A Prospective Study
Robert Fridman, DPM *, Jarrett D. Cain, DPM, MSc , Lowell Weil, Jr., DPM, MBA and Lowell Weil, Sr., DPM
Weil Foot & Ankle Institute, Des Plaines, IL.
Abstract
Background: Extracorporeal shockwave therapy has been shown to be effective in the treatment of chronic tendon pathology in the elbow, shoulder, and plantar fascia. This prospective study examines the efficacy of extracorporeal shockwave therapy in the treatment of chronic Achilles tendon disorders.
Methods: Twenty-three patients (23 feet) were treated with extracorporeal shockwave therapy for Achilles tendinosis, insertional tendonitis, or both. Indications for treatment were a minimum of 6 months of conservative care, and a visual analog pain score > 5. The mean follow-up was 20 months (range, 4–35 months).
Results: Ninety-one percent (14 patients) were satisfied or very satisfied (23 patients) with treatment. Eighty-seven percent (20 patients) stated that extracorporeal shockwave therapy improved their condition, 13% (3 patients) said it did not affect the condition, and none stated that it made them worse. Eighty-seven percent (20 patients) stated they would have the procedure again if given the choice. Four months after extracorporeal shockwave therapy, the mean visual analog score for morning pain decreased from 7.0 to 2.3, and activity pain decreased from 8.1 to 3.1.
Conclusion: High-power extracorporeal shockwave therapy is safe, noninvasive, and effective, and it has a role in the treatment of chronic Achilles tendinopathy.
Wednesday, November 19, 2008
Thursday, November 13, 2008
FLAT FEET
Flat Feet describes a position of the foot that has kept numerous people out of the armed forces for decades.
However, a flat foot may neither be painful or bad. It may simply be the natural position for those patients to function in. There are many occasions however, where a flat foot can cause other painful conditions to develop and fester.
As an infant, we are born with a flatter foot than an adult to provide an increased base for stabilization. Over the next several years the arch height gradually increases and reaches its highest point some where between the ages of 7-9. From that point on, as we go through life, the arch height actually decreases.
Genetics has a large part to play in the starting position of the foot and arch height; the maximum height the foot reaches between ages 7-9; and how fast the arch breaks down over a life time.
Obviously, a highly active lifestyle also will accelerate the break down of the arch height and structure of the foot.
As the arch height begins to descend and activity remains high enough, the foot begins to develop instability. This instability is exhibited by movement of the bones of the foot. It is necessary for the ligaments, muscles of the foot and leg and the tendons that cross over the major joints to stabilize the bones. As the bones move around secondary conditions can and will develop such as bunions, hammer toes and tailor bunions as well as arthritis. Stress fractures can also develop if unequal amounts of stress are applied to bones over a specific time frame during a time of instability.
The muscles of the leg and their long tendons which insert onto the foot exert a stabilizing effect onto the foot during function. If the foot is unstable enough and the muscle/tendon complex must exert enough of a force, the ligaments, muscle or tendons may become injured during the process.
Conditions such as Adult Acquired Flat Foot (Posterior Tibial Tendon Insufficiency), Plantar Fasciitis, Tendonosis and Synovitis are all soft tissue strains and injuries that develop when the soft tissue is strained beyond its elastic point.
A Flat Foot therefore should be watched. At the first sign of trouble, intervention should be performed to help stabilize the foot and help prevent irreversible injury. Often times, custom orthotics, custom arch supports, can be utilized to stabilize the foot. At other times, the condition may have gone beyond what an orthotic can reasonably protect and surgical correction is utilized to stabilize what nature cannot.
However, a flat foot may neither be painful or bad. It may simply be the natural position for those patients to function in. There are many occasions however, where a flat foot can cause other painful conditions to develop and fester.
As an infant, we are born with a flatter foot than an adult to provide an increased base for stabilization. Over the next several years the arch height gradually increases and reaches its highest point some where between the ages of 7-9. From that point on, as we go through life, the arch height actually decreases.
Genetics has a large part to play in the starting position of the foot and arch height; the maximum height the foot reaches between ages 7-9; and how fast the arch breaks down over a life time.
Obviously, a highly active lifestyle also will accelerate the break down of the arch height and structure of the foot.
