Monthly Archives: July 2014

Exercise benefits more than just the waistline

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In this article published by Stephen H. Hochschuler, MD on Spine-Health.com, the importance of exercise and fitness on your back is discussed. Keeping strong and active, keeps the muscle from becoming stiff, which can lead to more pain. However, make sure before you do ANY activity, especially after surgery or an injury, be sure to consult with your doctor to make sure it’s safe.

Exercise and Fitness to Help Your Back

A common (and harmful) misconception is that exercise should be avoided when a patient is experiencing back pain. Understandably, many patients are reluctant to exercise out of the fear that any exercises or stretching will aggravate their existing back pain. This may make them rely too heavily on medical treatments and underemphasize the importance of exercise for healing and long term back pain relief.

For most back problems, exercise and movement are the natural stimuli for the healing process. Controlled, gradual and progressive exercise, rather than inactivity and bed rest, most often provides the best long-term solution for reducing back pain and preventing (or lessening) future episodes of pain.

Most experts recommend no more than one or two days rest at the onset of most episodes of back pain. Prolonged inactivity can actually increase back pain as the back becomes stiff, weak, and deconditioned. As the pain increases, many patients reduce their activity and exercise levels, resulting in even more back pain and aggravating the cycle of inactivity and back pain recurrence.

Exercise plays the dual role of both treating back pain and helping prevent future episodes of pain.

  • By nourishing and repairing spinal structures, exercise helps alleviate existing back problems.
  • Movement and exercise keep the anatomy of the back healthy, flexible and strong in order to reduce the chances of further injury and back pain.

It is always advisable for patients to first consult with a health professional before beginning any exercise or fitness program. Working with a physician or experienced spine specialist will ensure that patients’ activities are safe for their back and for their overall health. With back pain, it’s particularly important to get an accurate diagnosis for the cause of the patient’s pain from a physician or chiropractor in order to rule out possible types of back pain that may be aggravated by exercise (such as spinal instability).

How Exercise Helps the Back
Engaging in exercise and fitness activities helps keep the back healthy by allowing discs to exchange fluids which is how the disc receives its nutrition. A healthy disc will swell with water and squeeze it out, similar to the action of a sponge. This sponge action distributes nutrients to the disc.

In addition, fluid exchange helps to reduce the swelling in the other soft tissues that naturally occurs surrounding injured discs. When there is a lack of exercise, swelling increases and discs become malnourished and degenerated.

Exercising the back reduces stiffness by keeping the connective fibers of ligaments and tendons flexible. Improved mobility through back exercise helps to prevent the connective fibers from tearing under stress, which in turn prevents injury and back pain.

Another important effect of exercise is that it stretches, strengthens, and repairs muscles that help to support the back. The back and abdominal muscles act as an internal corset supporting the vertebrae discs, facet joints, and ligaments. When back and abdominal muscles are weak they cannot support the back properly. Back strengthening exercises help to strengthen these supporting muscles in order to prevent straining soft tissues (e.g. muscles, ligaments, and tendons) and provide sufficient support for the structures in the spine.

Additionally, stretching is good for the back. For example, stretching hamstring muscles helps to relieve stress on the low back. Another benefit of back exercise is that the motion helps lubricate the facet joints, which are synovial joints that require appropriate motion.

Integrating Exercise with Medical Treatment

Exercise and fitness are necessary for healing existing back problems, recovering from back surgery, and especially for keeping the back healthy to help prevent (or at least lessen) future episodes of back pain.

Ideally, an exercise and fitness program should be integrated during most phases of treatment for pain relief and to improve the overall health of patients. If the pain is severe, however, patients may first need to be treated for the pain prior to starting a back exercise program.

Specific Exercise Strategies

The following guidelines and insights are designed to help patients plan and follow through with a safe and effective exercise program to condition the back. The key goals of engaging in exercise and fitness activities are to aid the healing process for an injured back and alleviate existing back pain while helping to prevent (or at least minimize) future problems.

