Bunions: Cause & Treatments

Bunions are bony humps that form at the base of the big toe. When this happens, the big toe will curve towards the other toes and cause the base of the toe to push towards the first metatarsal bone. It usually occurs at a joint and the entire body weight will be acting on it. This will result in tremendous pain and discomfort.

Causes

As we grow and develop, more pressure is acting on the foot due to the need to support the body’s entire weight. Therefore, it gets worse as age increases. Bunions is hereditary and will run in the family due to the fact that foot type and shape is hereditary. In some cases, bunions will develop with existing medical conditions such as arthritis. Women are also at a higher risk of suffering from bunions due to the fact that most women wear tight and ill-fitting high heeled shoes, pushing the foot bone into awkward positions for long periods of time.

Non-surgical treatment

Non-surgical is targeted to reduce pressure on the big toe and provide pain relief.

  • Wearing wide and comfortable shoes with sufficient space for toes to wriggle. The insoles should also provide good arch support.
  • Custom made orthotics will help to distribute the body’s weight equally throughout the foot and reduce any unnecessary pressure acting on the big toe.
  • Pain relief medication will provide instant pain relief for patients and bring down the swelling.
  • Ice is a cheap and effective method to reduce swelling and provide pain relief.

Surgical treatment

If non-surgical treatment does not provide adequate pain relief, daily activities such as walking can be severely hindered. In such cases, surgery may be the only option left. The main aim of bunion surgery is to straighten the curved toe bone and provide pain relief.

  • Bunionectomy is a bunion specific surgery and involves removal of part of the affected metatarsal head.
  • Osteotomy involves the cutting of bones located in the toe to prevent bone spurs from sticking out and re-alignment the soft tissues around the toe joint.
  • Resection arthroplasty is reserved for more serious cases and involve the removal of bone located at the end of the first metatarsal joining the metatarsophalangeal joint.

As the saying goes, prevention is better than cure. A good pair of footwear is often all that is needed to prevent one from getting bunions. Selecting a pair of functional shoes over one that is aesthetically pleasing is a much sensible choice.

Lisfranc (Midfoot) Injury: Cause & Treatments

Lisfranc or midfoot injuries are often the results of broken bones in the midfoot or torn ligaments. Lisfranc injuries can vary from complex to simple depending on the number of joints and bones that are involved. Many patients often mistaken their midfoot injury to that of a simple sprain. As a result, many choose to self-medicate with pain relief cream. However, Lisfranc injury is not as simple as it seems and may even require surgery in some cases.

Located in the midfoot are clusters of small bones forming an arch at the top of the foot. There are five long metatarsal bones extending to the tones and ligaments and tendons hold the bones in place. However, there are no connective tissues holding the first metatarsal to the second metatarsal.

Lisfranc injuries can occur due to either direct or indirect trauma. Direct trauma is often result of an external force striking the foot while an indirect trauma occurs due to a force transferring to the stationary foot that deforms the foot. The foot is a smart system that is divided into three different sections namely the hindfoot, midfoot and forefoot. The role of the midfoot is to translate force and provide rotational stability and it is the keystone for plantar flexion and dorsiflexion. Therefore with a lack of dorsal support, the load acting on the foot is sufficient to cause dorsal displacement, leading to broken bones and/or ligaments.

The earlier a Lisfranc joint injury is diagnosed, the better it is for both patient and doctor. An initial clinical evaluation involving radiographs such as x-rays and MRI will be performed to indicate the probability of a mild, moderate or complex sprain. If diastasis is not present, immobilisation will be needed. This will include the usage of an immobilisation cast for a period of four to six weeks followed by limited movements. After six weeks, rehabilitation exercises need to start immediately. This is due to the bone being a piezoelectric material and will resorb after periods of inactivity.

If surgery is needed, it will be performed within 24 hours of the injury or after 10 days to allow for the drainage of bodily fluid due to swelling. Kirshner wires will be used to fix the bones together and bone fragments will be removed. After surgery, patients need to be immobilised in a cast for up to 12 weeks with minimal movements.

