Ankle and Subtalar Joint Instability

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Article by Dr. Misako McLeod 

Have you ever felt like you ankle is ready to roll at anytime, or your foot feel unstable and you might roll your ankle? Do you roll your ankle  easily and feel like you have a “loose” ankle?

Many patients suffer from a condition called “Ankle instability,” a condition where the ankle joint ligaments are loose due to previous trauma or sprained ankles. Also, the subtalar joint, the joint that lies underneath the ankle joint, can have ligaments that become lax or stretched out due to previous injury.

Most of the time, the feeling of instability can be remedied with a solid and consistent physical therapy to strength the peroneal muscles, the muscles on the outside of the leg, which serve to stabilize the ankle and subtalar joints. Whereas, small ligament tears can sometimes heal over time and a properly made, custom orthotic with a lateral flange can help to support the foot on the side and prevent future inversion type injuries.

However, some patients, even after a trial of physical therapy and proper custom orthotics, still experience pain, instability, and the feeling as if they are going to roll their ankle anytime. These patients often require surgery to stabilize the ankle ligaments.

There are several type of surgical procedures that address ankle joint instability:

The subtalar joint is a bit more complicated in that, there are less procedures for subtalar joint instability at this time. Surgery focuses on fusing the subtalar joint in order to stabilize the subtalar joint under the ankle and leg, and prevent future inversion-type injuries or sprains of the deep ligament of the subtalar joint.

Regardless of the procedure, all patients should receive physical therapy after surgery to retrain and develop the muscles to regain strength, function, coordination, and to prevent future incidents of injury.

Once walking, the patient should be evaluated for any structural issues and biomechanical problems that may have predisposed the patient to sustaining an injury in the first place. At this point, the patient should have a custom made orthotic with a supportive lateral flange to support the side of the foot and to prevent future inversion type injuries.

For the future, patients should be counseled on future athletic activity limitations. That is, non-impact sports such as swimming, bicycling, and other activities that avoid future high-impact injury risk are optimal.

For a consultation with Dr. McLeod to discuss your ankle issues, please call 1-844-442-FOOT (3668).

Dr. Misako McLeod is proud to be a member of the following organizations:

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American College of Foot and Ankle Pediatrics, an organization dedicated to advanced training and education in the field of pediatric specific foot and ankle problems and deformities.

 

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AO Trauma. Dr. McLeod is an AO International Trauma Fellow and a member of the AO Alumni Association. This organization is dedicated to the teaching and research of surgical techniques for trauma related orthopedic problems. 

 

 

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LIGA International consists of volunteer surgeons, physicians, pilots, and support staff that provides free medical care to the people of Sinoloa, Mexico.

 

 

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Ponseti International is an international organization dedicated to the teaching of the methods of clubfoot casting and correction of Clubfoot. In memory of Ignacio Ponseti, pediatric orthopedic surgeon who pioneered this technique and spread it throughout the world saving thousands of children from the disabling condition of clubfoot.

 

 

Dr. Misako McLeod discusses shin splints and their treatment.

 

Article by Dr. Misako McLeod

Shin Splints are very common problems that many athletes experience in their lifetime.  Patients will experience pain along the sides of the “shin bone” in the leg.  This is usually worsened with increased activity and sports. Shin splints are common in runners, soccer players, and other athletes.

Fortunately, most shin splints are from biomechanical problems that can be easily resolved with stretching programs, orthotics, and other modalities. It’s important, however, to ensure that the patient doesn’t suffer from a tibial stress fracture or other sports injury by ordering and evaluating x-rays.

When you evaluated for shin splint by Dr. McLeod, she will perform the following:

Typically, Dr. McLeod will review the type of shin splints you have and prescribe a stretching program to help elongate the muscles that are attached to your shin bone (tibia) and relieve stress. This will be followed by icing and MicroVas treatments to reduce inflammation.

Once the majority of the pain is improved, Dr. McLeod will perform a full biomechanical and gait examination to evaluate what is causing the shin splints. Typically, patients with shin splints have some degree of flatfoot and orthotics are very helpful to support and balance the foot’s mechanics so shin splints don’t recur.

 

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In 2011, Dr. McLeod was awarded an invitation to fellowship at the Russian Ilizarov Centre for Restorative Orthopaedics and Traumatology, an international center for the teaching, advancement, and utilization of Ilizarov technique and external fixation in Kurgan, Russia.

Patients from all over the world travel to this famous medical center – in the middle of Siberia – to be treated for severe deformities and orthopedics problems that were once considered uncorrectable.