  • Find the right type of professional to help with the exercise and fitness program. Patients should always consult with a physician prior to beginning any exercise or fitness program. A healthcare professional can assist with the development of an appropriate list ofback exercises and activities in which to engage or avoid. Health professionals such as physical therapists, chiropractors, and physical medicine and rehabilitation physicians (physiatrists) often have specific training and expertise with exercise and fitness programs for pain relief. It’s particularly important to see a health professional with expertise in spinal conditions and back pain, as different back conditions often require very different exercise programs.

See How a Physical Therapist Can Help with Exercise

  • Expect some initial discomfort when beginning a new exercise and fitness program. However, start slowly, because the results of back exercise, such as soreness, may not be felt for 24 to 48 hours after the exercise session. Beginning an exercise program after an episode of back pain will likely cause some increase in pain in the beginning. However, the back pain experienced during exercise should be “good pain.” This pain is to be expected as a natural part of increasing activity and stretching tissues that have become stiff and deconditioned.
  • Set a careful pace when starting to exercise. When returning to activity after an episode of pain or following surgery, ease into back exercise and physical activity. Be careful not to overwork or strain muscles that may have become deconditioned after a period of inactivity. Taking into account that there may be some initial discomfort, a cautious approach to back exercise can help keep back pain under control and prevent a flare-up.

Include a combination of stretching, strengthening, and low-impact aerobic conditioning exercise. Utilizing these three components of exercise will help heal existing problems, avoid injury and prevent future problems. Muscles will become strengthened and more flexible, repairing strained muscles that cause back pain. Low-impact aerobic conditioning helps to stretch and strengthen the back as well as the abdominals and hamstrings, two muscles that help to support the back.

Engage in gentle forms of exercise, such as water therapy or walking. For patients experiencing higher levels of back pain, exercise may be more comfortable in the water than on land. Water therapy provides the therapeutic effect of relieving pain and also can help prepare the body for more extensive exercise. Another form of gentle physical activity is exercise walking, a good option for patients in less pain who are ready to move onto more intensive exercises on land.

Consider alternative forms of exercise, such as Pilates, yoga, or Tai Chi. Pilates, yoga, and Tai Chi provide gentle strengthening and stretching exercise that can help alleviate present back pain. They help improve overall fitness and posture, which in turn prevents future episodes of back pain. Other benefits of alternative therapies like Pilates, yoga, and Tai Chi are stress relief and relaxation, which can also assist with back pain relief.

  • Know when to reassess the exercise and fitness program. If back pain during exercise becomes severe, it is important to redesign the back exercise program with the help of a professional. The individual patient is the best judge of whether the pain during exercise is normal discomfort or if the level of pain is signaling that the patient should discontinue the specific exercise.
  • Build a motivating support system during the course of the exercise program. Friends and family may often encourage patients to rest and avoid physical activity because of the common misconception that exercise causes back pain. However, the opposite is true when patients perform the appropriate back exercises. The patient may need to educate others about the importance of back exercise and fitness for back pain relief. Telling friends and family about plans to increase start exercising and asking for their encouragement may help the program’s success.
  • Keep a written record of progress made during the exercise and fitness program. Tracking progress is useful for the patient as well as for health professionals who are helping with the exercise program. Records could include a list of the specific back exercises performed, number of sets and repetitions, duration of exercise, and pain and sensations experienced during exercise. This helps both the patient and the exercise professional track progress toward fitness goals and ensures that information is accurately communicated among different professionals and to the patient. Monitoring progress may also help keep the patient motivated to continue with the exercise and fitness program.
  • Many people will experience some kind of lower back pain at some point in their lives. An ounce of prevention by doing a few simple exercises daily to keep the back nice and healthy will go a long way to alleviate lower back pain problems. Learn why exercise is so important for a pain-free, healthy back in this video.

 Article courtesy of Spine-Health.com and Stephen H. Hochschuler, MD

 

BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. For your convenience, both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton  office at 540.347.9220 or our Gainesville office at 703.743.2814. Or Click here to make an appointment.

 

Acupuncture offers a drug-free approach to pain relief.

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What is Acupuncture?

Acupuncture is a form of Chinese medicine that has been practiced for centuries. It’s based on the theory that energy, called chi (say “chee”), flows through and around your body along pathways called meridians.