As the arch height begins to descend and activity remains high enough, the foot begins to develop instability. This instability is exhibited by movement of the bones of the foot. It is necessary for the ligaments, muscles of the foot and leg and the tendons that cross over the major joints to stabilize the bones. As the bones move around secondary conditions can and will develop such as bunions, hammer toes and tailor bunions as well as arthritis. Stress fractures can also develop if unequal amounts of stress are applied to bones over a specific time frame during a time of instability.
The muscles of the leg and their long tendons which insert onto the foot exert a stabilizing effect onto the foot during function. If the foot is unstable enough and the muscle/tendon complex must exert enough of a force, the ligaments, muscle or tendons may become injured during the process.
Conditions such as Adult Acquired Flat Foot (Posterior Tibial Tendon Insufficiency), Plantar Fasciitis, Tendonosis and Synovitis are all soft tissue strains and injuries that develop when the soft tissue is strained beyond its elastic point.
A Flat Foot therefore should be watched. At the first sign of trouble, intervention should be performed to help stabilize the foot and help prevent irreversible injury. Often times, custom orthotics, custom arch supports, can be utilized to stabilize the foot. At other times, the condition may have gone beyond what an orthotic can reasonably protect and surgical correction is utilized to stabilize what nature cannot.
Thursday, November 6, 2008
One Man ... Three Perspectives
A college soccer player, athletic trainer and podiatric surgeon: one man, three different perspectives on injuries to the foot and ankle.
Jeff Baker, DPM, AACFAS – Podiatric Surgeon, Weil Foot & Ankle Institute
When it comes to sports related foot and ankle injuries, I have many different perspectives to draw from. At a relatively later age I became interested in soccer. It started with a game during gym class in the 5th grade where I scored 3 goals. My gym teacher at the time was also the high school varsity soccer coach and he encouraged me to play in the local recreational league. My father was a former high school football and wrestling coach, but he was completely supportive in my pursuit of the game of soccer. Soccer became a year-round part of my life, culminating in playing Division 1 varsity soccer for 4 years at Northeastern University in Boston. Little did I know that later on in life I would become a podiatrist as I participated in a sport played almost exclusively with the feet. Soccer players do some weird things when it comes to their feet. Our cleats are an extension of our feet. So the tighter the cleat, the better touch on the ball. Therefore we purchase cleats that are too small, immediately get them wet, and stretch them to the size of our feet. The cleat ends up fitting like a tight slipper. This brings about injuries and deformities that I have myself and now encounter on a daily basis such as hammertoes and blisters.
When deciding in high school as to what profession I would like to pursue in college, I decided on sports medicine. I was an athletic training major at Northeastern University where during my time I was a student athletic trainer for both the Northeastern University and Tufts University basketball teams. After graduation from Northeastern University in 1992, I then spent four years as the head athletic trainer at Westwood High School in Westwood, Massachusetts. It was a wonderful experience that helped to build relationships with patients. The majority of my athletes had ankle injuries and a large portion of my day was spent taping ankles and providing rehabilitation for ankle injuries. The main purpose of my position was to keep athletes participating in their activities as long as it was safe and not going to worsen any injuries. A unique portion of my duties was to determine the balance between injury and performance. If I could get an athlete with an ankle injury to return to playing with the use of a brace at 80%, does that help team performance or is it a detriment.
In 2000 I graduated from the Ohio College of Podiatric Medicine. I completed a three-year reconstructive foot and ankle surgery residency at St. Mary Hospital in Hoboken, New Jersey and a one-year fellowship in reconstructive foot and ankle surgery at the Weil Foot & Ankle Institute.
Jeff Baker, DPM, AACFAS – Podiatric Surgeon, Weil Foot & Ankle Institute
When it comes to sports related foot and ankle injuries, I have many different perspectives to draw from. At a relatively later age I became interested in soccer. It started with a game during gym class in the 5th grade where I scored 3 goals. My gym teacher at the time was also the high school varsity soccer coach and he encouraged me to play in the local recreational league. My father was a former high school football and wrestling coach, but he was completely supportive in my pursuit of the game of soccer. Soccer became a year-round part of my life, culminating in playing Division 1 varsity soccer for 4 years at Northeastern University in Boston. Little did I know that later on in life I would become a podiatrist as I participated in a sport played almost exclusively with the feet. Soccer players do some weird things when it comes to their feet. Our cleats are an extension of our feet. So the tighter the cleat, the better touch on the ball. Therefore we purchase cleats that are too small, immediately get them wet, and stretch them to the size of our feet. The cleat ends up fitting like a tight slipper. This brings about injuries and deformities that I have myself and now encounter on a daily basis such as hammertoes and blisters.
