Archive for the ‘Ankle Surgery’ Category

Custom Functional Orthotics

Custom orthotics are the best decision people can make to improve their foot health and function. Custom orthotics are unique and specially made to your feet.  Orthotics treat and correct individual foot ailments. Proper shoes fitted with custom foot orthotics are the best insurance that we can give ourselves to protect our feet.

Your orthotics are manufactured by a state-of-the-art fabrication facility utilizing the latest advancements in machinery and technology available today.  The fabrication starts with an analysis of your feet and a laser casting.  The image produced from this scan is sent to our lab where your device is “born”.  The technicians analyze these scans and make subtle adjustments to ensure a precise fit and form. Exact models of your feet are created on an automated CAD/CAM milling machine.  These models are used to form your orthotics with a high temperature pressure fit system.  Then they are assembled by hand and laminated.  The result is a set of orthotics made to your feet with Dr. Murray’s or Dr. Chang’s specific instructions and modifications to optimize your foot function.  This process typically takes 2 weeks and you will be called when they are ready.

Please bring the shoes you plan on using the orthotics with so one of our assistants can check for a proper fit. You will be given instructions to use with the orthotics during the “breaking-in” period. A follow up appointment will be made to discuss with the doctor how the orthotics are working for you. Some patients may need more time to get used to their orthotics and some orthotics may require adjustments.  Although most patients are happy with their devices immediately, we want you to appreciate the uniqueness of the human body and understand this process can sometimes take time to make the proper adjustments. Our goal is to help treat and correct your ailment so you can live a healthy and active lifestyle. Therefore, we include free adjustments for 90 days.  

One set of orthotics may suffice for many of our patients, but different activities require different accommodations. Therefore, some of our more active patients order multiple pairs of orthotics. Here are a few of the reasons why:

Custom Orthotics by Blue Ridge Foot and Ankle Clinic

Blue Ridge Foot and Ankle Clinic Custom Orhotics

I need a second set of orthotics for when my other pair gets wet.” – Local runner

I need orthotics for standing on a concrete floor all day and another pair for hiking with my family.” – Factory worker

My orthotics really help in my athletic shoes. I wish they worked in my dress shoes.” – Local business woman (we offer the Cobra, which is an orthotic designed to work with many casual and dress shoes)

Most of our orthotics are designed to last 5 to 10 years. Depending on your particular ailment, activity, and amount of use, your orthotics may need to be refurbished (re-covered) during this time period.

Cost:

First set – $395.00

Additional set – $300.00

Refurbishment – $75.00

These are the prices for non-covered orthotics; when covered by insurance, the prices are predetermined by the terms of the insurance plan.

Insurance coverage: Please verify with your insurance company that custom orthotics are a covered benefit and how your deductible and coinsurance apply.

Welcome to the Blue Ridge Foot and Clinic team. We look forward to helping you stay healthy and active.

 
Blue Ridge Foot and Ankle Clinic
 
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887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 417 South Magnolia AveWaynesboro, VA 22980
540-949-5150
New office in Fishersville will open early 2015 @
66 Parkway Lane Suite #102
Fishersville, VA 22939
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
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Achilles Tendonitis and Achilles Tendonosis

July 21st, 2014 by Dr.Chang

Achilles Tendonitis and Achilles Tendonosis

The Achilles tendon connects the calf muscle to the heel bone and is the thickest and strongest tendon in the body in humans. While helping raise the foot off the ground with each step, the Achilles tendon can receive a load stress 3.9 times body weight during walking and 7.7 times body weight when running. Despite its ample strength, the Achilles tendon is prone to injury. The most common Achilles injuries are Achilles tendonitis and tendonosis, the former being inflammation of theachil Achilles tendon and the latter being degeneration of Achilles tendonitis. The inflammation from Achilles Tendonitis is usually short-lived. Over time, if tendonitis is not treated, it can degenerate into a worse condition called tendonosis, marked by tears in the tendon. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.