Acupuncturists believe that illness occurs when something blocks or unbalances your chi. Acupuncture is a way to unblock or influence chi and help it flow back into balance. It is done by putting very thin needles into your skin, at certain points, on your body. This influences the energy flow. Sometimes heat, pressure, or mild electrical current is used along with needles.

What happens during acupuncture?

Your acupuncture provider will give you an exam and ask questions about your pain and how well you are functioning. He or she will also ask about your overall health.

Then your provider will look for the places (called points) on your body to access the chi that is blocked or not flowing right. Each of the points relates to certain health problems or body functions.

Your provider will look for landmarks on your body—using certain muscles or bones, for example—to find the points so that he or she can place the needles.

After the provider finds the points, he or she will quickly tap very thin needles into your skin. He or she will probably place several needles. Some may be placed deeper than others, depending on what the provider believes is needed to restore the flow of chi.

Every provider is different, but in most cases treatment lasts for 15 minutes to an hour. You may have several visits to complete your treatment. Some people have ongoing visits.

What does it feel like?

You may feel slight pressure when a needle goes in. Most people find that it doesn’t hurt. The area may tingle, feel numb, itch, or be a little sore. Providers believe that this is a sign that the energy flow, or chi, has been accessed.

After the needle is placed, your provider may roll the needle slightly back and forth. Or he or she may use heat or electrical current on the needle.

What is acupuncture used for?

People use acupuncture to relieve pain and treat certain health conditions. You can use it by itself or as part of a treatment program. Studies have found promising results for the use of acupuncture to treat nausea and vomiting related to pregnancy, chemotherapy, and postsurgery pain.  Acupuncture also may be useful for:

  • Stroke rehabilitation, which involves relearning skills that a person lost because of brain damage from a stroke.
  • Headache. A study shows that adding acupuncture to standard treatment leads to significant, long-lasting relief from chronic headaches, especially migraines.
  • Menstrual cramps.
  • Tennis elbow.
  • Fibromyalgia, or widespread pain and tenderness of muscle and soft tissue.
  • Myofascial pain, caused by spasm in the muscles.
  • Osteoarthritis, or the breakdown of the tissue (cartilage) that protects and cushions joints. A study found that acupuncture can reduce knee pain and increase movement of the knee in people with osteoarthritis.
  • Low back pain. For people who have low back pain, acupuncture may help decrease pain and increase activity. Some studies show that acupuncture reduced pain and disability related to back problems more than usual treatment. Another summary of several studies showed that acupuncture reduced pain and increased the ability to be active, but not any more than other treatments.
  • Carpal tunnel syndrome, or pressure on a nerve in the wrist that results in tingling, numbness, weakness, or pain of the fingers and hand.
  • Asthma, or inflammation in the tubes that carry air to the lungs, resulting in periodic episodes of difficulty breathing, wheezing, chest tightness, and coughing.
  • Drug addiction. Acupuncture may help reduce symptoms of withdrawal after a person stops taking a drug he or she is addicted to. It may also help prevent a relapse. More studies are needed to learn about the benefits of acupuncture.
  • Dental pain
  • Labor pain

Is Acupuncture safe?

In general, acupuncture is safe when done by a certified provider. A state license ensures that the provider has a certain level of training and follows certain guidelines. But there are still a few states where acupuncture is not licensed.

In very rare cases, problems may occur after acupuncture. You could get an infection, especially if the needles aren’t sterile. But licensed providers throw away their needles after one use. Make sure your provider uses a new pack of sterile needles every time.

Talk with your doctor if you have other questions about the safety of acupuncture.

Always tell your doctor if you are using a treatment like acupuncture.

Choosing an acupuncturist

Check to see if your state licenses providers. Many providers also may have a certificate from the National Certification Commission for Acupuncture and Oriental Medicine. This is a non-profit group that promotes standards in acupuncture and Oriental medicine. Ask your doctor and friends for recommendations.

 You also may want to pick a provider who:

  • Will work on a treatment plan with you, your doctor, and other health professionals
  • Clearly explains what he or she is doing during treatment
  • Explains how often you may need treatment and how much it will cost

 

BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. For your convenience, both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton  office at (540-347-9220) or our Gainesville office at (703-743-2814). Or Click here to make an appointment.

