Happy Holidays!

From the TOCA Family to yours: Have a Wonderful and Safe Holiday Season!

Foot Pain & High Heels Q&A:

Do a lot of people come in with foot pain as a result of wearing heels?

High heels are a western society icon for dressing well and making a fashion statement for today’s women. Wearing high heels can come with a cost beyond the price tag. Foot pain from wearing heels can occur in virtually any part of the foot. Because the heel is elevated, body weight is taken off 

the heel and driven through the mid-foot into the forefoot. Most of today’s fashions typically have a tightly constrained forefoot leading to compression of the forefoot and toes. This position can lead to forefoot mechanical deformity and pain (bunion, hammertoe, bunionette deformities), pressure pain (corns and calluses), and nerve pain (neuritis and Morton’s neuromas). It can also lead to mid-foot pain (tendonitis, joint) and heel pain (plantar fasciitis, Achilles tendonitis, pump bump). All of these issues are commonly seen in our office. Many can be treated with conservative care and some require surgical intervention.

What are some general tips you’d give to women to prevent pain from the heels they wear?

Unfortunately, the higher the heel, the higher the abnormal load that is placed on the foot and also the ankle. Logically, the narrower the base of the heel the more unstable it will be. As a result, this will increase the risk of rolling and spraining your ankle. A lower heel with a wider base will be safer. If this is not in your fashion future or can’t be found in your closet, avoiding walking on uneven surfaces especially if you have had a drink or two will help avoid injury.

Make sure you wear high heels that fit well. Buying a cheaper shoe or one that is too small or large can feel good at the store but may cause pain after walking in them for a while. After you buy them, wear them at home for a while before taking them out on the town or to work. This can prevent being trapped for a day with a painful pair of shoes and an ongoing painful problem in the foot or ankle.
If you wear high heels regularly, don’t wear the same pairs routinely. Mix up heel heights, forefoot widths and try to use flats as much as you can when you don’t need to wear heels. Stretching the calf muscle on a step can also help prevent calf muscle, Achilles tendon, and plantar fascia issues.

Are there heels that don’t cause much damage?

A lower wider heel in a shoe with softer form fitting leather and wider forefoot is going to be your best option if you are dressing in heels.

What are some tips that you would give for preventing leg pains, varicose veins, etc?

Leg and ankle pains can come from wearing high heels. Commonly, these pains can come from inflammation of the muscles or tendons from overuse or altered use because of the alignment and tension on the muscles, tendons and ligaments. Limiting use or altering shoes along with calf stretching, strengthening and massage can help prevent these pains.
Sometimes pain can come from varicose veins. Blood enters the legs through arteries and exits through veins. The veins bring blood back to the heart against gravity and there are valves in the deep veins that allow this to happen. If the valves leak, the segmental feeding veins start to dilate causing varicose veins. These are difficult to prevent. Genetics, pregnancies, weight and prolonged times on your feet can promote varicose veins. Maintaining good muscle tone and strength, along with occasional leg elevation and sometimes vascular compression hose can all help guard against this problem.

Common Injuries to Look Out for This Football Season

The intense thrill of a football game makes it one of the most popular sports in the country. However, the physical demands of this high-energy sport make players especially prone to orthopedic injuries. With football season at last, it is important to know about common injuries that you should avoid on the field:

·         Meniscus Tear
The piece of cartilage that cushions your knee joint is called the meniscus. Players who experience knee pain may be suffering from meniscus tears. This injury can easily occur during a football game if you accidentally twist your upper leg while your foot is firmly planted. The forceful rotation can cause an immediate locking of your knee, or may simply make you feel weak if the injury is small.

·         Ankle Sprain
An ankle sprain is a very common injury that occurs when the ligaments surrounding the ankle joint are overstretched. Depending on the severity of the sprain, you could seriously hinder your ability to walk. Football players who accidentally apply pressure to the foot while it is in an inverted position can bring on an ankle sprain. This often happens while running and losing a step.

·         Achilles Tendonitis
Active runners are most likely to experience Achilles tendonitis. The Achilles tendon joins the calf and lower leg muscles to the heel of the foot. While it is structurally important, it is also one of the most vulnerable tendons in your body. Overrunning can lead to inflammation—a painful symptom that worsens if you continue exerting physical activity.

·         Herniated Disc
The tackling elements in football can put significant pressure on your back if you’re not careful. Repeated or sudden strain on your back could put you at risk for a herniated disc. When the discs in your spinal column are damaged, you may experience severe aching or the inability to straighten your back.  

The best way to avoid these common sports injuries is to implement proper stretching and exercise techniques before practice. You can learn more about sports medicine by consulting the team at TOCA. Our orthopedic specialists are committed to the prevention and treatment of sports injuries in Arizona—we are even the team physicians for The Phoenix Suns, ASU, and The Phoenix Mercury. Call us at (602) 277- 6211 today.

