Chronic Ankle Instability by Dr. Shawn Khademi

11 Jun 2020 All, Blog

Ankle sprains represent one of the most common musculoskeletal injuries seen in both athletes as well as the general population. Studies show that these types of injuries can even account for up to 40 percent of injuries in sports! Depending on the severity of the injury, ankle sprains are generally treated conservatively with a gradual return to activity as tolerated. However, what if there’s still pain several months later? What if the ankle still feels like it’ll “give out” at any moment? 

Patients with a history of recurring ankle sprains and chronic pain and discomfort often present to the office with confusion and disappointment that they are not healing in an appropriate period of time. They often rely on an over-the-counter ankle brace to at least give them some support in shoes and during activity. This is not a sustainable modality of treatment and certainly not something that patients would like to be in for the rest of their life. Oftentimes, if the original ankle injury was not rehabilitated properly or if a severe injury was not recognized early in the treatment course, this can unfortunately lead to chronic pain with instability.

The first step in treating chronic ankle instability is to assess the ankle radiographically to ensure that there are no obvious osteochondral defects within the ankle joint or other surrounding osseous injuries. A thorough physical examination will generally elicit tenderness in the lateral ankle complex and sometimes even within the peroneal tendons. Various exam maneuvers may or not may reveal clinical instability of the lateral ankle complex although patients will say that they feel unstable while walking, especially on uneven surfaces. 

An MRI is generally obtained at this time to truly assess the underlying soft tissue structures.  Unrecognized osseous injury in the ankle joint can be uncovered and tearing vs. attenuation of tendinous and ligamentous structures are intricately visualized. Definitive treatment varies from patient to patient, however, it is unlikely at this point that conservative treatment will improve pain long-term and lessen instability. A last ditch-effort in functional bracing and focused physical therapy can be utilized, however, patients need to understand that surgery may very well be inevitable if there is persistent pain and discomfort, especially with instability.

Depending on the underlying injury, surgical intervention can be tailored to best benefit the patient and allow for optimal recovery. Diagnostic ankle arthroscopy can usually be performed first which allows the surgeon to visualize the interior of the ankle joint with a camera and other instruments; this is all done through very small incisions. All inflammatory and scar tissue can be effectively debrided (i.e. cleaned up) with specialized instruments and any loose bony fragments can be removed. If there are osteochondral defects in the ankle joint, these can also be addressed at the same time per the discretion of the surgeon.

Repair of the damaged tendinous/ligamentous structures obviously depends on the patient’s clinical findings with correlation to MRI results. While this can sometimes be done arthroscopically depending on the surgeon, an open incision can give excellent visualization to the underlying damage and allow the surgeon to repair the torn ligaments/tendons and even tighten them using bone anchors inserted into the fibula. There are a variety of surgical techniques and types of suture/bone anchors that can be utilized—it is important to have a discussion with your surgeon regarding how he/she will repair the ankle and what this will mean in terms of recovery time.

After surgery, patients will generally be immobilized in a cast for approximately 4 weeks depending on the procedure performed. They will then transition to a walking boot and will proceed with focused physical therapy for the next 4-6 weeks. An ankle brace is typically utilized for the first 1-3 months as patients transition back to shoes and generally, they are able to progress into normal, strenuous activities between 3-6 months after surgery. This all depends on the type of surgery performed and how the patient progresses post-operatively and can absolutely vary from person to person. 

If you have problems with recurring ankle sprains and feel unstable while walking, make an appointment with our office by calling 847-639-5800 for evaluation and treatment options!

Lawn Mowing and Foot Injuries by Dr. Summer Bochat

22 May 2020 All, Blog

Many people enjoy the outdoors by mowing their lawns in the Summer months. We all know that the lawnmower blades are dangerous, but people continue to mow their lawns barefoot. The blades on the lawnmower whirl at 3,000 revolutions per minute and can produce kinetic energy 3 times that of a .357 handgun! Caution needs to be exercised when mowing the lawn to prevent injuries.

  • Losing control on wet grass is the leading cause of foot injuries caused by power mowers.
  • Do not wear sandals or sneakers. Heavy shoes and work boots are recommended when mowing.
  • Use extreme caution when children are around. They should not be allowed to ride on your lap, as injury can occur when they are getting on and off the machine. Keep them away from the lawnmower to protect them from projectiles. 
  • Never go down or up slopes, always mow across them.
  • Do not pull backwards when the mower is running.
  • Protect from projectiles by keeping the clip bag attached when operating a power mower.
  • The release mechanism on the lawnmower handle should always be used to automatically shut off the mower when the hands let go.

