Frequently Asked Questions

Frequently Asked Questions

Following are answers to some questions commonly asked by our patients.

Foot & Ankle

  • What should I do to care for my sprained ankle?

    Ankle sprains, a stretching or tearing of the ligaments that support the bones of the ankle, are one of the most common orthopaedic injuries. The sprain very often results from a sudden, inward rolling of the foot. Swelling of the damaged ligaments follows, and pain and stiffness can be considerable. Immediate care of a sprain should include ice and elevation of the affected limb. Ice applied for the first 24-48 hours after injury helps to decrease swelling. It is important to maintain ankle mobility during the healing process, and exercises can be recommended by the orthopaedic surgeon. Full recovery, depending on the severity of the sprain, takes time – requiring anywhere from two to twelve weeks.

  • Why do my heels hurt, particularly in the morning?

    Stiffness or pain in the heel or bottom of the foot may be caused by a common condition known as plantar fasciitis. The plantar fascia is a thick, fibrous material on the bottom of the foot. It attaches to the heel bone and fans forward, allowing the foot to retain its arch. Where the fascia originates is a common site of pain and stiffness. Pain is typically worse with the first few steps out of bed in the morning and when rising from a sitting position.

    Treatment for this common source of foot and heel pain includes antinflammatory therapy such as Motrin or Aleve. Home exercises to stretch the Achilles and and strengthen the forefoot will also help to alleviate the problem. Your orthopaedic surgeon may prescribe soft heel cups that can be worn in any shoes to redistribute and disperse the weight on the heel and bottom of the foot. In severe cases of plantar fasciitis which do not resolve with conservative therapy, a cortisone injection in the heel can often relieve pain.

  • What is a bone spur?

    Patients are frequently concerned that their foot pain may be due to a "bone spur." While spurs can cause pain, there are numberous other conditions that can contribute to pain in the foot. Bone spurs are a common manifestation of osteoarthritis. Spurs are small outgrowths of a mixture of bone and cartilage which typically develop around the periphery of the joint, such as around the sides of the kneecap. Spurs commonly develop on the bottom of the heel as a result of excessive stretching of the Achilles tendon on the bottom of the foot. While spurs can cause chronic pain, a spur can exist as a part of an osteoporotic joint and may be only an incidental finding on x-ray.

  • What is gout?

    Gout is a type of arthritis that affects the peripheral joints, such as those in the great toe. The first signs of gout can sometimes resemble an infection with swelling, warmth, redness and tenderness. The great toe is most often involved, but gout can prevent in the instep, ankle, knee, wrist and elbow.

    Some patients will endure only a single episode of gout. Often patients may suffer mutliple attacks. Certain individuals produce too much or excrete too little of a substance known as uric acid. A blood sample can determine uric acid levels and aid in the diagnosis of gout. Various medications can be used to help resolve gouty attacks as well as to prevent future attacks. Dietary modifications are also useful in preventing gout. Certain substances in red wine, processed meats, cheese and other foods can contribute to gout attacks.

  • Where can I find quality running shoes and over-the-counter orthopaedic appliances?


    Runner's Edge (high-quality running shoes, fit to accommodate various orthopaedic conditions)
    111 East Cook Avenue
    Libertyville, IL
    (847) 549-1108

    Agony of DeFeet (over the counter orthotics, shoewear designed to accommodate a variety of orthopaedic conditions)
    30 East Park
    Mundelein, IL
    (224) 475-0026

    Foot Smart (many kinds of over-the-counter orthopaedic devices)
    www.footsmart.com
    1-800-707-9928

Back Pain

  • My back hurts – will I need surgery?

    Low back pain is one of the most common problems that brings patients to the orthopaedic office. The most frequent cause of low back pain is a pulled muscle. Muscles strain when they are stretched during contraction such as when a sudden twist or turn is done while lifting something. The result is pain, tenderness and a often a "knot" or spasm in the back muscle.

    Fortunately, about 95 percent of back pain resolves in six weeks without intervention. Conservative measures like over the counter anti-inflammatories (Motrin, Advil) combined with heat and gentle stretching can often provide relief and facilitate healing of common low back pain. Physical therapy is often helpful. Pain that persists despite conservative treatment measures or that is accompanied by pain radiating to the leg, numbness, tingling or any changes in bladder or bowel habits should be evaluated by the orthopaedic surgeon.

  • What is a "slipped disc?"

    Ruptured intervertebral discs, commonly known as "slipped discs" are often related to an episode of a sudden twisting movement while the back is flexed – such as when lifting. The bones of the back, called vertebrae, are cushioned by sponge-like intervertebral discs. The bones and discs are surrounded by a protective sheath called the annulus fibrosis . A ruptured disc occurs when the annulus fibrosus is torn by movements, like those described above, and the disc material is able to poke through the torn protective covering.