What's the Difference Between Osteoarthritis and Rheumatoid Arthritis?

Under the large umbrella of arthritic diseases, two have very similar symptoms that can make them difficult to diagnose: osteoarthritis and rheumatoid arthritis. An orthopedic surgeon will be able to determine the subtle differences. Read the following overview of these two joint disorders to recognize how they differ:

 

Osteoarthritis

·         Causes
Also known as “wear and tear” arthritis, osteoarthritis is the result of the smooth articular cartilage in your joints gradually wearing away. This makes it difficult to bend your joints in a smooth and painless motion. Those who are affected are generally middle-aged or older. Obesity and a family history of osteoarthritis can increase your risk of this disorder.
 

·         Symptoms
Any joint in your body can be affected by osteoarthritis. If you experience pain when you move a certain joint, it may be the result of bones with diminished cartilage that rub directly against each other. If left untreated, pain and inflammation will develop over time. Joints that lock, buckle, or make a grinding noise may also indicate osteoarthritis.
 

·         Treatment
There are several treatment options available to slow the progression of osteoarthritis and help you regain strength. Conservative therapies, such as lifestyle modifications or a balanced fitness program, are beneficial to those who suffer from mild symptoms. Surgical options, such as arthroscopy or joint replacement, are also available.

Rheumatoid Arthritis

·         Causes
Unlike osteoarthritis, rheumatoid arthritis is not inherited, but rather may be triggered by an infection that causes your immune system to respond inappropriately. When this occurs, your immune system produces substances that lead to the erosion of articular cartilage in your joints. Deformity of your joints and pain will increase as the disease progresses.
 

·         Symptoms
Swelling, pain, and stiffness are symptoms of rheumatoid arthritis that are similar to osteoarthritis. However, a deformity or contracture of the joint tends to be what sets these two diseases apart. If you notice multiple affected joints and experience symptoms of fever or decreased energy, you may have rheumatoid arthritis.
 

·         Treatment
Similar to osteoarthritis, there is no known cure for this disease. However, there are several treatment options that will alleviate the pain and enable sufficient function of the affected joints. Certain medications and injections help control the progress of the disease. Overall, exercise plays a crucial role in restoring function.

If you are experiencing pain in your bones or joints, consult TOCA, The Orthopedic Clinic Association in Phoenix. 

TOCA Announces Electric Car Charging Station - Supporting Energy Conservation

TOCA (The Orthopedic Clinic Association), is proud to announce the official availability of 3 electric car charging stations at our TOCA Tempe Location: 5002 South Mill Ave., Tempe, AZ 85282. 

As a company and as individuals, TOCA is dedicated to promoting clean energy technologies and energy conservation.

Top 10 Sports Injuries

The most common sports-related injuries primarily are overuse injuries. Certain types of injuries plague sports participants. Most of them, however, are minor. Knowing the early signs and what to do can help prevent them from becoming nagging problems.

1) Muscle Pull

Muscle Pull Treatment
The universally held treatment for a muscle pull or tear is to apply ice and rest until the pain and swelling subside. The ice relaxes the muscle and helps relieve any spasm. Ice should be applied for about 20 minutes on, then 20 minutes off, as much as possible for a few days. The dull ache of a muscle pull usually disappears within a few days.

As soon as tolerable, begin gently stretching the muscle. A pulled muscle may go into spasm as a reaction to being overstretched. If the muscle fibers are not gradually re-lengthened, the muscle will pull again with return to activity because it will have healed in a shortened state. In general, you can return to action when the injured body part can be stretched without pain as far as the healthy one on the other side of the body. That may take a week for a calf muscle or more than a month for a hamstring pull.

2) Neck Pain

Neck Pain Treatment
The proper treatment for neck stiffness is to apply ice for 20 minutes at a time and gently stretch the neck. Sit in a chair and hold onto the seat with the hand on the painful side of your neck. Bend your trunk and head to the opposite side. Hold the stretch for 20 seconds. Or gently drop your chin to your chest and move the chin in a semicircle from shoulder to shoulder five times. The same exercises can strengthen the neck and prevent pain.

Severe pain may require prescription medication, such as a muscle relaxant or anti-inflammatory agents, and physical therapy. Pain radiating down the arm and into the hand may be due to a pinched or stretched nerve, and should be seen by a doctor immediately.

3) Shoulder Impingement 

Shoulder Impingement Treatment
Many doctors overlook the true problem with a shoulder impingement. They treat the tendinitis with anti-inflammatory agents or corticosteroid injections. But the anti-inflammatories soon wear off, and the next time the shoulder is used, the tendon is impinged again. The pain recurs, requiring another injection or more anti-inflammatories.