 

Osteoarthritis causes and treatments

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OSTEOARTHRITIS


Osteoarthritis is the most common form of arthritis, affecting millions of people around the world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time.

While osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips.

Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can slow the progression of the disease, relieve pain and improve joint function.

Symptoms

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

  • Pain. Your joint may hurt during or after movement.
  • Tenderness. Your joint may feel tender when you apply light pressure to it.
  • Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.
  • Loss of flexibility. You may not be able to move your joint through its full range of motion.
  • Grating sensation. You may hear or feel a grating sensation when you use the joint.
  • Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.

When to see a doctor

If you have joint pain or stiffness that lasts for more than a few weeks, make an appointment with your doctor.

Causes

Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints deteriorates over time. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In osteoarthritis, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone.

Risk factors

Factors that increase your risk of osteoarthritis include:

  • Older age. The risk of osteoarthritis increases with age.
  • Sex. Women are more likely to develop osteoarthritis, though it isn’t clear why.
  • Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.
  • Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.
  • Obesity. Carrying more body weight puts added stress on your weight-bearing joints, such as your knees.
  • Certain occupations. If your job includes tasks that place repetitive stress on a particular joint, that joint may eventually develop osteoarthritis.
  • Other diseases. Having diabetes, underactive thyroid, gout or Paget’s disease of bone can increase your risk of developing osteoarthritis.

 

Complications

Osteoarthritis is a degenerative disease that worsens over time. Joint pain and stiffness may become severe enough to make daily tasks difficult. Some people are no longer able to work. When joint pain is this severe, doctors may suggest joint replacement surgery.

 

Preparing for your appointment

While you may initially bring your concerns to your family doctor, he or she may refer you to a doctor who specializes in joint disorders (rheumatologist) or orthopedic surgery.

What you can do

You may want to write a list that includes:

  • Detailed descriptions of your symptoms
  • Information about medical problems you’ve had
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take
  • Questions you want to ask the doctor

What to expect from your doctor

Your doctor may ask some of the following questions:

  • When did your joint pain begin?
  • Is the pain continuous, or does it come and go?
  • Do any particular activities make the pain better or worse?
  • Have you ever injured this joint?

Tests and diagnosis

During the physical exam, your doctor will closely examine your affected joint, checking for tenderness, swelling or redness. He or she will also check the joint’s range of motion. Your doctor may also recommend imaging and lab tests.

Imaging tests

Pictures of the affected joint can be obtained during imaging tests. Examples include:

  • X-rays. Cartilage doesn’t show up on X-ray images, but the loss of cartilage is revealed by a narrowing of the space between the bones in your joint. An X-ray may also show bone spurs around a joint. Many people have X-ray evidence of osteoarthritis before they experience any symptoms.
  • Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to produce detailed images of bone and soft tissues, including cartilage. This can be helpful in determining what exactly is causing your pain.

Lab tests

Analyzing your blood or joint fluid can help pinpoint the diagnosis.

  • Blood tests. Blood tests may help rule out other causes of joint pain, such as rheumatoid arthritis.
  • Joint fluid analysis. Your doctor may use a needle to draw fluid out of the affected joint. Examining and testing the fluid from your joint can determine if there’s inflammation and if your pain is caused by gout or an infection.

Treatments and drugs

There’s no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement.

Medications

Osteoarthritis symptoms can be relieved by a variety of medications, including:

  • Acetaminophen. Acetaminophen (Tylenol, others) can relieve pain, but it doesn’t reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may reduce inflammation and relieve pain. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Stronger NSAIDs are available by prescription. NSAIDs can cause stomach upset, ringing in your ears, cardiovascular problems, bleeding problems, and liver and kidney damage. Older people have the highest risk of complications.
  • Narcotics. These types of prescription medication typically contain ingredients similar to codeine and may provide relief from more severe osteoarthritis pain. These stronger medications carry a risk of dependence, though that risk is thought to be small in people who have severe pain. Side effects may include nausea, constipation and sleepiness.