Repeat after me: I will not run through my Achilles injury. The Achilles will not heal if you keep running on it. When you hurt your Achilles, it is time to start cross training and being gentle with it. The most common risks to the Achilles are sudden increases of repetitive activity without giving it enough time to repair itself. Intense activity causes micro-injuries in the tendon fibers, which require time to heal. Additionally, athletes and runners with inconsistent workout schedules, such as weekend warriors and those who increase their workout intensity and volume too quickly, are prone to Achilles injuries. Achilles injuries may also be due to physiological reasons such as excessive pronation and flat feet, which put extra pressure on the tendon while walking or running.

Achilles tendonitis and tendonosis will result in pain, aching and tenderness along the tendon’s path, increasing when the sides of the tendon are squeezed, but with less pain in the back of the tendon. To diagnose Achilles injuries, your podiatrist will examine the foot, its range of motion, and conduct further assessment with imagining techniques such as X-rays. Initial treatment will include rest. Using heal lift inserts on both feet, or wearing high-heeled shoes with an open back, can help relax the tendon and give it the rest it needs.

Treatment plans will focus on reducing force on the Achilles tendon by means of a cast or walking boot, reducing swelling with ice and oral medications, long term preventative strategies such as custom-made orthotics and night splints, and gradually building a physical therapy regimen that includes stretching and strengthening exercises, soft-tissue massage and mobilization, and ultra-sound therapy. Eccentric stretching and strengthening of the Achilles – that is, elongating the Achilles while doing exercises – are key to long-term rehab. Examples include, first, doing calf stretches in a small lunge with your hands pressing against a wall, second, sitting with one leg straight in front of you while flexing and pointing your toe, or, finally, doing toe raises at the edge of a step or stair. You may even want to consult your podiatrist and physical therapist about working on your gait and stride while running, as gait abnormalities can lead to Achilles tendon and other injuries.

To prevent Achilles tendon injuries, be sure that you strengthen and stretch your calf muscles daily, maintain proper footwear, and use custom-made orthotics if you have flat feet or pronate.


 

Our feet are susceptible to a variety of injuries and conditions: fractures, flat feet, bunions, ingrown toenails, and the list goes on…and on… Anticipating surgical treatment for your feet can certainly be frustrating, but thinking about the positives of recovering from your injury and being pain free is an important element for a successful surgery and expedient recovery.  First off, if you are reading this blog, chances are you are in the experienced and attentive hands of Dr. Kevin Murray and Dr. Stewart Chang. With years of podiatric care and foot surgery under their belts, you can be confident that they will take great care of you and your feet. On a more personal note, think of the surgical recovery process as providing you with time to regroup and care for your feet, your body and your self. Preparation for surgery can allow for long-term planning of your podiatric health and the recovery process can enable you to enlist the support and care from your friends and family.

That being said, knowing more about your surgery and what to expect after surgery will help you prepare for the process, ensuring a successful and efficient recovery from general foot surgery.  The pointers below will provide guidelines and suggestions for the different steps along the way.

PRE-SURGERY PREPARATION

Each individual’s feet, injuries and conditions are unique, and it’s important that you know the basics of your injury and why surgery is the best option for you. Whether you are suffering from an injury or underlying condition, what surgical procedure you will have and the expectations from the procedure are all important questions for you and your podiatrist to answer together. You should also know whether you will have general or local anesthesia during the surgery and about the post-operative recovery room conditions, especially if you have other preexisting conditions (if you are diabetic, for example, note that glucose monitoring is available during surgery).

There is an enormous variety of surgical procedures and healing times for them. Cryosurgery, for example, has a recovery period of two days to a week. Other invasive surgeries can take up to six months or more to heal. This time frame could put a considerable wrench in your schedule and regular daily activities. Be sure to discuss a realistic recovery time frame with your Charlottesville or Waynesboro podiatrist so that you can plan ahead and give your body the proper time to rest.