When deciding in high school as to what profession I would like to pursue in college, I decided on sports medicine. I was an athletic training major at Northeastern University where during my time I was a student athletic trainer for both the Northeastern University and Tufts University basketball teams. After graduation from Northeastern University in 1992, I then spent four years as the head athletic trainer at Westwood High School in Westwood, Massachusetts. It was a wonderful experience that helped to build relationships with patients. The majority of my athletes had ankle injuries and a large portion of my day was spent taping ankles and providing rehabilitation for ankle injuries. The main purpose of my position was to keep athletes participating in their activities as long as it was safe and not going to worsen any injuries. A unique portion of my duties was to determine the balance between injury and performance. If I could get an athlete with an ankle injury to return to playing with the use of a brace at 80%, does that help team performance or is it a detriment.
In 2000 I graduated from the Ohio College of Podiatric Medicine. I completed a three-year reconstructive foot and ankle surgery residency at St. Mary Hospital in Hoboken, New Jersey and a one-year fellowship in reconstructive foot and ankle surgery at the Weil Foot & Ankle Institute.
The Toe Bones connected to the Foot Bone...
We have all heard the old refrain, " The toe bone is connected to the foot bone and the foot bone is connected to the ankle bone, the ankle bone is connected to the leg bone...". This is and old rhyme used to teach anatomy to children.
However, most folks do not realize that not only are the bone connected, but they work together as well. What one bone shifts or moves , it will effect the position and structure of other bones that connect to it.
They same is true to groups of bones. Take the foot for instance. The foot connects to the ankle. The ankle connects to the leg. Movement of the foot therefore will effect the action of the leg and visa versa, contracture of the muscles of the leg will effect the movement and position of the foot.
The leg muscles contract normally to help lift the heel bone and push the leg forward during walking. One can see and feel this if they concentrate when they walk. You can feel the calf tighten as the foot gets onto the ball of the foot and the calf squeezes and the foot will push forward. Walking, climbing stairs, running are all activities that will tighten the calf as the muscles must squeeze to help the foot push forward. In fact the only exercise that will stretch the calf is stretching the calf.
Abnormal movement of the foot,usually exhibited by abnormal lowering of the arch which occurs to all of us as we get older from wear and tear as well as by genetics, will cause excessive tightening of the calf muscles. However as the calf muscles tighten, the foot will work more abnormally. This unfortunately will cause the calf muscles to tighten more and the process goes on. Eventually the foot assumes an abnormal position and the calf muscle is excessively tight. This situation usually will cause an overload syndrome of the foot and is a great cause of the development of tendinitis, synovitis, bone bruises, foot fatigue and muscle cramping.
Often times stretching the calf several times a day will help maintain the normal flexibility of the calf and help maintain the normal function of the foot.
However, most folks do not realize that not only are the bone connected, but they work together as well. What one bone shifts or moves , it will effect the position and structure of other bones that connect to it.
They same is true to groups of bones. Take the foot for instance. The foot connects to the ankle. The ankle connects to the leg. Movement of the foot therefore will effect the action of the leg and visa versa, contracture of the muscles of the leg will effect the movement and position of the foot.
The leg muscles contract normally to help lift the heel bone and push the leg forward during walking. One can see and feel this if they concentrate when they walk. You can feel the calf tighten as the foot gets onto the ball of the foot and the calf squeezes and the foot will push forward. Walking, climbing stairs, running are all activities that will tighten the calf as the muscles must squeeze to help the foot push forward. In fact the only exercise that will stretch the calf is stretching the calf.