Therapy

A combination approach to treatment often works best. Your doctor may suggest:

  • Physical therapy. A physical therapist can work with you to create an individualized exercise regimen that will strengthen the muscles around your joint, increase the range of motion in your joint and reduce your pain.
  • Occupational therapy. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have finger osteoarthritis. A bench in your shower could help relieve the pain of standing if you have knee osteoarthritis.
  • Braces or shoe inserts. Consider trying splints, braces, shoe inserts or other medical devices that can help reduce your pain. These devices can immobilize or support your joint to help you keep pressure off it.
  • A chronic pain class. The Arthritis Foundation and some medical centers have classes for people with osteoarthritis and chronic pain. Ask your doctor about classes in your area or check with the Arthritis Foundation. These classes teach skills that help you manage your osteoarthritis pain. And you’ll meet other people with osteoarthritis and learn their tips and tricks for reducing and coping with joint pain.

Surgical and other procedures

If conservative treatments don’t help, you may want to consider procedures such as:

  • Cortisone shots. Injections of corticosteroid medications may relieve pain in your joint. During this procedure your doctor numbs the area around your joint, then places a needle into the space within your joint and injects medication. The number of cortisone shots you can receive each year is limited, because the medication can worsen joint damage over time.
  • Lubrication injections. Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) may offer pain relief by providing some cushioning in your knee. These agents are similar to a component normally found in your joint fluid.
  • Realigning bones. During a surgical procedure called an osteotomy, the surgeon cuts across the bone either above or below the knee to realign the leg. Osteotomy can reduce knee pain by shifting your body weight away from the worn-out part of your knee.
  • Joint replacement. In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint surfaces and replaces them with plastic and metal devices called prostheses. The hip and knee joints are the most commonly replaced joints. Surgical risks include infections and blood clots. Artificial joints can wear out or come loose and may need to eventually be replaced.

Lifestyle and home remedies

Lifestyle changes and home treatments also can help reduce osteoarthritis symptoms. You might want to try some of the following tips:

  • Rest. If you’re experiencing pain or inflammation in your joint, rest it for 12 to 24 hours. Find activities that don’t require you to use your joint repetitively.
  • Exercise. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Stick to gentle exercises, such as walking, biking or swimming. If you feel new joint pain, stop. New pain that lasts for hours after you exercise probably means you’ve overdone it.
  • Lose weight. Being overweight or obese increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce your pain. Talk to your doctor about healthy ways to lose weight. Most people combine changes in their diet with increased exercise.
  • Use heat and cold to manage pain. Both heat and cold can relieve pain in your joint. Heat also relieves stiffness, and cold can relieve muscle spasms and pain.
  • Apply over-the-counter pain creams. Creams and gels available at drugstores may provide temporary relief from osteoarthritis pain. Some creams numb the pain by creating a hot or cool sensation. Other creams contain medications, such as aspirin-like compounds, that are absorbed into your skin. Pain creams work best on joints that are close to the surface of your skin, such as your knees and fingers.
  • Use assistive devices. Assistive devices can make it easier to go about your day without stressing your painful joint. A cane may take weight off your knee or hip as you walk. Carry the cane in the hand opposite the leg that hurts. Gripping and grabbing tools may make it easier to work in the kitchen if you have osteoarthritis in your fingers. Your doctor or occupational therapist may have ideas about what sorts of assistive devices may be helpful to you. Catalogs and medical supply stores also may be places to look for ideas.

Alternative medicine

People who aren’t helped by medications for osteoarthritis pain sometimes turn to complementary and alternative medicine practices for relief. Common treatments that have shown some promise for osteoarthritis include:

  • Acupuncture. Some studies indicate that acupuncture can relieve pain and improve function in people who have knee osteoarthritis. During acupuncture, hair-thin needles are inserted into your skin at precise spots on your body. Risks include infection, bruising and some pain where needles are inserted into your skin.
  • Glucosamine and chondroitin. Studies have been mixed on these nutritional supplements. A few have found benefits for people with osteoarthritis, while most indicate that these supplements work no better than placebo. Don’t use glucosamine if you’re allergic to shellfish. Glucosamine and chondroitin may interact with blood thinners such as warfarin (Coumadin) and cause bleeding problems.
  • Tai chi and yoga. These movement therapies involve gentle exercises and stretches combined with deep breathing. Many people use these therapies to reduce stress in their lives, though small studies have found that tai chi and yoga may reduce osteoarthritis pain. When led by a knowledgeable instructor, these therapies are safe. Avoid moves that cause pain in your joints.

