain or something worse and see a doctor.   I will get to this question later in the blog.

ANATOMY

Most people sprain their ankle with an inversion type injury.  This is where the foot rolls in and the ankle rolls out.  This stretches and may tear the ligaments on the outer part of the ankle.  Outer ligaments of the ankle are always injured in the common ankle sprain.

However, in severe cases, the ligaments on the inner part of the ankle (medial ankle sprain) or between the ankle bones (high ankle sprain) can be injured.  The medial sprain will be a topic for future blogs.

A high ankle sprain occurs when the ankle rolls out to the point where the ligaments between the fibula (outer leg bone) and the tibia (inner leg bone) tear.  This ligament structure is known as the syndesmosis.   This can be a stable or unstable injury.  If the ligament is stretched or strained, the ankle is usually stable and does not require surgery.  If the ligament is fully torn, the ankle is unstable.  This injury pattern requires surgery.

Below is an xray of an individual with an unstable syndesmosis tear.

SYMPTOMS

When an individual has a high ankle sprain, walking and jumping on the injured ankle is difficult.  One may experience pain, swelling, bruising, weakness and even a black and blue mark.  Usually people have some level of pain with motion of the ankle.  Rest, ice, elevation, an ace wrap and antiinflammatories can help relieve some of these symptoms.  But if you suspect a high ankle sprain, you should see a physician sooner than later.

TREATMENTS

Initially, after a high ankle sprain, rest, ice, elevation, an ace wrap and antiinflammatories can help relieve some of these symptoms.  If xrays suggest a stable high ankle sprain, the patient is placed in a boot or short leg cast.  The individual is nonweightbearing (not allowed to placed any weight on the injured ankle) for 4 to 6 weeks.

If the syndesmosis is torn, surgery is needed.  In the operation, the tibia and fibula are put back in their proper position and held in place with screws or a device called a tightrope (see xrays).  These patients are not allowed to put weight on the ankle for 3 months.  

In either injury pattern, physical therapy is necessary to help regain range of motion and strength of the ankle.  Physical therapy has been shown in the medical literature to be very beneficial in preventing what is known as “chronic ankle pain”.  Some physicians may want you to use an ankle brace for a short period of time, while others may not want you to use one at all.  Rarely is surgery needed.

OUTCOMES

Most individuals with high ankle sprains are able to return to their lifestyles and activities after 6 to 8 weeks and a lot of therapy.  Being the Super Bowl, Gronkowski will play.  The question is how effective will be.  Just as Ben Roethlisberger's level of play decreased with this injury, it is likely that Gronkowski's will suffer as well.  Cutting, pushing off defenders, and blocking will all be problematic for him.  

VIDEO/ANIMATIONS

Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.

13^th ranked, University of North Carolina (UNC) Tar Heels, will continue the rest of the season without reserve Reggie Bullock. Bullock tore the lateral meniscus in his left knee during UNC’s victory on Sunday against Maryland.  What is the meniscus and what role does it play?

ANATOMY

The knee consists of 3 bones: the knee cap (patella), the thigh bone (femur), and the leg bone (tibia).  These three bones interact to give range of motion to the knee.  Inside the knee joint, the bones are covered with a substance known as cartilage.  The cartilage allows the bones to glide together, painlessly.  This substance is critical to the function of any joint in the human body.  Between the bones are cartilage discs, known as menisci.  These discs cushion the knee.

The meniscus can tear anywhere along its course.  These tears come in a variety of forms and can lead to pain, catching, popping, or clicking of the knee.

CAUSES

Meniscal tears can occur with trauma, twisting injuries, and arthritis.  Tears that are towards the central portion of the knee can be cleaned up, whereas those that are towards the periphery may be repaired.

SYMPTOMS

Not all meniscal tears cause symptoms.  However, symptoms can include pain, swelling, clicking, popping, or even catching.

TREATMENTS

Meniscal tears are treated with shaving procedure to “clean-up” the tear.  

Occasionally, if the tear is located towards the periphery of the meniscus, a repair can be attempted.

WHEN TO SEEK MEDICAL CARE

If you suspect that you have symptoms concerning for a cartilage injury of the meniscus, you should seek medical attention.  A good physical exam, x-rays, and an MRI may be needed to evaluate the injury.

RETURN TO ACTIVITIES/OUTCOMES

Most athletes with meniscal tears that are treated with a shaving procedure are out of competitive play for 3-4 weeks. Those with meniscal tears that need to be repaired are out from competitive plays for at least 3 to 4 months. Extensive rehabilitation is needed to optimize the range of motion and strength of the knee.

VIDEO/ANIMATION

For a video animation of "Anatomy of the Knee", please see the “Education” tab of my website.  Click orthopaedics, then knee, then conditions, then "Anatomy of the Knee".

For a video animation of "Meniscus Tears", please see the “Education” tab of my website.  Click orthopaedics, then knee, then conditions, then "Meniscus Tears".

For a video animation of "Partial Meniscectomy", please see the “Education” tab of my website.  Click orthopaedics, then knee, then procedures, then “Partial Meniscectomy".

For a video animation of "Meniscal Repair", please see the “Education” tab of my website.  Click orthopaedics, then knee, then procedures, then “Meniscal Repair ".

Bullock will be out for the remainder of this season, but I am sure we will see him ready for action next year.

Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog. For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics.

Tony Parker, guard of the San Antonio Spurs, suffered from a calf strain on his left leg against Memphis.  What is a calf strain?