Abnormal movement of the foot,usually exhibited by abnormal lowering of the arch which occurs to all of us as we get older from wear and tear as well as by genetics, will cause excessive tightening of the calf muscles. However as the calf muscles tighten, the foot will work more abnormally. This unfortunately will cause the calf muscles to tighten more and the process goes on. Eventually the foot assumes an abnormal position and the calf muscle is excessively tight. This situation usually will cause an overload syndrome of the foot and is a great cause of the development of tendinitis, synovitis, bone bruises, foot fatigue and muscle cramping.
Often times stretching the calf several times a day will help maintain the normal flexibility of the calf and help maintain the normal function of the foot.
Thursday, October 9, 2008
Dr. Weil Sr and Dr. Weil Jr Co-Author Important Research on Low Energy Extracorporeal Shock Wave Published in the American Journal of Sports Medicine
Radial Extracorporeal Shock Wave Therapy Is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis: Results of a Confirmatory Randomized Placebo-Controlled Multicenter Study
Ludger Gerdesmeyer, MD, PhD1*, Carol Frey, MD2, Johannes Vester, PhD3, Markus Maier, PhD4, Lowell Weil Jr, DPM5, Lowell Weil Sr, DPM5, Martin Russlies, PhD6, John Stienstra, DPM7, Barry Scurran, DPM7, Keith Fedder, MD2, Peter Diehl, MD8, Heinz Lohrer, MD9, Mark Henne, MD10, Hans Gollwitzer, MD10
1 Technical University Munich and Mare Clinic
2 Orthopaedic Foot and Ankle Center, Manhattan Beach
3 IDV Data Analysis and Study Planning, Biometrics in Medicine
4 Ludwig Maximilian University
5 Weil Foot and Ankle Institute
6 University Schleswig Holstein, Campus Lübeck
7 The Permanente Medical Group Inc
8 University Rostock
9 Institute of Sportsmedicine
10 Technical University Munich
* To whom correspondence should be addressed. E-mail: gerdesmeyer@aol.com.
Abstract
Background: Radial extracorporeal shock wave therapy is an effective treatment for chronic plantar fasciitis that can be administered to outpatients without anesthesia but has not yet been evaluated in controlled trials.
Hypothesis: There is no difference in effectiveness between radial extracorporeal shock wave therapy and placebo in the treatment of chronic plantar fasciitis.
Study Design: Randomized, controlled trial; Level of evidence, 1.
Methods: Three interventions of radial extracorporeal shock wave therapy (0.16 mJ/mm2; 2000 impulses) compared with placebo were studied in 245 patients with chronic plantar fasciitis. Primary endpoints were changes in visual analog scale composite score from baseline to 12 weeks' follow-up, overall success rates, and success rates of the single visual analog scale scores (heel pain at first steps in the morning, during daily activities, during standardized pressure force). Secondary endpoints were single changes in visual analog scale scores, success rates, Roles and Maudsley score, SF-36, and patients' and investigators' global judgment of effectiveness 12 weeks and 12 months after extracorporeal shock wave therapy.
Results: Radial extracorporeal shock wave therapy proved significantly superior to placebo with a reduction of the visual analog scale composite score of 72.1% compared with 44.7% (P = .0220), and an overall success rate of 61.0% compared with 42.2% in the placebo group (P = .0020) at 12 weeks. Superiority was even more pronounced at 12 months, and all secondary outcome measures supported radial extracorporeal shock wave therapy to be significantly superior to placebo (P < .025, 1sided). No relevant side effects were observed.
Conclusion: Radial extracorporeal shock wave therapy significantly improves pain, function, and quality of life compared with placebo in patients with recalcitrant plantar fasciitis.
Friday, September 26, 2008
Brazil and Foot & Ankle Surgeons from around the World
Last week, I attended and presented at the International Federation of Foot and Ankle Surgeons Third Annual Congress. This Congress is held every three years and features the premier foot and ankle surgeons (Orthopedic and Podiatric) from around the world. This Congress was held in Bahia, Brazil. Previous Congresses were held in San Francisco, CA and Naples Italy.
Over 500 foot and ankle surgeons from around the World attended this years meeting with less than 50 giving presentations. An incredible amount of interesting research was presented with mid and long term results on emerging techniques and technologies and a wealth of new ideas and procedures.
I was fortunate enough to have two of my papers selected to present. I presented on a new technique that we developed over the last couple of years on repairing the plantar plate of an unstable or dislocated metatarsophalangeal joint. This is a difficult problem without a previous good solution. The paper was well received with most finding this new technique as a good alternative to explore in the future.