Some people will no longer be able to return to pre-injury levels of activity after a midfoot injury despite advancement in medical technology.

 

Olecranon Fractures: Treatment & Management

Our elbow is a complex hinge joint made up of three different bones. It can also perform various functions. The elbow is able to bend and straighten up, rotate and turning up and down. When you try to bend your elbow, the sharp tip protruding out is called the olecranon. Olecranon fractures are injuries that affect the particular bone.

Treatment

After a patient suffers from an Olecranon fracture, the first thing a doctor will administer is ice and pain relief medication followed by elbow immobilization. The doctor will then determine if surgery is required depending on the extent of the fracture.

Nonsurgical treatment

Patients who do not have a severe fracture will not be required to undergo surgery. Nonsurgical treatment is fairly straightforward. The patient will need to immobilize the fractured elbow using a splint or sling during the healing process. The patient will also need to visit the hospital once a week for X-ray imaging to monitor the healing process. If there are no protruding bone fragments, movement will resume after a month. During the healing process, a physiotherapist will be assigned to teach basic strengthening exercises. If the fracture shifts during this process, the patient will eventually surgery to piece the bones together.

Surgical treatment

Surgery will be needed for patients who have serious fractures such as an open fracture or displaced fracture. In a displaced fracture, the fracture is out of place. This is due to the strong attachment of the bicep muscles to the olecranon. Once the fracture is out of place, the elbow will be unable to straighten at all. An open fracture on the other hand means that the bone fragments have cut the skin, leading to an increased risk of infection. This is a much more serious condition and patients will be administered with antibiotics and tetanus shot. An incision will be made at the back of the elbow where the surgeon will piece the bone fragments together again. Large pieces of bones may be joined together using pins, wires, screws or plates and these metal implants can be permanent or biodegradable.

Management

Following surgery, rehabilitation will be required in order to regain the elbow to its previous condition. As the healing process is lengthy, bone resorption could have taken place. As such, the region is much weaker. A physiotherapist will thus concentrate on regaining bone mass and muscular strength in the elbow.

What Are The Advantages Of Minimally Invasive Surgery For Hip Replacement?

Medical technology is constantly evolving for the better. There are better and faster diagnostic equipments, robots to assist in surgery and safer anaesthesia techniques. With these advances in technology, surgery now is a lot lower in risk, shorter recovery time and less discomfort for patients. One of the greatest surgical development is the usage of minimally invasive surgery. In this article, we will be talking about the advantages of minimally invasive surgery for hip replacement.

During a minimally invasive surgery procedure, tiny incisions instead of large openings are made. Due to its extremely small nature, the risk of infections is much lower and recovery time is significantly reduced. Patients will also feel less discomfort compared to traditional surgery procedures with no strings attached. In order to qualify as a minimally invasive surgery, incisions no more than 4 inches can be made.

In traditional open hip replacement surgery, surgeons will have to make a 12 inch incision at the thigh area which cuts through the tendons and muscles in order to reach the hip joint. This will not only cause trauma to the area but also large amounts of blood loss. Not only that, the hip must be dislocated by physical means and this will cause tissue damages to the surrounding tissues as well. Through minimally invasive hip replacement surgery called the MIS 2-Incision Hip Replacement procedure, 2 small incisions are made over at the buttock and groin. This will allow access to the femur and socket with little to none trauma on the tissues and leaving the muscles untouched. Through the tiny incisions, robotic arms will place the prosthetics precisely between muscles, eliminating the chances of misalignment.

Patients can get out of their bed in as little as a few hours post surgery as compared to days when open surgery is performed. This will cut down the hospital stay to an average of 2 days as compared to 4 days, saving the patient hefty medical bills. Patients will also be able to start their physical therapy faster, reducing the recovery time. Most importantly, the patient will feel significantly less pain and discomfort.

Despite the many advantages of minimally invasive hip replacement surgery, it is not meant for everyone. Patients who are obese or have existing bone problems such as osteoporosis are not recommend. Minimally invasive surgery is also a complex procedure and hours of fine tuning in skills is required.