Coping and support

Medications and other treatments are key to managing pain and disability, but another major component to treatment is your own outlook on life. Your ability to cope despite pain and disability caused by osteoarthritis often determines how much of an impact osteoarthritis will have on your everyday life. Talk to your doctor if you’re feeling frustrated. He or she may have ideas about how to cope or refer you to someone who can help.

Content courtesy of the Mayo Clinic Staff at the Mayo Clinic:
http://www.mayoclinic.org/diseases-conditions/osteoarthritis/basics/definition/con-20014749

BRO-Logo-color      joint-right

Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. For your convenience, both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton  office at (540-347-9220) or our Gainesville office at (703-743-2814). Or Click here to make an appointment.

 

Ladies, love the shoes but not the pain? It may not always be your shoes!

It’s no secret than women love their shoes and many pay the price for that love of fashion. But did anyone ever consider that it may not be just the shoes causing the problems?

Are foot and ankle problems worse for women?

By Judith F. Baumhauer, MD, and Kathryn O’Connor, PT
Article courtesy of: http://www.aaos.org/

For many years, research on foot and ankle pain and deformity has focused on shoes. In fact, shoe style is the most studied extrinsic factor for foot and ankle injuries in women. Athletic shoes for women, for instance, have traditionally been designed as scaled-down versions of men’s shoes. Research shows, however, that women’s feet are not just smaller versions of men’s feet.

 womans foot in stilletto
“Aesthetic prosthetic” by Susan Kingsley

Understudied differences in foot structure, muscle strength, ligament laxity, and proprioception are all intrinsic factors that can initiate a predisposition for pain and injury in females. Little attention, however, has been given to intrinsic physical differences in male and female foot structure.

A research study by Wunderlich and Cavanagh examining lower limb and foot measurements of approximately 300 men and 500 women in the U.S. Army concluded that biologic differences existed between male and female feet and legs. They noted significant differences in arch shape, size of the lateral side of the foot, great toe, and ball of the foot. Women, for example, had a wider forefoot, shorter arch length, and shorter metatarsals compared to men. This study was among the first to promote incorporating the structural differences between the female and male foot into the design and manufacturing of women’s shoes.

Differences extend beyond the foot
According to a report by Fessler and associates, males have higher foot length-to-body height ratios than females. Therefore, the differences in foot length between men and women is generally proportional to stature. Studies have shown that differences in the structure and size of the foot bones (specifically by measurements of metatarsal, phalangeal, calcaneal, and talar bones) have allowed for forensic identification of sex.

In addition to differences in skeletal structure, studies by Eckstein and associates used magnetic resonance imaging to observe differences in cartilage between men and women, including volume, surface area of the joint, and cartilage thickness. Although the initial purpose of the study was not to identify sex differences, statistically significant disparities were noted. For instance, the study showed that women had a 20 percent to 25 percent lower volume and surface area in the subtalar, talonavicular, and ankle joints and up to 16 percent thinner cartilage.

Women and men also have significant differences in gait. Studies by both Kerrigan and associates and Sepic and associates have shown that plantar flexion and range of motion of the ankle are greater in women, possibly due to greater laxity in female ligaments. Numerous studies have observed greater ankle and knee laxity values in women.

Glass slippers are for fairy tales
An appropriate fitting, comfortable shoe rarely equates to stylish, fashionable footwear in a woman’s world. Unfortunately, the typical, more fashionable high-heeled shoe with a narrow toe box causes increased plantar pressure and toe crowding, which can cause bunions (hallux valgus), bunionettes, hammer toe, and even neuromas in severe cases.

Studies show that 88 percent of women wear shoes too small for their feet and 70 percent were noted to have associated hallux valgus deformity. National studies show approximately 1 percent of all adults have hallux valgus, with an increasing prevalence with age; although only 9 percent of 30-to- 60-year-olds have bunions, approximately 16 percent of people older than age 60 have them. Women are two to four times more likely to have hallux valgus than men, likely due to a combination of intrinsic structural features and extrinsic footwear options.

