Click the image above to view the PDF brochure.
A bunion is a prominence at the base of the great toe that leads to shoe wear difficulty, pain and swelling. The deformity is caused by the 1st metatarsal (the long bone in the foot) spread inward and the great toe turned outward toward the 2nd toe. Other toe deformities may occur as a result of the abnormal position of the great toe.
There are many causes for the development of a bunion. Heredity plays a role. Some people are born with a foot shape that can lead to a bunion. Shoes that are tight and constrictive often accelerate the formation of a bunion. An estimated 85% of bunions occur in women. A bunion may lead to great toe arthritis over time.
The diagnosis of a bunion is based on examination and X-ray evaluation. There are various types of bunion deformities, and treatment is based on the type of deformity. The primary treatment option is to alter shoe wear. Wear shoes that do not cramp the forefoot. Prescription shoes or orthotics may help. Bunion pads are available, but may be too bulky to fit in shoes.
Surgery can correct painful bunions. There are several surgical procedures depending on the severity of the deformity. Most involve realigning a bone to achieve correction. Surgery is performed as an outpatient with a nerve block and sedation.
If you have questions, or would like an evaluation, please call 727-446-5993 (ext. 110) to make an appointment with Richard V. Abdo, M.D.
Hip replacement is a common surgical procedure to relieve pain, improve motion, and provide better quality of life for patients suffering from advanced arthritis of the hip. Arthritis is wear and tear degeneration and thinning of the protective joint lining called cartilage. The symptoms of arthritis can usually be controlled with non-surgical treatment that includes medication, physical therapy, modifying activity, and injections including cortisone, platelet rich plasma (PRP) and stem cell therapy.
Hip replacement is indicated when the symptoms have become disabling, and are not responding to non-surgical treatment. There are several surgical approaches for THR. Although anterior approach THR is not new, it is gaining in popularity because of the potential benefits, and improved instruments and equipment. An anterior THR is performed through a small incision in the front of the hip. The technique is tissue sparing because it does not detach muscles.
The potential benefits include:
- Accelerated recovery because muscles are not detached.
- Fewer restrictions during recovery.
- Improved stability of the implants.
- Decreased hospital stay.
- Decreased dislocation rate
If you would like more information, or would like to make an appointment with Richard V. Abdo, M.D., please call 727-446-5993 (x 110).
Total ankle replacement (TAR) is a surgical procedure to provide pain relief for patients with arthritis of the ankle joint.
Arthritis is wear and tear degeneration and thinning of the joint cartilage that causes pain, stiffness, and, sometimes, deformity. Arthritis may result from osteoarthritis, past trauma, instability, rheumatoid arthritis, and other conditions.
TAR replaces the joint surfaces with metal and plastic components similar to total hip and knee replacements. This provides pain relief and preserves some motion.
Ankle fusion is another surgical option for pain relief, but stiffens the ankle, putting increased stress on nearby joints. For mild cases, outpatient ankle arthroscopy may provide temporary relief.
Non-surgical treatment for ankle arthritis includes anti-inflammatory medication, ice, braces, physical therapy, cortisone injection, platelet rich plasma injections, or stem cell therapy. TAR is considered when non-surgical treatment no longer helps relieve pain.
An orthopedic foot and ankle surgeon should be seen for management of ankle arthritis, and to determine if ankle replacement is an option. If you would like more information, or would like to make an appointment with Richard V. Abdo, M.D., please call 727-446-5993 (x 110).
The goal of joint preservation is to treat a patient’s arthritic knee in such a way as to avoid joint replacement surgery and return the patient to a more normal and active life style.
Anthony Marcotte, D.O. is our Hand Specialist at Orthopaedic Specialties
Arthritis of the Hand
The hand and wrist have multiple small joints that work together to produce motion. This gives the fine motion needed to thread a needle or tie a shoelace. When the joints are affected by arthritis, activities of daily living can be difficult. Arthritis can occur in multiple areas of the hand and wrist. It can have multiple causes.
It is estimated that one out of every five people living in the United States has at least one joint with signs or symptoms of arthritis. About half of arthritis sufferers are under age 50. Arthritis is the leading cause of disability in the United States. It typically occurs from either disease or trauma. The exact number of people with arthritis in the hand and wrist is not known.
Cartilage works as nature’s “shock absorber.” It provides a smooth gliding surface for the joint. All arthritic joints lose cartilage. When the cartilage becomes worn or damaged, or is lost due to disease or trauma, the joint no longer has a painless, mobile area of motion.
The body attempts to make up for the lost cartilage. It produces fluid in the joint lining (synovium), which tries to act like a cushion, like water in a waterbed. But it also causes the joint to swell. This restricts motion. The swelling causes stretching of the joint covering (capsule), which causes pain.
