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

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

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

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

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

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

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

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

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

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

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

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

 

About Western Connecticut Orthopedic Surgical Center:

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

 

 

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

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

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

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

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

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

Running Right – to Avoid Common Injuries

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

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

What the Pros Say

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

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

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

The Top 5 Complaints

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

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

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

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

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

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

Pain is a warning!

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

Accidents happen

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