Recovering From Total Joint Replacement

Immediately after your total joint replacement surgery, you will be moved into a recovery room to be monitored for a couple of hours. After the anaesthesia has worn off and you are awake, you will then be moved to your ward where you will stay for the next few days. A typical stay in the hospital will be between 3 to 5 days depending on your progress. Before the effects of the anaesthesia have fully worn off, you should consume pain killers to prevent a sudden onset of unbearable pain. So how do you recover from total joint replacement surgery?

Physical therapy

Muscle atrophy is the result of depriving muscles activities, leading to muscle wastage. This can happen after a couple of days post surgery, leading to shrinking of muscles and muscular apoptosis. In order to prevent this, physical therapy will be required. Physical therapy helps to strengthen the hip joints through various small but effective exercises. It usually begins almost immediately after surgery in order to prevent scar tissues from forming. A physical therapist will be there to teach you some basic exercises to help you regain strength and full hip movement in the shortest time. It continues even when you have been discharged, and you will be required to show up for your physical therapy classes up to 4 times a week.

Understand possible medical complications

Hip replacement surgery has a low risk and infections are at a low rate of 2%. However, this does not mean that you are completely clear of any complications. Blood clots in the leg veins can occur due to prolonged immobility, leading to serious consequences if they travel up to the heart or brain. Therefore, some surgeons will recommend the usage of compressive stockings.

Do not be complacent

As time passes, the hip will be stronger and the usage of walking aids such as crutches or walkers will no longer be required. Some patients will tend to get complacent and start to skip physical therapy sessions or ignore symptoms which may indicate infection. Therefore, always be mindful of your responsibilities as a patient and continue your physical therapy sessions until your therapist has given you the all clear.

Your new hip will be able to last you for at least a decade and provide you with freedom you never imagined. However, you still need to know that it is an artificial joint inside you and materials can fail due to various reasons and a second surgery may be required in future.

How Do I Know If I Need Hip Replacement Surgery?

Hip replacement surgery is not something that everyone needs. However due to certain medical conditions such as osteoarthritis, hip replacement surgery may be the only way to get back a good quality of life. The choice is still ultimately up to you on whether to undergo hip replacement surgery or to take pain relief medication to tide you through. Let’s discuss on how you know if you really need surgery.

Unbearable pain and stiff hips

When pain gets unbearable and hips are always stiff, simple actions such as climbing the stairs, walking and even standing can be extremely difficult. Pain relief medication can only help you to overcome pain for certain duration and cannot be used forever. Therefore, when your osteoarthritis is this bad, hip replacement surgery is the only option available for you in order to get back a good quality life.

Bone damages

Due to osteoarthritis, bones are damaged and the bones are unable to regenerate and grow again. The joint cartilages are also disintegrated and no form of medication or physical therapy can help to repair it. When damages to the bone happen, hip replacement surgery will be required to repair it.

Alternative treatments failed

Surgery will usually be the last option that your surgeon will consider. Usually, he will prescribe you pain relief medication followed by physical therapy in order to help you regain flexibility in your joints and strengthen the surrounding muscles. However when all these treatments fail, surgery will be the only option left.

Conditions with no known cure

Rheumatoid arthritis is an auto-immune disease where the body’s immune system attacks the joint mistakenly instead of protecting it. The body does not recognise it as its own and treats it as something foreign and will continuously attack it until it is no longer there. There is no known cure for rheumatoid arthritis yet and patients who suffer from it must undergo hip replacement surgery in order to recover.

Above are 4 common scenarios where a hip replacement surgery needs to be considered. There are many factors that must be considered prior to surgery such as the age of the patient, overall health condition and bone density. Attempts to try alternatives to surgery such as medication and physical therapy will be made before suggesting surgery. Hip replacement surgery is a major and costly procedure and careful thought must be made before a final decision is made.