Over time, if the arthritis is not treated, the bones that make up the joint can lose their normal shape. This causes more pain and further limits motion.
When arthritis occurs due to disease, the onset of symptoms is gradual and the cartilage decreases slowly. The two most common forms of arthritis from disease are osteoarthritis and rheumatoid arthritis. Osteoarthritis is much more common and generally affects older people. It appears in a predictable pattern in certain joints. Rheumatoid arthritis has other system-wide symptoms and may be passed from parent to child (genetically).
Fractures within the finger joints.
When arthritis is due to trauma, the cartilage is damaged. People of any age can be affected. Fractures, particularly those that damage the joint surface, and dislocations are the most common injuries that lead to arthritis. An injured joint is about seven times more likely to become arthritic, even if the injury is properly treated.
Arthritis does not have to result in a painful or sedentary life. It is important to seek help early so that treatment can begin and you can return to doing what matters most to you.
Bone scans of the hands.
A doctor can diagnose arthritis of the hand by examining the hand and by taking X-rays. Specialized studies, such as magnetic resonance imaging (MRI), are usually not needed. Sometimes a bone scan is helpful. A bone scan may help the doctor diagnose arthritis when it is in an early stage, even if X-rays look normal.
Arthroscopy pictures of the wrist joint. The white objects are some of the wrist bones as seen through the arthroscope. The metal rod is an arthroscopic probe with a tip measuring 2 mm. It can be seen moving between two of the wrist bones that have a ligament tear between them. Normally, the bones are close together and cannot be moved apart.
Arthroscopy is another way to look at the joint by direct inspection. During an arthroscopic procedure, the surgeon inserts a small camera into the joint to look inside. It provides the clearest picture of the joint without having to make a large incision. However, this is an invasive procedure and should not be used as a routine diagnostic tool.
Early symptoms of arthritis of the hand include joint pain that may feel “dull,” or a “burning” sensation. The pain often occurs after periods of increased joint use, such as heavy gripping or grasping. The pain may not be present immediately, but may show up hours later or even the following day. Morning pain and stiffness are typical.
As the cartilage wears away and there is less material to provide shock absorption, the symptoms occur even with less use. In advanced disease, the joint pain may wake you up at night.
Pain might be made worse with use and relieved by rest. Many people with arthritis complain of increased joint pain with rainy weather. Activities that once were easy, such as opening a jar or starting the car, become difficult due to pain. To prevent pain at the arthritic joint, you might adapt the way you use your hand.
Thumb extension deformity. This patient has lost mobility at the base of the thumb due to arthritis. The next joint closer to the tip of the thumb has become more mobile than normal to make up for the arthritic joint. Normally, the thumb does not come to a right angle with the rest of the hand.
When the affected joint is subject to greater stress than it can bear, it may swell in an attempt prevent further joint use.
Changes in Surrounding Joints
In patients with advanced thumb base arthritis, the neighboring joints may become more mobile than normal.
The arthritic joint may feel warm to touch. This is due to the body’s inflammatory response.
Crepitation and Looseness
There may be a sensation of grating or grinding in the affected joint (crepitation). This is caused by damaged cartilage surfaces rubbing against one another. If arthritis is due to damaged ligaments, the support structures of the joint may be unstable or “loose.” In advanced cases, the joint may appear larger than normal (hypertrophic). This is usually due to a combination of bone changes, loss of cartilage, and joint swelling.
Mucous cyst of the index finger.
When arthritis affects the end joints of the fingers (DIP joints), small cysts (mucous cysts) may develop. The cysts may then cause ridging or dents in the nail plate of the affected finger.
Treatment options for arthritis of the hand and wrist include medication, splinting, injections, and surgery.
- How far the arthritis has progressed
- How many joints are involved
- Your age, activity level and other medical conditions
- If the dominant or non-dominant hand is affected
- Your personal goals, home support structure, and ability to understand the treatment and comply with a therapy program
Medications treat symptoms but cannot restore joint cartilage or reverse joint damage. The most common medications for arthritis are anti-inflammatories, which stop the body from producing chemicals that cause joint swelling and pain. Examples of anti-inflammatory drugs include over-the-counter medications such as Tylenol and Advil and prescription drugs such as Celebrex.
Glucosamine and chondroitin are widely advertised dietary supplements or “neutraceuticals.” Neutraceuticals are not drugs. Rather, they are compounds that are the “building blocks” of cartilage. They were originally used by veterinarians to treat arthritic hips in dogs. However, neutraceuticals have not yet been studied as a treatment of hand and wrist arthritis. (Note: The U.S. Food and Drug Administration does not test dietary supplements. These compounds may cause negative interactions with other medications. Always consult your doctor before taking dietary supplements)
When first-line treatment with anti-inflammatory medication is not appropriate, injections may be used. These typically contain a long-acting anesthetic, similar to novacaine but longer lasting, and a steroid that can provide pain relief for weeks to months. The injections can be repeated, but only a limited number of times, due to possible side effects, such as lightening of the skin, weakening of the tendons and ligaments and infection.
