Twisted Ankle with Dr. Jason Tarno

What are the most common injuries that you see for basketball players?

I think without question ankle injuries lead the way. Of course, knee injuries are not far behind.

What are the common injury patterns of the ankle?

Typically the ankle is injured with an inversion or eversion stress. These terms relate to which way the sole of the foot goes. With an inversion injury, the sole of the foot turns in, and the lateral or outside ligaments are stressed. With an eversion injury, the sole of the foot turns out (or to the side), and the inside ligament is stressed. If the force is significant enough, the bone can actually fracture, or break.

How many bones make up the ankle?

On the medial side of the ankle there is one main ligament called the deltoid ligament. It is a large triangular shaped ligament that attaches the tibia to the talus. It is usually injured with an eversion stress at the ankle. On the lateral, or outside of the ankle, there are three ligaments that connect the fibula to the talus and calcaneus (heel bone). The ligaments are named by what they attach to and their position at the ankle. The first ligament is called the anterior talo-fibular ligament (ATF). This is the ligament that is most commonly injured with an ankle inversion. The next ligament is the calcaneo-fibular ligament (CF). The last ligament on the lateral aspect of the ankle is the posterior talo-fibular ligament (PTF). In some cases all three ligaments can be sprained and the ankle becomes very unstable.

What is the difference between a sprain and a strain?

A sprain refers to an injury to a ligament. Ligaments connect bone to bone. Sprains are graded from grade I to grade III, which refers to the degree of tear. In a grade I sprain, most of the ligament is intact, and just a few fibers are torn. A grade III sprain refers to a complete tear or rupture of the ligament or ligaments. A strain refers to injury of a muscle.

Is it necessary to get an x-ray if someone twists their ankle?

There are no absolutes as to when to take or not to take an x-ray. Physicians train for many years, and often it is still a judgement call on the part of the physician. But, if the athlete cannot weight-bear on the foot and ankle, it probably warrants an x-ray.

Why is it that after an ankle sprain there is often a black and blue mark to the lower aspect of the foot?

This is called dependent edema. That means that there has been swelling in the ankle that has traveled to the lower aspect of the foot due to gravity. The black and blue color is from blood that has accumulated in the tissues. Blood has iron in it that stains the skin for a week or two. This usually resolves itself after the athlete regains weight-bearing status.

- Jason M. Tarno, D.O., is Board Certified and Fellowship trained in Sports Medicine. Dr. Tarno is an associate of Crovetti Orthopaedics and Sports Medicine.

For further information call: 990-2290.

Or visit us at: www.CrovettiOrtho.com

Dealing with Arthritis with Dr. Jason Tarno

Many seniors remain active in sports such as golf, tennis, walking, and cycling. Arthritis is a common problem with the aging athlete, and can slow down their activity level. What nonsurgical measures can be used to treat the athlete with arthritis?

It is important to determine what type of arthritis the athlete has first. Treatments are different depending on what type of arthritis is involved. Probably the most common form of arthritis in the senior athlete is termed osteoarthritis (or OA).

Is OA similar to rheumatoid arthritis?

No. OA is the type of arthritis that occurs from years of “wear and tear” on the joints. Rheumatoid arthritis is an autoimmune disorder in which the person’s own immune system attacks the joints. There are characteristic differences in clinical presentation between the two as well as characteristic differences on X-ray.

Many older athletes do not want to go through surgery. What types of nonsurgical things can be done for people that suffer from OA?

There are really several treatments that can be offered. Unfortunately, nothing has been found that stops the advancement of the disease. Currently, physicians treat OA by aiding people with their pain.

How important is weight loss in regards to OA of the hip or knee?

When discussing OA of the hips or knees, weight loss cannot be overemphasized. For every pound that a person reduces of their body weight, it is roughly equivalent to like losing three to four pounds off of the joints. Therefore, someone that reduces their body weight by 10 pounds in essence takes 30 to 40 pounds off of their hips, knees, and ankles. Unfortunately, some people that have advanced disease are unable to increase their activity because of pain, and have difficulty losing weight.

How does physical therapy help someone with OA?

Physical therapy seems to help some people by strengthening the muscles around the arthritic joint, thereby reducing some of the stress on the joint itself.

What are your thoughts on supplementation such as glucosamine/ chondroitin?

The jury is still out on the effectiveness of this kind of supplementation in the medical literature. These products are termed supplements and are not pharmaceuticals.

Therefore, they are not monitored by the FDA, and the public needs to be careful as to what it is they are actually buying. Many people claim that these supplements help relieve their arthritic pain in their joints. Some people see no change in their pain at all. Fortunately, there does not seem to be a lot of bad side effects from these supplements. The main side effect tends to be water retention which can elevate blood pressure. I would recommend to anyone that is considering taking glucosamine that they have their blood pressure monitored by their primary care physician before beginning any supplementation, and have it checked periodically as well.

What is viscosupplementation?

This refers to a new type of treatment for OA of the knee. It has not been approved as yet for any other joints of the body, although research is being performed on the shoulder and elbow. There are two types of medications in this class OA treatments. Each are injectable medicines that are injected in the knee joint weekly for either 3 or 5 weeks, depending on which medication is used. The medicines act as a sort of lubricant in the knee and can give pain relief for 6 months to a year.

Why are steroid injections offered to some patients?

Steroid medication is used as an anti-inflammatory agent to treat pain. Some people have such advanced disease that the above listed treatments no longer offer them any relief. The positive with steroid injections is that they can be given to just about any joint in the body. The downside is that there is a limited number of times a person can receive this medication due to side effects that can occur.

It really seems like there are a lot of choices for physicians and senior athletes when it comes to osteoarthritis.

Depending on the stage of OA that the person has, that can be true. Physicians always try to exhaust all conservative measures prior to discussing a surgical procedure. Hopefully, as new advances are made in this area, more conservative treatments will be developed.

- Jason M. Tarno, D.O., is Board Certified and Fellowship trained in Sports Medicine. Dr. Tarno is an associate of Crovetti Orthopaedics and Sports Medicine.

For further information call: 990-2290.

Or visit us at: www.CrovettiOrtho.com