SPORTS MEDICINE

Sports Medicine:

From the weekend warrior to the elite athlete, sports injuries can lead to chronic pain and dysfunction in the active individual. Dr. Hook has extensive training in treating sport related injuries of the foot and ankle. Dr. Hook utilizes custom physical therapy programs and arthroscopic and minimally invasive surgical procedures when treating athletic injuries. More information on common sports injuries may be found below:

Achilles Ruptures (Minimally Invasive Repair):

The Achilles tendon is the largest tendon in the human body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump. Even though the Achilles tendon can withstand great stresses from running and jumping, it is vulnerable to injury. A rupture of the tendon is a tearing and separation of the tendon fibers so that the tendon can no longer perform its normal function. Achilles tendon ruptures are common in the elite and recreational athlete, often occurring in

patients who are not consistently training. For some patients, conservative treatment with immobilization in a boot or cast may heal the tendon rupture without surgery. However, in patients who wish to resume to an active lifestyle, excellent outcomes can be achieved with a minimally invasive surgical repair of the Achilles rupture. Historically, open techniques have been utilized for repair of the rupture but can be complicated by wound healing issues and infection. Dr. Hook performs a percutaneous Achilles tendon rupture repair which is a minimally invasive technique that helps minimize risk of complication. Most patients begin ambulating in a walking boot several weeks after surgery and can return to recreational activities or sports in approximately 4 to 6 months.

Ankle Sprains:

An ankle sprain occurs when the ligaments that support the ankle stretch beyond their limits and tear. Ligaments are strong, fibrous tissues that connect bones to other bones. The ligaments in the ankle help to keep the bones in proper position and stabilize the ankle joint. Ankle sprains are very common injuries that occur among people of all ages. There is a wide range of severity, depending upon how much damage is sustained to the ligaments and the surrounding structures.

Most ankle sprains are minor injuries that may heal with home treatments like rest and applying ice. However, if your ankle is very swollen, painful to walk on, or if you are having trouble putting weight on your ankle, be sure to schedule an appointment with your doctor. Almost all ankle sprains can be treated nonoperatively. Even a severe or complete ligament tear can heal without surgical repair if it is immobilized and treated appropriately. For minor sprains, it can take as little as 2 weeks for treatment. For more severe injuries, it can take up to 6 to 12 weeks.

Without proper treatment and rehabilitation, a more severe sprain can weaken your ankle and increase the likelihood that you will re-injure your ankle again. Repeated ankle sprains can lead to lingering problems, including chronic ankle pain, arthritis, and lateral ankle instability.

Lateral Ankle Instability:

Once you have sprained your ankle, you may continue to sprain it if the ligaments do not have time to completely heal. Patients can have difficulty deciphering whether their sprain has healed or not because the tendons on the outside of the ankle also provide stability to the ankle joint.

 

If you have chronic ankle pain, difficulty walking on uneven surfaces, a general feeling of unsteadiness, or recurrent ankle sprains for an extended period of time, you may have lateral ankle instability. Diagnosis can be confirmed by a thorough history and physical exam. Further imaging may be required to determine the underlying pathology. X-Rays may be ordered to visualize the joints, bones, and alignment of the ankle to rule out conditions such as arthritis, fractures, or biomechanical deformities. An MRI may also be obtained to visualize the integrity of the soft tissue structures of the foot and ankle or determine if there is an underlying injury to the cartilage of the ankle.

 

Treatment is determined by the diagnosis and each patients’ symptoms, but conservative and surgical options are available for all pathologies. Conservative modalities include anti-inflammatory medications, bracing, physical therapy, and corticosteroid injections. If conservative therapy fails, surgical options include repairing or reconstructing the ligaments and tendons, removal of loose fragments, cleaning (debriding) the ankle joint, and correction of underlying boney deformities that may cause the chronic lateral ankle instability.

Ankle Arthroscopy:

Ankle arthroscopy is a minimally invasive procedure used to treat conditions of the ankle joint. In this procedure, a small fiber-optic camera is utilized to magnify and transmit a video of the ankle joint. Utilizing small instrumentation, surgical treatment can be performed through two small stab incisions in the front of the ankle. Arthroscopy can be used to diagnosis and treat the following disorders of the ankle joint:

  • Lateral Ankle Instability – Arthroscopy may be utilized to remove lose fragments or repair underlying damage to cartilage.

  • Osteochondral defect (OCD) - OCD’s are small areas of damaged cartilage within the ankle joint. OCD’s can be caused by a variety of injuries ranging from minor rotational injuries to severe ankle fractures. Symptoms include pain, swelling, clicking or catching of the ankle. Imaging useful in diagnosis of an OCD includes X-rays, MRI, or CT scan. Arthroscopic surgery often includes removing the cartilage fragment and drilling to promote healing. Some larger lesions require cartilage transplants which can aid in healing the underlying OCD.

  • Anterior and Posterior ankle impingement - Ankle impingement occurs when bone or soft tissue at the front of the ankle joint becomes inflamed. Symptoms include ankle pain and swelling. This can limit the ability for you to bend your ankle up and down. Walking up or downhill is often painful. Arthroscopy can be utilized to shave away inflamed tissues and bone spurs.

  • Synovitis-  Synovitis is described as inflammation of the tissue making up the ankle capsule. There are a variety of underlying causes ranging from rheumatoid or osteoarthritis. Arthroscopy can be used to remove the inflamed tissue when it does not respond to conservative treatment.

  • Ankle arthritis- Arthroscopic ankle fusion is an appropriate treatment for patients with end-stage ankle arthritis.

  • Ankle fractures- Arthroscopy may be utilized along with open techniques of fracture repair to visualize and treat damage to the joint.

  • Ankle Joint Infection: Infection the joint space typically requires both antibiotics and surgery to wash out the joint. Arthroscopy can assist in the treatment of an underlying joint infection.

 

After the procedure, most often you will have two small stab incisions at the ankle with an overlying dressing. Weight bearing is procedure dependent but can range from immediate weight bearing to immobilization for several weeks. All postoperative protocols are discussed with patient prior to their procedure.                                   

Achilles Tendinitis:

Achilles tendinitis is a common condition that occurs when the large tendon that runs down the back of your lower leg becomes irritated and inflamed. Achilles tendonitis is described as pain in the tendon either at its insertion on the heel bone or middle of the Achilles tendon. The cause is primarily a degeneration of the tendon. Most patients describe a gradual onset of pain and swelling behind their heel or around the Achilles tendon without specific injury. Typically, the pain is noted after activity alone, but becomes more constant over time. The pain is made worse by jumping or running and especially with sports requiring short bursts of these activities. There is tenderness directly over the back of the heel bone and often there is a bone prominence at this area. Achilles tendonitis pain is due to the chronic inflammation from these causes and is drastically improved with immobilization. If that fails, treatment includes physical therapy, biologic injections, and potentially the need for surgery in severe cases.

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© Copyright 2019 by Jonathan Hook DPM, MHA. All Rights Reserved.