Hand Fracture and Aftercare Instructions

In our hand are 5 bones which connect the wrist to the thumbs and fingers. These are the metacarpal bones and they are located between the phalanges and carpus bones. When one of these bones breaks, it is classified as a hand fracture and a splint or cast is often required to be worn whilst the bones heal on their own. For serious cases, surgery may be required to surgically reconnect and mend them using cement. In this article, we will be looking at the causes of fracture as well as the aftercare instructions for them.

Although our bones have good compressive strength, it has poor tensile strength. When sufficient force is applied, the bone can fracture and when this occurs, it is accompanied by pain, swelling and the inability to utilise it. A cast or splint will usually be placed in order to immobilise the hand as well as to prevent any unwanted stresses while it heals. In order to make the pain more bearable, your doctor will prescribe pain relief medication to be taken orally. Since this medication requires some time before it works, you should take it before the previous one wears off in order to prevent feeling any unwanted pain. In cases where inflammation is present, antibiotics will need to be consumed in order to treat the infection caused by bacteria. Always make sure that medication is taken on time to prevent any gaps in the recovery process.

When you are at home, you can apply an ice pack to the fractured portion of your hand. Icing helps to decrease inflammation and the pain associated with it. It also constricts the blood vessels and help to speed up the delivery of essential nutrients required for healing. It also reduces tissue damages to the sensitive parts. However, always remember to remove your cast or splint prior to the application of ice as the cast and splint cannot get wet. In order to regain finger movement in the shortest time, you should try to work out your fingers. A hand grip is great for building up hand strength and muscle and you can use it anywhere.

Hand fractures will usually require between 4 to 6 weeks for it to fully heal, but it will take an even longer time for you to regain full strength. In order to reduce this timeframe, you should make use of any possible time to gain those muscles.

3 Reasons Why Physical Therapy is Important to a Sports Injury Recovery

Swelling, pain and loss of motion are common complaints following a sports injury. In order to regain post-injury levels, movement is extremely important. The experts in body movements are physical therapists who are trained to conduct specific exercises and stretches meant for aiding recovery to a specific part of the body. So, what are some reasons why physical therapy is important to a sports injury recovery?

Identification of deficiencies

Physical therapists are the ones who conduct each physical therapy session and they are trained to indentify deficiencies in the biomechanics of our body. Just by looking at how to body work will help them to know which part needs help. Therapists are also able to prescribe exercises which are helpful post surgery and help to ensure a fast recovery.

Increase range of motion

Post injury or surgery, the range of motion in that particular joint is extremely limited due to swelling and scarring. There will also be severe pain and the lack of ability to fully use the joint. As a result, exercises are required to be performed in order to overcome it. Physical therapy will help by ensuring a gradual increase in the intensity of exercises, helping to move your joints as much as possible without increasing much pain. It also helps to restore joint movements and strengthen the surrounding muscles.

Inhibit scar tissues formation

One of the side effects post surgery is the formation of scar tissues. However, scar tissues are undesirable due to various reasons such as cosmetic appearances, impediment of motion and as a source of discomfort. Scar tissues are usually darker in colour and their sizes depend on the depth of the wound. This can cause women to feel inferior and lose self confidence. Also, scar tissues are thicker and harder than normal tissues and this can impede motion especially if the scarring is at the joints. Being thicker and harder, it also presses down on other tissues, causing pain and lead to a higher chance of re-injury. Physical therapy starts early and this helps to reduce and inhibit the formation of scar tissues, lessening the chances of those effects mentioned above.

Physical therapy is an important part of the healing process. It actually starts before surgery and lasts all the way until around a year later. It helps to strengthen the muscles around the injury to help better support it and regain the range of motion after surgery.

3 Common Procedures Performed By Orthopaedic Surgeons

Orthopaedic surgeries are surgeries that involve the musculoskeletal system including our hands, shoulders, foot and knees. It is one of the most established arm of surgery and one of the most important. At one point or another in our lives, we will definitely require orthopaedic surgery to deal with issues such as sports injuries, musculoskeletal injuries or degenerative diseases. What are some common procedures performed by orthopaedic surgeons?