If shoulder pain lasts for more than a day or two after practicing the serve or hitting a bucket of balls, a program of range-of-motion exercises can help strengthen the rotator cuff muscles. Strengthening these muscles will help hold your shoulder firmly in place, then the head will not slip out of the socket and the tendons will no longer become inflamed or irritated. Physical therapy, ultrasound, moist heat and electrical muscle stimulation followed by rehabilitative exercises are also recommended. If the shoulder exercises do not help ease the pain, or there is numbness or tingling in your hand, consult a doctor.

4) Lower Back Strain 

Lower Back Strain Treatment
Fortunately, most simple backaches go away within a few weeks, with or without treatment. After about a week, start a workout that strengthens the lower back, hamstring and abdominal muscles to help support the back to prevent any back pain from recurring.

When back muscles go into spasm, the excruciating pain may be disabling. Rest for a few days and take medication such as aspirin or other anti-inflammatory agents. Ice the back for 20 minutes at a time for as long as the pain persists.

Physical therapy may also be necessary if these symptoms do not quiet down in about 10 days. This includes ice, then heat, electrical stimulation of muscles, stretching and deep-finger massage. This should be followed by exercises to strengthen the back and abdominals. These same exercises can also help head off future back pains.

5) Tennis Elbow

Tennis Elbow Treatment
Tennis elbow is cured with lessons more than medicine. Tennis players need to learn how to move the feet to put the body in position to hit with full body weight behind the ball. This takes the stress off the elbow. Golfers with chronic elbow problems should also consider taking a lesson to smooth out any swing problems.

Cortisone injections, once the standard treatment, may reduce the inflammation around the elbow and ease the pain, but they do not address the cause of the problem, which is over-stressing the forearm tendon. Exercises can help improve forearm strength. These exercises include wrist curls, flexing the wrist forward while holding a light dumbbell at the side with the palm facing forward, and reverse wrist curls, the same exercise with the palm facing backward. Squeezing a soft rubber ball until the hand is fatigued also strengthens the forearm muscles.

6) Runner's Knee

Runner's Knee Treatment
Treatment involves strengthening the quadriceps muscle, which hooks into the kneecap and helps align it into the center of the groove. Isometric exercises are recommended to begin strengthening the quadriceps by contracting and relaxing the muscle. Strengthening progresses to less than full range-of-motion leg extensions. Do not attempt full leg extensions with the knee bent because this will cause the kneecap to rub more and worsen the symptoms.

Treatment also includes stretching the quadriceps, and soft tissue massage to work on the center of the quadriceps. Work from the upper part of the thigh towards the knee, stroking downward. This helps stretch muscle fibers and alleviates the muscle contraction, which is pulling the kneecap up. A large dose of aspirin, two plain or buffered aspirin pills four times a day until the knee improves, also may help reduce inflammation within the kneecap cartilage.

7) Shin Splints

Shin Splints Treatment
The key element of treatment is an arch support to prop up the foot and prevent excessive pronation and pull on the tendon. Many people do well with a simple commercial arch support. This usually solves the problem almost immediately. Others who have a more serious problem may need an orthotic device to control the pronation.

To help prevent shin splints, start exercising slowly to warm up the leg muscles, wear athletic shoes with good support and run on a softer surface, for example, changing from asphalt to grass every few runs.

8) Ankle Sprain

Ankle Sprain Treatment
The tried-and-true treatment for an any ankle sprain is RICE: Rest, Ice, Elevation and Compression. The goal is to limit internal bleeding and cut down on swelling.

As soon as tolerable, begin range-of-motion and strengthening exercises. These can help overcome stiffness and restore mobility. To do this, sit in a chair and cross the affected leg over the other leg at the knee. Using the big toe as a pointer, trace the capital letters of the alphabet from A to Z. Hold the big toe rigid so all the motion comes from the ankle. Repeat this exercise hourly, if possible. The letters will be very small at first but they will increase in size as range of motion improves. A good strengthening exercise is light kicking in a pool with a kick board or swim fin to create resistance.

Balance training is an important part of rehabilitation. Practice balancing on one foot with the arms extended to the sides without swaying, first with the eyes open, then eyes closed.

9) Achilles Tendinitis

Achilles Tendinitis Treatment
The treatment is to minimize physical activity until it feels better and to ice the tendon several times a day during this time. Anti-inflammatory agents help to relieve swelling and pain. Stretch the tendon as well by doing toe raises--stand on your toes for 10 seconds and then put your heels flat on the floor. Work up to doing three sets easily, then raise up on one foot at a time.

When the tendon has healed, do heel drops. Stand with your forefeet on a raised surface, such as the edge of a step. Let your heels down below the level of the surface so that the back of the calf is stretched. Hold for 10 seconds. Repeat until the calf is fatigued.