If someone is injured by a lawnmower they should seek medical treatment immediately. Severe wounds may need surgical debridement, but superficial wounds can be treated at an office or outpatient center to prevent infection.

Lawn care should be enjoyable and not dangerous if you use proper caution.

Tendinitis: A Common Spring & Summer Injury by Dr. Bret Musser

14 May 2020 All, Blog, Tendinitis

As the spring and summer months inch closer and closer, more and more are beginning to exercise again. It is important to be educated and not overdo it in the early stages of working out. Your body fatigues quickly without the proper exercise routine. This can lead to injuries. One of the most common spring and summer injuries we see is tendinitis. Tendons are structures in the body that cause motion by moving joints. If tendons undergo too much stress, then these structures start to fatigue and break down. This is called tendinitis. Tendinitis is an overuse injury. The tendon is being worked too hard and starts to break down. This is commonly seen in our patients who get into exercise and do too much too fast. Signs and symptoms of tendinitis include pain with motion, swelling, and stiffness. 

Seeing the signs and catching tendinitis early is the key to successful treatment. Treating tendinitis in its early states is fairly simple. All you need to do is reverse the cause. Since tendinitis is an overuse injury, its treatment is to underuse the tendon. Which means rest. Reducing the strain and motion of the tendon in the early stages allows the tendon to recover. This reduces swelling within and around the tendon. Other important treatments are anti-inflammatories, compression, and ice. Once the pain resolves, a course of physical therapy is recommended. Working on flexibility and strengthening techniques is vital for reducing recurrence.

In many cases, tendinitis can be worsened by poor foot function. This is usually due to flat feet or high arch feet. Orthotics are a great way to give the foot proper function and displace pressures on the foot. This allows the tendons to function at maximum capacity and reduce the chance of tendon flare-ups. I highly recommend orthotics for my active patients. Especially runners.

If tendinitis goes untreated the tendon continues to wear down. This can lead to chronic swelling and possible tears of the tendon. This may require more advanced treatment, including immobilization in a boot or a cast. Other advanced techniques include but are not limited to amniotic. These injections are rich in healing factors that can help accelerate the healing process in advance stage tendonitis. In some cases, further imaging may be needed to evaluate the tendon. Our practice has a new, state of the art extremity MRI to further evaluate these injuries. Northern Illinois Foot and Ankle is proud to have the most advanced treatment options in medicine today.

If you are experiencing symptoms of tendinitis, call and schedule an appointment to see one of our specialists today. We are here to keep your body healthy and make sure you exercise smart!

The key is early recognition!

Foot Pain on the Golf Course By Dr. Summer Bochat

7 May 2020 All, Blog

When the weather starts to warm up, many people take to the golf courses to make the most of the Spring weather. Foot pain on the golf course can directly affect how well you play the game. 

Heel pain during stance can affect critical parts of your swing. Pain in the heels can also limit the amount of walking exercise you would get if it is painful to walk from tee to tee. 

Big toe joint pain can also be a problem, especially with the golf swing. Wear and tear to the big toe joint over time can lead to arthritis. This arthritis can be painful with activity, as well as limit the amount of motion that is available to the joint.

If you have pain in the ball of your foot, it can also affect your golf swing. During follow through of your swing you transfer weight from one foot to the other. Pain to the ball of the foot may be due to compression or irritation of the nerves to the ball of the foot.

If you are concerned about foot pain affecting your golf game, make an appointment with our office by calling 847.639.5800 for evaluation and treatment options!

For more on the news surrounding the May 1st rules on the Golf Courses re-opening please read this article: https://www.chicagotribune.com/sports/ct-illinois-golf-reopens-twosomes-only-20200424-es3wrcbsabgcnocneytefupqqe-story.html

New COVID-19 Skin Symptoms Affect the Feet

22 Apr 2020 All, Blog

What we know and understand about COVID-19 is evolving rapidly and changing every day.  For doctors and patients alike, it is important to stay informed on breaking treatment options, as well as symptoms that can help with the fight against this disease.  Aside from proper protective equipment and medical supplies like ventilators, the most important resource in the fight against COVID-19 right now is communication.  It is communication that is helping us stay on top of the novel coronavirus, as well as developing our understanding of the best screening and treatment options.