POST-SURGERY PREPARATION

Preparing for the post-operative phase begins well before your surgery even starts. Consider what care and support you’ll need, such as a drive home from the hospital and help cooking meals or taking showers. Enlist the support of your family, friends or a nurse. You will want to stock up on basic groceries for when you return home and medications you might need for after surgery. Chances are that your movement will be restricted, so you may want to have a bed on the ground floor or in a main room of your house. Having pillows to elevate your foot, a backrest for sitting up, water bottles, writing materials, and a way to keep track of your medications are all helpful post-surgery. You may need to supply yourself with a range of entertainment – a computer and plug within reach, DVDs, magazines, books, and music.

Showering can be challenging after getting surgery, and falls in the shower after surgery commonly lead to damage of the surgical area or additional injuries. Preparing the bathroom and shower area with grab bars and a shower stool may be helpful. You may also want to stock up on plastic garbage bags or purchase a cast protector in order to keep your leg and foot dry while showering. Obtaining a Temporary Handicap Placard from the DMV is possible for post-surgery patients. In most states this requires your physician to complete Temporary Disabled Parking Permit form. You can also download a form from the Virginia DMV.

POST SURGERY: Managing the Pain

After surgery, be prepared for your foot to swell at the incision site. This swelling is due to the increased blood flow in the foot because of the surgery and compounded by the lack of movement in your leg, decreasing your capacity to return blood to the heart. Swelling often causes pain. Since the greatest swelling occurs in the first few days after surgery, it is no surprise that this is also when you will need to pay the most attention to pain and swelling management.

Throughout your recovery process, and especially right after surgery, try hard to stay on top of your pain using a number of strategies. Your foot surgeon may use nerve blocks around the operative site that numb your foot and reduce pain for the hours immediately after the procedure. Your podiatric surgeon will also provide you with a prescription for narcotic pain medications. Be sure to discuss pain medication options with your podiatrist, and know whether your medication is long acting (requiring only 2-3 doses per day) or fast acting (requiring a higher dosage). Because pain medication side effects can include confusion, felling strange, and nausea and vomiting, keep track of your medication intake. Additionally, be aware that these drugs may also cause problems including constipation (which you can counteract with products like Metamucil) and the potential for addiction. Your podiatrist may also recommend that you take non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, Advil, Motrin, or Aleve, after the initial recovery period. Consult your podiatrist before self-prescribing these, as they may have negative effects on bone, tendon and ligament healing. These drugs can also cause stomach irritation, ulcers and kidney problems when taken in high dosages. Drink lots of water with NSAIDs and consult your podiatrist or physician if you are having any such side effects.

Other methods of pain-reduction include foot elevation (prop your foot up 6-18 inches above your heart as you lie down), avoiding activities that require you to keep your foot dangling downwards for long periods of time and using crutches and/or a walker to keep your weight off your foot. If your foot is not in a cast, then place ice in a plastic bag or use a cold pack, applying it to the swelling for 15 minutes at a time. Ice will restrict the blood vessels in your foot, reducing blood flow to the area just enough to help minimize the swelling. Note that you should never ice your foot when it is numb from post-operative drugs like nerve blocks, since your foot will be prone to frostbite.

On top of managing swelling, try to keep your bandages clean and dry in order to keep the incision site infection-free. Consult your local Charlottesville or Waynesboro podiatrist if your foot, ankle or leg turns blue, cold or numb or if you are running a fever or have thigh or calf pain.

POST SURGERY: Resting Up

Resting up is a full time job and will help your recovery enormously. In the first week to month after your surgery, you will need to be a dedicated couch potato, lying down with your foot elevated. Don’t plan on being productive during post-operative rest! Chances are that you will be woozy from your medications, in pain, and need more rest than anticipated. Just focus on your recovery, allowing yourself and your body the time it needs to be on the mend. In addition to plenty of rest, healing requires your attention to eating well and drinking plenty of water. Additionally, be sure to avoid caffeine, alcohol and cigarettes as these will have negative effects on your healing process.