Additionally, the incidence of hammer toe is four to five times more common in women. In 1991, approximately 209,000 bunionectomies, 210 hammer toe corrections, 66,500 neuroma resections, and 119,000 bunionette repairs were performed.

Poorly fitting shoes affect more than just feet. Shoes with a heel of 1.5¢¢ or higher increase knee torque with walking, which may be associated with the increase of knee osteoarthritis among women who prefer higher-heeled shoes. Additionally, pain caused by an ill-fitting shoe can increase the risk of falling and otherwise hamper mobility, which may lead to injury. This is particularly significant in the elderly population.

Numerous studies have examined footwear in elderly patients at the time of a fall and have shown that a high percentage of those who fell were wearing slippers. The excessive flexibility of slippers and their lack of stability are associated with a higher incidence of tripping and falls.

Next steps?
We have a long way to go in examining intrinsic differences between the female and male foot. Limited research has been published on sexual dimorphism of the foot and ankle; many of the studies only retrospectively observed anatomic differences to explain injuries unique to women. Several investigators have suggested that proprioceptive differences are to some extent responsible for ankle ligament injuries.

As knowledge of sexual dimorphism and the unique healthcare needs of women advance, interventions that are related to intrinsic differences, as well as the extrinsic factors of the foot and ankle, will be imperative to provide appropriate preventive and therapeutic care for women.

Judith F. Baumhauer, MD, is professor of orthopaedic surgery at the University of Rochester School of Medicine.
She can be reached at judy_baumhauer@urmc.rochester.edu

 

Kathryn O’Connor, PT, is a physical therapist.

Article courtesy of: http://www.aaos.org/

 

Let Our Experts Get You Back In the Game!

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Treatment for sports-related injuries is more specialized and sophisticated than ever before, and Blue Ridge Orthopaedic & Spine Center prides itself on providing the most advanced care available. Student athletes, weekend warriors, and anyone else who maintains an active lifestyle benefit from recent advances in the diagnosis and treatment of various sports injuries.

Our Sports medicine specialists are experts in the diagnosis, treatment, and prevention of common injuries that occur during sports or exercise. Overuse injuries and repetitive trauma can occur to the tendons, bones, and joints.

There are many things to consider in caring for an athlete beyond the diagnosis. This includes sport-specific rehabilitation and timing to get back on the field as soon as possible. We team with physical therapists who work closely with our physicians to speed recovery and treat the whole patient.

Sports medicine conditions we treat include:

Tendonitis: Inflammation of the tendon that can be caused by minor or serious injury to parts of the body. Tendonitis can affect the elbow, shoulder, hip, knee, thumb, and Achilles tendon. Symptoms include pain and a loss of range of motion. Treatment for tendonitis includes ice and anti-inflammatory drugs.

Sprains and strains: Sprains are injuries to ligaments while strains are injuries to muscles or tendons. Both are caused by physical stress, and can affect the ankle, knee, neck, wrist, back, legs, and hands. Symptoms include pain and swelling. Treatment for strains and sprains includes R.I.C.E (rest, ice, compression, elevation) or, in severe cases, surgery.

Dislocations: These occur when extreme force is put on a ligament allowing the bones to become disconnected.  Common Body Parts affected by Dislocations include the shoulder, knee, hip, and finger. Symptoms include pain, discoloration, deformity and immobility. Treatment requires returning a bone to its normal position.

Fractures: There are two types of fractures, or broken bones. Stress fractures are caused by repeated stress on the bone. Compression fractures result from osteoporosis, when bones lose calcium there are more susceptible to breaking. Fracture symptoms include swelling, discoloration, and pain. Treatment includes R.I.C.E (rest, ice, compression, elevation), medication, and a cast or splint.

 

Ligament injuries and tears: Ligaments are tough bands that connect bones. Stressing them can cause injuries, such as sprains and tears, which are often diagnosable only through thorough examination and, in some cases, arthroscopic surgery. Treatment includes physical therapy, bracing and surgery.

Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. For your convenience, both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton  office at (540-347-9220) or our Gainesville office at (703-743-2814).