 

The most typical symptoms of COVID-19 still include fever, dry cough, fatigue, and shortness of breath.  Other possible secondary symptoms that are often overlooked are muscle pain & weakness, diarrhea, nausea, and vomiting.  There is however a new symptom with reports coming out recently across the globe which show the virus affects the hands and feet.  These lesions seem to resemble other viral lesions typical of chickenpox, measles, or vasculitis.  Many of us have had or seen these types of skin lesions in our lifetime.  The lesions have been described as purple-colored lesions most common on the toes as well as the soles of the foot and heel.

 

One of the earliest case studies was published by the International Federation of Podiatrists (IFP) which describes a 13-year-old boy in Italy with purple skin lesions to the foot.  These lesions included blisters and necrosis or gangrenous changes which ulcerated and were painful.  2 days later the boy presented with a fever of 101.3 degrees and began to experience muscle pain, itching, and burning to the skin lesions.  It was later found that the boy lived in a household with his mother and sister experiencing COVID-19 symptoms.  The lesions all ultimately resolved after a few weeks.

 

Another study by the same authors in the European Journal of Pediatric Dermatology describes several case studies of similar foot lesions that present in, mostly healthy children and adolescent patients with no symptoms prior to developing the skin lesions.  These lesions were found on the hands and feet, but the foot lesions were most severe causing pain, blistering, ulceration, and necrosis.  This study showed mostly resolution of the lesions within 12-20 days without complication.

 

It is worth noting that these reports are all still anecdotal, and no large-scale study has come out as of yet with good high-level evidence.  This means there is still much that we don’t know about the skin lesions related to this new virus.  There are multiple registries that have recently been started which can compile evidence from physicians all over the world.  These registries are important tools used to assess patterns and guide future treatment and research opportunities which can help to turn the tide against the virus.

 

My take-away from this new information is that we should all be on the lookout for these types of skin symptoms which are most common in children.  If you notice these types of lesions it is important to call your local podiatric specialist immediately because COVID-19 like symptoms can begin in as little as 2 days after the skin lesions appear.  It may be prudent to have the child undergo close monitoring to see if other symptoms develop or be tested for the virus if COVID-like symptoms begin.  The good news is that reports show that most of these lesions resolve without complication in just a few weeks.  Foot lesions occur in a small percentage of COVID-19 cases, with the exact number unknown at this time.  The lesions may represent an early warning sign of a possible COVID-19 infection to hopefully allow us to stay ahead of the disease.

 

Dr. Peter Lovato is a Podiatric Physician & Surgeon with Northern Illinois Foot & Ankle Specialists.  He is also on the board of directors of the Illinois Podiatric Medical Association.

How does COVID-19 Impact Your Foot & Ankle? by Dr. Pete Lovato

16 Apr 2020 All, Blog, Foot & Ankle

At first glance, this seems like a pretty ridiculous question.  I mean COVID-19 can’t really infect your feet, right? Well, that is correct, but with the stay at home order still in place for Illinois, that means fewer visits to physicians for all your foot & ankle pain unless it is absolutely necessary. 

The purpose of this blog article is to answer the biggest question on most people’s minds with foot & ankle pain. The question of what qualifies to come into the office for a visit currently.

First off, physicians are still an essential service so anything that normally causes you to make an appointment at our offices is acceptable under the current stay at home order.  We must exercise good judgment though. Patients that are at a higher risk we do recommend staying at home unless it can’t be avoided. Higher risk patients are anyone of advanced age with the highest risk being 80 years or older according to newer statistics.  People at higher risk are also patients with lung conditions (COPD, asthma, etc.), immune deficiency conditions, or heart disease.

Currently, we are still seeing any patients at every office that deems it necessary to come in.  Some conditions can’t wait to be treated and these involve injuries or trauma. Trauma includes fractures of the foot and ankle, sprains, or falls.  It is safer to come to our office to get an Xray and be evaluated than the ER. We are also treating general orthopedic problems, chronic pain, surgical consults, wounds, or infections.  Nail conditions are also important to not wait on because ingrown nails can cause infections which if bad enough can cause you to present to an ER. Basically anything else that can’t wait until the stay at home order is lifted we are happy to see in the office.

The point I would most like to make with this article is that If in doubt about where to go, our offices are much safer than an emergency room or urgent care.

Flatfeet by Dr. Nooreen Ibrahim

3 Apr 2020 All, Blog, Foot & Ankle

Why do my feet hurt?

Do you wonder if you have flatfeet that may be causing your pain?