During the initial bed-ridden period, you can expect generalized soreness and aches, often because of being more sedentary than usual. Movement stimulates blood flow, cycling of oxygen and the removal of toxins from our bodies. Inactivity can therefore cause us to be sore. To counteract this achiness and to stimulate the release of toxins generally prompted by everyday exercise and movement, you can gently stretch, move and massage the non-effected areas of your body with neck, shoulder and arm rolls or by gently twisting your torso to loosen up your abdominal muscles. Do not stretch or massage your legs or feet until your podiatrist tells you it is okay to do so. And again, drink plenty of water and eat oxygen rich foods like vegetables (especially leafy greens) and fruits, in order to help flush your system and to provide metabolic support for your joints.

REHABILITATION

Once you’ve made it through the post-operative period of being a (healthy and medically sanctioned) couch potato and managed to finagle as many massages out of your family and friends as possible, it’s time for you to start activity again. In this phase, expect to visit the Physical Therapist often as well as your podiatrist for follow up appointments. Since your body has been sedentary while recovering, expect that you will feel slower and a bit weaker than you did before surgery. Work with your Physical Therapist and your podiatrist, pacing yourself with activity and being honest about your level of pain. Be sure that you don’t over-do the rehab process; slow and steady is the name of the game. If you feel like you’re doing too much too soon, speak with your physical therapist and podiatrist to modify your rehabilitation plan. And finally, recognize that your body should set the pace for recovery. Be patient with your feet and continue to be responsible and caring for them.

All the best with your surgery and recovery: stay positive, communicate you’re your health providers, accept help from your family and friends, and remember that you can control the conditions of your recovery, whether by healthy eating and fluid intake, managing swelling and pain or dedicated rehab. Your local Charlottesville and Waynesboro podiatrists, Dr. Chang and Dr. Murray, are around when you need them or have questions.

Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

Blue Ridge Foot and Ankle Clinic

              Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116

Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150

Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.

 

What Is ‘His Achilles Tendon’

July 28th, 2011 by Dr.Chang

What did Alex Trebek, host of Jeopardy, rupture while chasing a burglar in a California hotel?  What is ‘his Achilles Tendon’.  We recently came across this achilles tendon story on the news and thought it would be a great time to elaborate a bit on what causes this painful injury and how it is typically treated. If you’re ever experienced a similar injury, we would love to hear about your experience in the comments.

What is the Achilles Tendon?
A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the “heel cord,” the Achilles tendon facilitates walking by helping to raise the heel off the ground.

What is an Achilles Tendon Rupture?
An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping. Achilles tendon ruptures are most often seen in “weekend warriors”— typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.

Signs and Symptoms
A person with a ruptured Achilles tendon may experience one or more of the following:

• Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf—often subsiding into a dull ache

• A popping or snapping sensation

• Swelling on the back of the leg between the heel and the calf

• Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes

These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the “R.I.C.E.” method should be used. This involves:

Rest. Stay off the injured foot and ankle, since walking can cause pain or further damage.

Ice. Apply a bag of ice covered with a thin towel to reduce swelling and pain. Do not put ice directly against the skin.

Compression.Wrap the foot and ankle in an elastic bandage to prevent further swelling.

Elevation. Keep the leg elevated to reduce the swelling. It should be even with or slightly above heart level.

Diagnosis

In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle.  If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes. The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests.

Treatment
Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches. The decision of whether to proceed with surgery or non-surgical treatment is based on
the severity of the rupture and the patient’s health status and activity level.

Non-Surgical Treatment
Non-surgical treatment, which is generally associated with a higher rate of re-rupture, is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. Non-surgical treatment involves use of a cast, walking boot, or brace to restrict motion and allow the torn tendon to heal.

Surgery
Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient’s push-off strength and improves muscle function and movement of the ankle. Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient. Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weightbearing. Complications such as incision healing difficulties, re-rupture of the tendon, or nerve pain can arise after surgery.

Physical Therapy
Whether an Achilles tendon rupture is treated surgically or non-surgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve the range of motion of the foot and ankle.

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