The centre is based upon surgical techniques that were developed by pioneer Russian surgeon, Dr. Gavril Ilizarov, for the treatment of open fractures, complex limb deformities, and congenital deformities.

Dr. Ilizarov was a pioneeer in the development of the use of external fixation for treatment of complex limb deformities and trauma,

 

 

 

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LIGA International is a charity based organization that provides medical and surgical care in Mexico. Volunteer pilots fly doctors, nurses, and other healthcare professionals into remote villages deep in the heart of Mexico to provide much needed medical care. Here, people travel for miles in order to access medical care that so many of us take for granted.

Watch this CBS Special on Liga International

Liga International, The Flying Doctors of Mercy

Dr. McLeod volunteers her time and skills to LIGA International. As a foot and ankle surgeon, she sees a vast range of problems – most of which haven’t been treated until end-stage – and severe, congenital deformities such as clubfoot deformities.

 

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For children with clubfoot deformity, treatment is life-changing. Imagine growing up in a small, rural village with a leg deformity where you walk on the side of your ankles, and no medical care around.

 

Although you may think that you cannot do anything, you’re wrong. Even the smallest donation can help provide medical supplies, antibiotics, surgical instrumentations, and other necessities that the doctors require to care for these people. Please consider a small donation.

Donations made be made at: LIGAInternational.org

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Article by Dr. Misako McLeod

Many people think that all bone heals the same. The general rule is that bone healing for fractures take about 6-8 weeks. When patients ask me how long their fractures take to heal, I reply that it usually takes 6-8 in a perfectly healthy “18 year old” without bone metabolism issues…so that eliminates most of my patient population.

Bone is a living organ and it will take the amount of time IT NEEDS  to heal on its own. Doesn’t matter what you think, its what mother natures thinks. Our bone quality is a reflection of our health and sometimes our body may take longer to heal than a healthy 18 year old.

Some of the factors that contribute to slowed bone healing may be steroids, osteoporosis, age, medications. prolong non-weightbearing, etc.

Another common issue than contributes to slowed bone healed is Vitamin D deficiency. This is a newer subject in the bone healing and metabolism realm and more and more studies are being produced on this subject.

 

Vitamin D is a major player in the bone healing and metabolism pathway. It’s a fat soluble vitamin essential for strong bones. Lack of it contributes to slowed bone healing and the can cause serious problem with regards to bone procedures involved in foot and ankle surgery.

Inadequate Vitamin D level can lead to:

Furthermore, there’s new research demonstrating that low Vitamin D levels increase the risk of cardiovascular events and problems such as heart attack and stroke. Those who are susceptible to low Vitamin D levels include: African-Americans, darker skinned individuals, people with limited sun exposure, obesity, fat malabsorption syndromes, and chronic steroid usage.

Vitamin D is not readily available through most foods. It is increased with sun exposure and supplementation. Many people have low Vitamin D levels and need a supplement to reach recommended levels.

The US FDA daily value for Vitamin D is 400 IU, but for those with vitamin D deficiency, higher levels maybe recommended.

I commonly perform routine bloodworm to check for Vitamin D deficiency and supplement patients that are deficient.  Fo those patient who are exceedingly low, I refer patient back to the primary care doctors for oral prescription level medication which is taken once a week.

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Article by Dr. Misako McLeod, DPM

The achilles tendon is the large tendon which connects the calf muscle to the back of the heel. It helps one during push-off during gait, running, and jumping.

Injuries and chronic inflammation (tendonitis) are common problems and, most of the time, can be easily treated with immobilization, physical therapy, anti-inflammatories, icing, and MicroVas. 

When the achilles tendon become inflamed one may experience difficulty walking, tightness, and cramping at night. If the inflammation continues for long periods of time, sometimes the tendons will begin to weaken and degenerate, and start to form a bulbous mass called tendonosis. Since this represents a chronic condition, I will often recommend obtaining an MRI to fully assess the condition of the whole tendon and to evaluate for tears in the tendon.

If the tears are detected and are small, usually immobilization and physical therapy will alleviate the problem. Sometimes, stem cells are an option and can be injected into the tendon to help facilitate the healing process.

When the tendon is degenerating and the condition is chronic also know as “tendonosis”.  I may recommend a minimally invasive procedure called Topaz coblation procedure. Here is a video demonstrating the Topaz technique from the Weil Foot and Ankle Institute.