Total joint replacement

Due to ageing or diseases, a healthy joint can be damaged and rendered almost useless. In order to regain the full range of motion of a good quality lifestyle, total joint replacement will need to be performed on patients using man-made materials called biomaterials. These biomaterials are biocompatible and will mimic the actions of the actual joint. However, they cannot fully replicate the functions of the original one to a full extent. Wear and tear over a period of time can cause the cartilage to wear off, causing stiffness and pain due to the lack of synovium which helps to reduce friction.

Rotator cuff repair

Rotator cuff repair is performed to repair injured or torn tendons in the shoulder. There is a group of muscles in the shoulder joint forming a cuff, resulting in the name rotator cuff. Our shoulder offers superb flexibility and range of motion but this causes the shoulder joint to be extremely unstable. A slight impact can cause the shoulder “ball” to pop out of the “socket”, resulting in a dislocation. The presence of the tendons will hold the shoulder muscles to the shoulder, preventing any accidental popping out action. Due to injuries or overuse, the tendons can become weak and will not hold as well. Surgery may be performed either as a traditional open surgery or a more modern arthroscopy depending on the extent of the tear. The surgery will fix back the tendon to the shoulder and it will be held together by self-vanishing sutures.

Anterior Cruciate Ligament reconstruction

There are 4 major ligaments in our knee and one of the most important one is the anterior cruciate ligament (ACL). The ACL is responsible for the overall stability and even surface stress distribution across the knee. It limits the rotational capability of the knee as well as prevents excessive forward motion of the tibia to the femur. The ACL is frequently torn during sporting activities involving high impact and sudden jerks. For example during rugby, the long metal studs from the boots can be still stuck in the soft grass field and an attempt to make a directional change results in the twisting of the knee, instantly tearing the ACL. ACL reconstruction is performed either by open surgery or arthroscopic.  The surgeon will remove a tendon from the hamstring and use it as a replacement for the ACL.

Above are 3 of the most common orthopaedic surgeries performed by orthopaedic surgeons worldwide. No matter what surgery you are about to undergo, we wish you a speedy recovery.

Questions To Ask Before Orthopaedic Surgery

Orthopaedic surgeries are major surgeries and are extremely stressful. There will be a lot of doubts going through your head and can trigger an anxiety breakdown. However, this can be controlled by asking questions prior to your surgery. Being knowledgeable about what you are about to go through will allow you to appreciate the entire surgical process, prepare yourself for it and set in mind a proper recovery plan post surgery. So what are some questions that you should be asking your surgeon before surgery?

Why am I doing this surgery?

It is easy to Google online for information regarding the particular surgery you are about to undergo. However, there is no clear answer to why you are doing the surgery. You should be asking your surgeon why he recommended this particular surgery for you and are there any other alternative treatment methods that are available as well as a comparison between the possible alternatives. This will allow you to have a high confidence level prior to surgery.

What are the risks?

Risks are inevitable in any surgery and some carry a higher risk level than others. It would be good to clarify on this issue as well as question about some surgical procedures which have lesser risk level such as the use of a local anaesthesia as compared to a general anaesthesia as studies have shown that patients who received general anaesthesia have a higher risk of post surgery bleeding.

What are the available pain relief methods?

Pain and discomfort is also unavoidable post surgery and some people have a lower pain threshold than others. Therefore, it is crucial to understand about the available pain relief methods which will help you get through this tough period. You should also know what medications you are allergic to so that proper medication can be administered to you.

What are the success rates?

Bluntly speaking, you undergo surgery with the hope that it is a success. However, as you have already known, some surgeries carry a higher risk factor than others and therefore the success rates will fluctuate. Knowing what the success rates are will allow you to make better plans for your future.

No matter what orthopaedic surgery you are about to undergo, you should always ask questions prior to it to clarify your doubts and set your mind at ease. Here’s wishing you to a successful surgery and quick post-surgery recovery.