Additionally, I presented our longer term results on the Calcaneal Scarf Procedure. This procedure is used to correct painful flatfoot deformity. The benefits of this procedure over others that are currently utilized is that it allows for larger and more stable correction and quicker return to weight bearing.
Dr. Weil, Sr. was an invited speaker who presented his long term experience on the Weil Metatarsal Osteotomy which is a procedure invented by him in the 1980’s and now used worldwide for several specific pathologies of the foot.
Besides the academic aspect of the Congress, it was interesting and enjoyable to spend time with surgeons from all over the World and learning about their countries, cultures and families.
The people of Brazil did an amazing job of putting on a 1st Class Congress and showed the spirit that they are famous.
Lowell Weil, Jr.
Over 500 foot and ankle surgeons from around the World attended this years meeting with less than 50 giving presentations. An incredible amount of interesting research was presented with mid and long term results on emerging techniques and technologies and a wealth of new ideas and procedures.
I was fortunate enough to have two of my papers selected to present. I presented on a new technique that we developed over the last couple of years on repairing the plantar plate of an unstable or dislocated metatarsophalangeal joint. This is a difficult problem without a previous good solution. The paper was well received with most finding this new technique as a good alternative to explore in the future.
Additionally, I presented our longer term results on the Calcaneal Scarf Procedure. This procedure is used to correct painful flatfoot deformity. The benefits of this procedure over others that are currently utilized is that it allows for larger and more stable correction and quicker return to weight bearing.
Dr. Weil, Sr. was an invited speaker who presented his long term experience on the Weil Metatarsal Osteotomy which is a procedure invented by him in the 1980’s and now used worldwide for several specific pathologies of the foot.
Besides the academic aspect of the Congress, it was interesting and enjoyable to spend time with surgeons from all over the World and learning about their countries, cultures and families.
The people of Brazil did an amazing job of putting on a 1st Class Congress and showed the spirit that they are famous.
Lowell Weil, Jr.
Tuesday, September 9, 2008
Fasciitis and the Firefighter
I am a 44 year old firefighter that has suffered with chronic heel pain (Plantar Fasciitis) for over 2 years. I also run a few miles several times a week as part of my regular exercise routine. To say that I was frustrated with my pain and the inability to treat it with all the conventional stretching, exercises, inserts, etc is an understatement.
After a referral from my Orthopedic Surgeon to Dr. Lowell Weil Jr., that was about to change. He was completely thorough in his diagnosis and offered several options for treatment. I had surgery, minimal invasive, last December and was back on my feet in 48 hours. Within a week I was back walking in gym shoes and back to the gym on a light workout within a month.
When I say the recovery was quick, it is amazing how good my feet felt. It took Dr. Weil's caution to take it easy at first to keep me from doing more right away. His options for treatment are not offered by all doctors and that's too bad. I have heard horror stories of multiple surgeries with 6 month recovery time. Nonsense - if you suffer from chronic heel pain, give Dr. Lowell Weil Jr. a call, I have referred several people to him and will continue to do so. It is 9 months since my surgery and I have had NO problems what so ever with my heel.
Thank You again Dr. Weil.
Firefighter - Tom (Chicago, IL)
After a referral from my Orthopedic Surgeon to Dr. Lowell Weil Jr., that was about to change. He was completely thorough in his diagnosis and offered several options for treatment. I had surgery, minimal invasive, last December and was back on my feet in 48 hours. Within a week I was back walking in gym shoes and back to the gym on a light workout within a month.
When I say the recovery was quick, it is amazing how good my feet felt. It took Dr. Weil's caution to take it easy at first to keep me from doing more right away. His options for treatment are not offered by all doctors and that's too bad. I have heard horror stories of multiple surgeries with 6 month recovery time. Nonsense - if you suffer from chronic heel pain, give Dr. Lowell Weil Jr. a call, I have referred several people to him and will continue to do so. It is 9 months since my surgery and I have had NO problems what so ever with my heel.
Thank You again Dr. Weil.
Firefighter - Tom (Chicago, IL)
Subscribe to:
Posts (Atom)
Posts