 

If the tears are long and extensive in nature, then open surgical repair may be indicated. This involves surgery under general Anesthesia where the tendon is repaired and sometimes wrapped with amniotic (stem cells) to speed healing and prevent scar formation.  Sometimes, if there is a”bump” on the back of the heel, also known as a Haglund deformity or “Pump Bump” (because it usually irritates the back of the heel in women wearing pumps) this bump can be shaved off and smoothed. The achilles tendon is the reattached.

If the patient has a tight calf muscle called Equinus, sometimes it’s necessary to lengthening the aponeurosis to better allow the heel to touch the ground. This procedure can be performed open or as an endoscopic gastrocnemius procedure. 

 

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Article by Dr. Misako McLeod, DPM

What is a Morton’s Neuroma? Many people have heard of this term and it’s a pretty common issue. A neuroma is basically a nerve anywhere in the body that is inflamed (neuritis), or so inflamed that it is beginning to form scar tissue (fibrosis). A common area is in the foot due to the fact that the constant pounding due to walking and weight bearing causing trauma and irritation to the nerve. This causes the nerve to become inflamed and, at times, scarred (fibrosis) and enlarged. Sometimes the nerve becomes so enlarged, that your practitioner can be a palpable “click” on physical exam. This is called a “Mulder’s click” and is indicative of a neuroma.

So, what are the treatments? When Dr. McLeod diagnoses a neuroma, the first question is why did the patient develop one n the first place? Dr. McLeod will perform a non-weightbearing and weight bearing exam to evaluate your mechanics. Next, x-rays be performed to screen for any soft tissue abnormalities and anything more serious such as sift tissue tumor, which is unlikely. Then, nonsurgical treatment such as steroid injections, physical therapy, and stretching the calf to offload the front of the foot will be recommended.

If non-surgical therapy doesn’t improve the symptoms, then surgical excision is an option. Due to the fact that the nerve will be removed, there will be permanent numbness in between the toes. However, this numbness is usually non-painful and patients “forget” that there is numbness there.

Neuroma surgery is an outpatient surgery and takes about 30 minutes. A local anesthetic block will be performed to control your pain and you will be released home after surgery with appropriate pain medication.

It’s important to be evaluated by a foot and ankle specialist to get an proper diagnosis. Plantar plate ruptures are often misdiagnosed as neuroma by non-speciality trained practitioners.

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At Dr. Misako McLeod’s, we believe in rewarding positive and healthy behaviors. We know how hard it is to maintain a healthy lifestyle in today’s hectic world. We know that in the end, all the “little things count” when it comes to your health, and wanted to reward our patient for making efforts towards their health!

Our patients can earn and redeem Patient Rewards Points for gift cards at:

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…..And much more!

Points can be rewarded for: 

Perfect attendance

Early Appointment arrivals

Diabetes screening exams

Diabetic Foot exams

Wearing you orthotics

Orthotic follow-up checks

MicroVas perfect attendance

Wearing your diabetic shoes

Improved lab work

Improved healthy behaviors

Smoking Cessation Program

Kid’s feet evaluation

Kid’s annual check up

Kids’ orthotic check ups

Video testimonials

Patient testimonials

Patient practice feedback

Learn more about our Patient Rewards Program!

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At Dr Misako McLeod’s,  we try to make your life easier!

Often times, patients will come into the office with a broken ankle or foot and can’t walk due to severe pain. At other offices, a prescription for a boot or crutches is often written and given to the patient. The patient then has to search all over town to find these items. At Dr. McLeod’s, we understand having an injury is not fun and we strive to make your life easier.

 

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At our office, we offer Knee Roller rentals for our patients as an added convenience. Often times, patient present to our practice after an injury. They are evaluated, x-rayed, casted for a fracture or sprain, and then given a knee roller that day. The patient continues on with their lives and no longer have to drive all around town looking for crutches or knee rollers. Much faster and with more expertise than an Urgent Care or Emergency Room!  Patient’s love the convenience and ability to get moving right away despite injury or surgery.

Our Knee Rollers are evaluated for safety and durability. We rent our knee rollers by week and month.

Weekly Rental: $35.00 

Monthly rental: $125.00

We recommend that your rent a knee roller for 2 months. This is the typical amount of time for foot and ankle fractures and surgery to heal. Most patient will be transitioned into a CAMboot or walking boot at that time.

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"Dr. Mcleod has been so helpful to me and my family during this difficult time. She is heighly skilled and experienced! Iwill personally like to recommend her as a top surgeon in our area."
- Sarah H.