Runners who simply slough off Achilles tendinitis can develop an acute avulsion where the Achilles tendon pulls right off the bone. This is a medical emergency and requires surgical reattachment within 24 hours.

10) Arch Pain

Arch Pain Treatment
The treatment is to put an arch support under the foot immediately to prevent the arch from collapsing and the plantar fascia from stretching. Also, put an arch support in your slippers and wear them as soon as you rise. Even a few steps barefoot without support can stretch the plantar fascia. Arch supports usually relieve pain within a few days.

To head off arch pain, begin an exercise routine slowly, take off any excess weight and wear arch supports in your athletic shoes.

Arch pain commonly smolders for months because people do not take the proper precautions. Continuing to do weight-bearing exercises will perpetuate the pain. While the foot is recovering, swim or do water workouts. Or work the upper body only. Some people are able to use a stationary bicycle by placing only the front part of the foot on the pedals.

Sports Injuries: How to Tell If It's a Sprain or a Strain

Sports Injuries: How to Tell If It's a Sprain or a Strain

Athletes tend to suffer from a number of injuries, including those that affect their spines, necks, shoulders, wrists, hips, knees, and feet. Some of the most common sports injuries include sprains and strains—both of which can be treated by an orthopedic surgeon in Arizona. However, very few people have a clear understanding of the difference between these two injuries.

Sprains

A sprain refers to a tearing or stretching of a ligament, or the fibrous bands of tissue that connect the ends of your bones and support and stabilize the joints within your body. Sprains are often the result of bodily trauma that overstretches the joint or knocks it out of position. In some cases, a sprain may be caused by a rupture of the supporting ligaments. The most common causes of sprains include falls or direct blows to the body. While the signs of a sprain may vary from patient to patient, the most common symptoms of a sprain include bruising, swelling, pain, and inflammation.

Strains

Unlike a sprain, a strain refers to an injury of a tendon or muscle and is often the result of repetitive, prolonged movements of the tendons and muscles. In some cases, chronic strains may be caused by a direct blow to the body, excessive muscle contraction, overstretching, or lack of rest between periods of intense physical activity. The most common symptoms of strains include muscle spasms, muscle weakness, swelling, inflammation, cramping, and pain.

The best ways to avoid both sprains and strains are to wear properly fitting shoes, perform stretching exercises on a daily basis, and warm up before participating in any type of sports activity. It is also a good idea to nourish your muscles by following a proper diet and conditioning your body to build muscle strength.

Whether you’re suffering from a sprain or strain, the orthopedic surgeons with The Orthopedic Clinic Association, also known as "TOCA",  are here to help. Visit our website or contact us at (602) 277-6211 to set up a consultation.

TOCA Orthopedic Sports Medicine Fellowship Program is the first accredited program in the state of Arizona!

The Accreditation Council for Graduate Medical Education (ACGME) has officially accredited the new TOCA / Banner Good Samaritan Orthopedic Sports Medicine Fellowship Program! 

TOCA Orthopedic Sports Medicine Fellowship Program is the first accredited program in the state of Arizona!  This is an honor to be recognized as a center of excellence for training future Sports Medicine Orthopedic Surgeons.

Congratulations to our Program Director, Anikar Chhabra, MD MS, Tom Carter, MD and Evan Lederman, MD as well as TOCA, Banner Good Samaritan, and ASU faculty.

What do Orthopedic Doctors Do?

Orthopedics is a branch of medicine focused on injuries to the musculoskeletal system, including spine and joint injuries or deformities. There are multiple branches of orthopedics, including orthopedic surgeons, rheumatologists, physical therapists, orthopedic pediatricians. They work in small, specialized practices, in larger, less specialized practices, or in hospitals.

Orthopedic doctors treat broken bones, joint problems, like arthritis, and degenerative conditions, like osteoporosis. They also treat sports injuries, infections, congenital conditions, and tumors in the bones. The work depends on what specialty a doctor chooses, or by where they choose to practice medicine.

The education and training to become an orthopedic doctor lasts about 13 years, with eight years of schooling (both undergraduate and postgraduate), and five years of residency. During this time, an orthopedic doctor chooses a specialty to study. This could be a focus the bones of a particular body part, such as the hand, musculoskeletal oncology, joint replacement, or any of the other numerous branches of orthopedics.

The typical work week for an orthopedic doctor lasts 50-55 hours. Most of this time will be spent seeing patients, either in a clinic or in surgery. They may also be asked to consult on other cases. Some of this time will be spent doing paperwork or other administrative duties. An orthopedic doctor will also spend time reading medical journals, or doing other types of research, to keep up to date on the latest information about bone and joint care.