    Symptoms of a ruptured disc include pain in the back and sometimes in the leg. Sciatica is a condition where the problem originates in the back, but the pain is perceived as a painful, burning sensation radiating down the buttock or leg. This problem occurs when spinal nerves, which also provide sensation to other parts of the body, are irritated or compressed by the bulging intervertebral disc.

Post Op

  • My fractured leg was repaired with screws and plates – will I be stopped at airport security?

    It is not uncommon for complicated fractures of the limbs to be repaired using stainless steel plates and screws to stabilize the bones for optimal healing. The hardware used can be removed at a later date, but it is sometimes left intact as are the metallic implants used in joint replacement surgery. If stopped at airport security, officials can simply use a handheld wanding device to scan the appropriate limb.

  • Is it normal for my stitches to itch and feel tight after surgery?

    Sutures, commonly known as "stitches," are used to repair surgical incisions in a manner that maximizes healing and minimizes scarring. The time for post surgical suture removal varies, depending on the part of the body, the complexity of the incision and whether the area is subject to frequent stretching and stress from movement (such as a knee or elbow). As new skin tissue forms, the suture may start to feel tight and to become somewhat itchy. This is a normal part of wound healing. Any warmth, redness, drainage or tenderness at the incision site should be reported to the orthopaedic surgeon. Once the sutures are removed, small bandages called steri-strips may be applied to give the incision site continued support while it heals. The strips typically fall off in about a week, at which time, vitamin E-containing products, such a cocoa butter, can be applied in an effort to minimize scarring.

  • How long will I have to wear my cast?

    There are many variables that govern how long a cast will be worn and whether or not the patient is permitted to bear weight on the leg. The purpose of casting is to immobilize the fractured bones in a manner that facilitates complete and well-aligned healing. On average, most casts are worn for six weeks. Certain fractures may require casting for longer or shorter periods. During that time, the patient may be rechecked with an x-ray to ensure that the alignment of the bones remains satisfactory. Depending on the severity and type of fracture, a "walking cast" may be applied. Other fractures require a non-weight bearing status to ensure optimal healing. Sometimes casts will be revised or shortened over the six-week healing process. It is extremely important to carefully follow your doctor's cast instructions for the best healing return.

  • What are the major risks of surgery?

    The decision to surgically repair an orthopaedic problem is, like many decisions in medicine, is one of balancing the risks and benefits. The decision to recommend surgery is generally made when conservative treatment measures (rest, immobilization, medications, etc.) have failed or when a surgical repair is the only viable solution to the orthopaedic problem. Risks of surgery include infection, bleeding, numbness, stiffness, chronic pain , injury to the surrounding nerves or the need for further surgery. There may be other complications specific to each type of surgery, which your doctor will discuss with you. While these risks are typically low, they must be considered when making the decision to pursue a surgical remedy.

  • Is swelling normal after an ankle fracture?

    Swelling is to be expected after an ankle fracture. As the body responds to injury, protective blood cells rush to the area causing what is known as inflammation. This process can be visualized in the swelling that follows. Elevating the affected extremity and applying ice can help alleviate swelling. Patients often report that they notice increased pain and swelling once the leg is no longer elevated. Swelling of a fractured ankle may take months to resolve post-operatively. Compression stockings, which work through gradient pressure to return blood upward toward the heart can sometimes help to reduce post-injury swelling.

  • How do I use a cane or crutches?

    Occasionally, rehabilitation from orthopaedic conditions requires the use of a cane or crutches for support and stability. A cane shuold be placed in the opposite hand from the affected leg. When the painful leg moves forward, the cane moves forward. With arms slightly bent, crutches work in much the same way. When the affected leg moves forward, the crutches move forward. One of the easiest ways to climb stairs with crutches is by sitting and scooting up backward

Osteoporosis

  • How can I prevent osteoporosis?

    Osteoporosis is a condition that affects the bones as we mature. More prevalent in small, thin Caucasian women, osteoporosis is characterized by a decrease in the amount of bone that would be expected in a person of the same age and sex. Bone mass decreases slowly but steadily beginning around the age of 40. This process is accelerated with menopause. Osteoporotic bone is weaker and fractures more easily.

    To prevent osteoporosis, a woman should supplement their diet with calcium ant vitamin D. Postmenopausal women require approximately 1,200 mg. per day of calcium, which can be obtained from dietary sources like dairy products or from supplementing with over-the-counter calcium tablets or calcium-containing antacids. Weight-bearing exercise, like walking, is also important in protecting the bones as it stimulates new bone growth. In addition, women over the age of 50 should have periodic bone density scans to look for early signs of osteoporosis or thinning of the bone. Individuals at risk for osteoporosis can be treated with various medications approved for prevention of bone loss.

Osteoarthritis

  • What does a cortisone shot do?