What are flatfeet? Flatfeet are feet that have lost or have a decrease in their medial arch, causing the foot to
appear flat like a pancake when standing up. Flatfeet are normal for younger children to have,
due to their internally rotated tibia (leg bone). However with time, the tibia will begin to
externally rotate and create an arch! Flatfeet are driven by the bones in your feet becoming
misaligned and are often driven by tight calf muscles, which is why it is important to stretch out
your calves!

What if my flatfeet don’t hurt?
Flatfeet can lead to tendonitis and arthritis, which is why it is important to get your flatfeet
checked out earlier rather than later. Along with stretching, it is important to have orthotics to
support your arch, provide stability and support to the tendons and ligaments struggling to
keep your arch from collapsing. Our offices can provide custom-made orthotics for your flat
feet!

I have flatfeet too, and I know that they can be really painful and inhibit the activities you want
to accomplish, whether it be taking a walk or playing competitive sports. As someone that has
dealt with flatfeet for years, I know it is really important to take care of them to minimize my
foot and ankle pain.

If you think you have flatfeet and would like to discuss whether or not you need to do anything
for treatment, come and see me today! As your Podiatrist, my number one priority is your foot
and ankle health. I’ll do my very best to get you feeling better and back on your feet! Call us
today!

Telehealth

20 Mar 2020 All, Blog

Dear Patients,

Our team is here to support you through these uncertain times. In addition to remaining open in each of our clinic locations, we have NOW made available telehealth services to our existing patients. For those of you who’d prefer to stay home, the options we have created are:

Telehealth Video, which is similar to FaceTime or Skype and Patient Communicator, texting through cell phones. These options are covered by most insurance plans. This temporary telehealth plan includes Medication refills.

To learn more information or get answers to questions call and to schedule appointments reach out to our triage department at, call 847.639.5800 ext 153

For more information about COVD-19 and what you can do to keep healthy and safe, visit the Centers for Disease Control at cdc.gov or your local health department’s website.

Regarding Coronavirus/COVID-19 Concerns

18 Mar 2020 All, Blog

 

As everyone knows the Coronavirus/COVID-19 outbreak is all over the news and social media. Unfortunately this is a real thing and may get worse before it gets better. As Foot & Ankle Specialists we are not currently treating any patients that have been diagnosed with the disease.

We are aware of the dangers and are implementing all necessary precautions if we experience a patient that could be possibly infected.Please be aware that your safety is our major concern and we are taking the following steps inside our clinics:

– Hand sanitizer is available on the front counters.
– We are reinforcing training procedures to ensure cleaning processes are implemented properly by our employees.
– We are taking extra time to wipe down “high touch” areas with disinfectant including all door knobs, patient rooms, chairs, podiatry chairs and x-ray machines after each use.

If you feel you may have been exposed, or are feeling unwell ahead of an upcoming appointment please call the office to speak to our triage department for assistance in rescheduling your appointment or addressing any concerns.

Don’t let Arthritis or Tendinitis keep you from enjoying spring activities

15 May 2017 All, Arthritis

Spring is here and people all around McHenry and Lake counties are emerging from their homes and taking advantage of the change in weather to play sports, start yard work, or get in some exercise. Those struggling with arthritis, tendinitis, or heel pain, however, may dread the increased activity.

Aching, stiff joints from arthritis or sharp, shooting pain from tendinitis and lingering pain in your heel or bottom of your foot can keep you from doing daily chores, sticking to a healthy fitness routine, and participating in the activities you enjoy. It doesn’t have to be that way, though! With laser therapy for arthritis, tendinitis, or heel pain, you don’t have to stay inside and suffer while others enjoy the beautiful Spring weather!

This non-invasive treatment method targets problem areas with a low-level beam of light, causing a cellular reaction within the painful areas of your foot or ankle. This, in turn, stimulates blood flow, promotes tissue repair, reduces inflammation, and boosts the healing process – thus relieving your pain and restoring your quality of life. Yeah, it can do all that!

Laser therapy for arthritis, tendinitis, and/or heel pain can be done right in our office. It is safe, effective, has no known side effects, and is pain-free. The number of sessions needed depends on the severity and location of your pain, but typically 6-12 treatments are performed over a period of 2-4 weeks.

Just think, you can go for a walk, maybe play fetch with your dog, even pull weeds – okay maybe that last thing isn’t so great, but no longer struggling with arthritis, tendinitis, or heel pain sure is! Call us at 847.639.5800 to see if laser therapy is right for you.

Happy Spring!

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