ANATOMY

The calf muscle, also known as the gastrocsoleus complex (GSC), runs from the top of the knee to the back of the heel bone.  It begins as two muscles bellies (the gastrocnemius muscle and the soleus muscle) and then merges to become one tendon – the Achilles tendon.  The Achilles tendon is the largest tendon in the human body.

The GSC is in charge of pointing the ankle towards the floor (plantarflexion), as you would do when pushing on a gas pedal.  The complex also functions to give you push off strength.

CAUSES

The GSC complex can be injured with direct trauma, sudden changes in direction when running, or pushing up on a plantarflexed ankle.

SYMPTOMS

There are different grades of muscle strains:

Grade I – the tearing is microscopic with stretching of the fibers.  Bleeding occurs in the muscle. These injuries associated with a twinge of pain.  Athletes may be able to return to play, but the soreness last for 3-5 days.

Grade II – the tearing is more severe. More bleeding occurs in the muscle.  There is a sharper pain in the back portion of the leg.  There is usually pain with walking and with plantarflexion. The soreness and tightness last for 7-10 days.

Grade III – this is a complete tear of the muscle.  There is sudden, intense pain in the calf.    The athlete is unable to plantarflex the ankle.  The entire muscle or tendon may be torn.  Athletes can be out of competitive play for 3-6 weeks.

TREATMENTS

Treatment is based on the severity of the injury.  Rest, ice, compression, and elevation (RICE) begin immediately.  Cold/ice therapy is applied first to minimize the bleeding and swelling in the calf.  Anti-inflammatories can help with the pain and inflammation.  A compression sleeve, sock, or stocking can help with the swelling. Physical therapy, with massage, ultrasound, stretching and strengthening exercises is essential.  Surgery is rarely needed, unless the tendon has torn.

WHEN TO SEEK MEDICAL CARE

If you suspect that you have symptoms concerning for a calf strain, you should seek medical attention within a few days.

RETURN TO ACTIVITIES/OUTCOMES

The timing for a return to play depends on the severity of the strain:

Grade I – Athletes may be able to return to play, but the soreness last for 3-5 days.

Grade II – The soreness and tightness last for 7-10 days.

Grade III –  Athletes can be out of competitive play for 3-6 weeks.

VIDEO/ANIMATION

To watch a surgical video of Achilles tendon repairs, go to:http://www.youtube.com/NCOCatDuke#p/u/5/rD3aI_7EneA

Based on reports on his injury, Parker will likely be back to action within 4 weeks.

Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics.

This will be the first attempt at starting a new way to educate patients regarding sports, and foot and ankle problems. My goal is to create a new blog on a weekly basis, ranging from orthopaedic topics, such as knee, hip, shoulder, and ankle problems, to total ankle replacements, and bunions.

I will discuss recent injuries to sports personalities and Hollywood tycoons. The goal is to educate my readers. I will not be providing medical advice or guidance over the Internet.

Here is a little about me. I joined the Division of Orthopaedic Surgery at Duke University on April 1, 2009. Prior to this, I was a foot and ankle surgeon in the Department of Orthopaedic Surgery at the University of North Carolina at Chapel Hill. There I was a consultant to many well-known UNC athletes. A graduate of the Boston University School of Medicine, I completed my internship and residency at the Hospital of the University of Pennsylvania, and my fellowship in foot and ankle surgery at the University of Pennsylvania.

Prior to graduating from medical school, I completed a Masters in Business Administration. This was supplemented by a one-year healthcare entrepreneurship fellowship at the Wharton School of Business. My experiences led to the development of the Business of Orthopaedics Conference, the first of its kind in the United States. The course exposes orthopaedic surgeons to a breadth of topics from practice management to product development and entrepreneurship, to personal financial management, to leadership in negotiations. At Duke University, I serve as an Adjunct Faculty Member at the Fuqua Business School.

Currently, my research interests encompass the clinical and basic science aspects of orthopaedic foot and ankle. Mainly interested in athletic foot and ankle disorders and total ankle arthroplasties, I am involved in new product developments. In the laboratory, I am hoping to find new ways to address foot and ankle fractures and ankle arthritis.

My clinical practice includes but is not limited to the treatment of the following foot and ankle disorders: Achilles tendon ruptures, osteochondral defects of the ankle, posterior tibial tendonitis, hallux valgus/bunions, complex reconstructions of the foot and ankle, dance injuries, athletic injuries, and total ankle replacements.

While in North Carolina, I established the Research Triangle Park Orthopaedic Society. This organization was formed with the goal of fostering education and camaraderie amongst the practicing orthopaedic surgeons in the community, the residents in training, and the fellows. The Research Triangle Park Orthopaedic Society holds a regional Grand Rounds on a monthly basis, inviting prominent orthopaedic surgeons from around the country to serve as Grand Rounds speakers.

My awards include the winner of the 2005 Ranawat Award at the Eastern Orthopaedic Association meeting, the 2002 Clinical Orthopaedic Society Wyeth Resident Award, and the American Association of the Physicians of Indian Origin Most Distinguished Resident Award. I am a reviewer for the Clinical Orthopaedics and Related Research journal, the Journal of Bone and Joint Surgery, and the American Journal of Sports Medicine.

My office websites are: http://www.footdronline.com or http://www.ncorthoclinic.com

Thanks and stay tuned! I welcome suggestions, comments, and discussions.

Dr. P

All material published through this blog/website is for informational purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.