    Cortisone is a steroid medication used to treat various conditions in which inflammation causes swelling and pain. Since it is administered locally, there are often none of the systemic side effects associated with oral steroid use. After conservative therapy, like non-steroidal medications (Advil, etc.) have been attempted and failed, steroid injections are sometimes recommended for treatment of painful joints such as the knees. Injections are done in the office using sterile procedure, and patients generally have relief from symptoms in a few days. A frequent question concerns the number of injections that can be administered in a single joint. The general guideline is no more than three injections each year in the same site. Exceeding the recommended number of injections can result in damage to the surrounding tendon and compromise the integrity of the joints.

  • Why is my knee pain getting worse?

    Erosion of the soft, smooth cartilage of the knee joint as a natural result of aging or from an inflammatory process like arthritis can result in significant pain as bone meets bone with each step taken. Early symptoms of arthritis in the knee can be treated with antinflammatory medications. The next line of therapy would be a corticosteroid injection. If those measures fail, another procedure called viscosupplemntation, where a lubricating injection is injected into the painful arthritic joint. The medication is given in a series of three injections a week apart.

    If pain persists, a total joint replacement may be considered, depending on the patient's age and level of pain. Prosthetic knee joints last an average of 12-15 years. They can be replaced, but subsequent surgery becomes more difficult given scar tissue and increased age of the patient. In general, the longer a knee replacement can be delayed, the better to ensure that the prosthetic joint will last for the remaining lifespan.

  • What is arthritis?

    Osteoarthritis, or inflammation of the joint space between bones, is an extremely common cause of orthopaedic pain. Most people, by age 40, have some arthritic changes although there may be no symptoms. By age 70, most individuals will have some degree of osteoarthritis. Men and women are equally affected. The onset of osteoarthritis is subtle and gradual.

    The earliest symptoms of osteoarthritis is unilateral pain made worse by exercise. Morning stiffness is common which resolves after the first 15 minutes of activity. As the disease progresses, joint motion decreases and crepitus (a grating sensation) may occur.

    Non-steroidal antiinflammatory medication (Motrin or Aleve) can work well to alleviate the inflamation of osteoarthritis. In addition, physical therapy may be prescribed to improve flexibility of the affected joints and to preserve strength and range of motion. If conservative therapy measures fail, injection of corticosteroids can sometimes help to relieve the discomfort of osteoarthritis. Sometimes a single injection does not alleviate symptoms and additional steroid injections may be required. The guideline for corticosteroid injections is no more than three per year in any single joint. Excessive use of steroids could cause further damage to the ligaments of the already diseased joint space.

    Another type of arthritis - rheumatoid arthritis (RA) is not be confused with the more common osteoarthritis. RA is a chronic disease characterized by usually symptomatic inflammation of the joints. Women are affected 2-3 times more than men. Onset typically occurs between 25 and 50 years. Morning stiffness lasts greater than 30 minutes on arising in the morning. Early afternoon fatigue and malaise may also occur. The diagnosis of RA depends on the pressence of a variety of symptoms - malady, stiffness, joint involvement, changes visible on x-ray and the presence of certain arthritis markers in the blood.

Upper Extremity

  • How is tennis elbow different from golfer's elbow?

    Pain in the elbow is one of the most common orthopaedic complaints. The elbow becomes sore, and pain often radiates from the elbow down the forearm. Simple motions, such as picking up a container of milk, can result in discomfort. Activities like tennis and golf, where the forearm is used in repetitive, swinging motions, are well known to be a cause of pain.

    "Golfer's elbow" or medial epicondylitis refers to pain over the inside of the elbow. "Tennis elbow," refers to pain on the lateral, or outside of the elbow. Many other activities that require repetitive lifting or twisting of the forearm, in addition to golf and tennis, can cause the same type of tendon inflammation. Treatment of tennis or golfer's elbow consists of resting and icing the affected area, anti-inflammatory drugs like Motrin or Aleve and sometimes the wearing of a supportive brace. If these conservative measures fail to provide relief, a cortisone injection in the elbow can often decrease the inflammation.

  • Why do I have tingling in my hands at night?

    Many patients make their way to the orthopaedic office with a complaint of numbness and tingling in the hands that wakes them from sleep. The numbness and tingling tends to be on the palm side of the hand, thumb and index finer.

    This condition, carpal tunnel syndrome, is caused by an inflammation of the tendons of the wrist "tunnel" or space in which one of the major nerves of the hand passes. Women are affected more often than men, and a tingling or numbness can be brought on by certain activities such as driving or grasping a book. Repetitive activities that bend the wrist, such as computer work, can contribute to inflammation of the tendon sheath.

    Mild cases of carpal tunnel can be treated by applying a brace that can be worn at night. This prevents the wrist from bending during sleep and keeps pressure off of the inflamed tendons. Anti-inflammatories, such as Motrin, can help reduce the size of the swollen tunnel, thus relieving pressure on the median nerve. If these measures fail to provide relief, an injection of corticosteroids in the wrist can help reduce the swollen synovial membranes. Early diagnosis and treatment can often make non-surgical care of carpal tunnel more effective. Sometime, if conservative measures fail, a surgical repair to release the trapped median nerve is required to relieve symptoms.