Injections are usually combined with splinting of the affected joint. The splint helps support the affected joint to ease the stress placed on it by activities. Splints are typically worn during periods when the joints hurt. They should be small enough to allow functional use of the hand when they are worn. Wearing the splint for too long can lead to muscle wasting (atrophy). Muscles can assist in stabilizing injured joints, so atrophy should be prevented.
If nonsurgical treatment fails to give relief, surgery is usually discussed. There are many surgical options. The option chosen should be one that has a reasonable chance of providing long-term pain relief and return to function. It should be tailored to your individual needs. It is important that the treating physician is well versed in current surgical techniques.
Thumb base fusion using a plate and screws.
If there is any way the joint can be preserved or reconstructed, this option is usually chosen.
When the damage has progressed to a point that the surfaces will no longer work, a joint replacement or a fusion (arthrodesis) is performed.
Finger joint prosthesis.
Joint fusions provide pain relief but stop joint motion. The fused joint no longer moves; the damaged joint surfaces are gone, so they cannot cause symptoms.
Joint replacement attempt to provide pain relief and functional joint motion. As with hip and knee replacements, there have been significant improvements in joint replacements in the hand and wrist. The replacement joints are made of materials similar to those used in weightbearing joints, such as ceramics or long-wearing metal and plastic parts. The goal is to improve the function and longevity of the replaced joint. Most of the major joints of the hand and wrist can be replaced. A surgeon often needs additional training to perform the surgery. As with any evolving technology, the long-term results of the hand or wrist joint replacements are not yet known. Early results have been promising. Talk with your doctor to find out if these implants are right for you.
After any type of joint reconstruction surgery, there is a period of recovery. Often, you will be referred to a trained hand therapist, who can help you maximize your recovery. You may need to use a postoperative splint or cast for awhile after surgery. This helps protect the hand while it heals.
During this postoperative period, you may need to modify activities to let the joint reconstruction heal properly. Typically, pain medication you take by mouth is also used to reduce discomfort. It is important to discuss your pain with your doctor so it can be adequately treated.
Length of recovery time varies widely and depends on the extent of the surgery performed and multiple individual factors. However, people usually can return to most if not all of their desired activities in about three months after most major joint reconstructions.
Research on the Horizon
Increasingly, doctors are focusing on how to preserve the damaged joint. This includes getting an earlier diagnosis and repairing joint components before the entire surface becomes damaged.
Arthroscopy of the small joints of the hand and wrist is now possible because the equipment has been made much smaller.
There have been encouraging results in cartilage repair and replacement in the larger joints such as the knee, and some of these techniques have been applied to the smaller joints of the hand and arm.
The neck (cervical spine) is composed of vertebrae that begin in the upper torso and end at the base of the skull. The bony vertebrae along with the ligaments (which are comparable to thick rubber bands) provide stability to the spine. The muscles allow for support and motion. The neck has a significant amount of motion and supports the weight of the head. However, because it is less protected than the rest of the spine, the neck can be vulnerable to injury and disorders that produce pain and restrict motion. For many people, neck pain is a temporary condition that disappears with time. Others need medical diagnosis and treatment to relieve their symptoms.
Neck pain may result from abnormalities in the soft tissues—the muscles, ligaments, and nerves—as well as in bones and joints of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms.
The vertebral column.
Rheumatoid arthritis can destroy joints in the neck and cause severe stiffness and pain. Rheumatoid arthritis typically occurs in the upper neck area.
Cervical Disk Degeneration (Spondylosis)
The disk acts as a shock absorber between the bones in the neck. In cervical disk degeneration (which typically occurs in people age 40 years and older), the normal gelatin-like center of the disk degenerates and the space between the vertebrae narrows. As the disk space narrows, added stress is applied to the joints of the spine causing further wear and degenerative disease. The cervical disk may also protrude and put pressure on the spinal cord or nerve roots when the rim of the disk weakens. This is known as a herniated cervical disk.
Because the neck is so flexible and because it supports the head, it is extremely vulnerable to injury. Motor vehicle or diving accidents, contact sports, and falls may result in neck injury. The regular use of safety belts in motor vehicles can help to prevent or minimize neck injury. A “rear end” automobile collision may result in hyperextension, a backward motion of the neck beyond normal limits, or hyperflexion, a forward motion of the neck beyond normal limits. The most common neck injuries involve the soft tissues: the muscles and ligaments. Severe neck injuries with a fracture or dislocation of the neck may damage the spinal cord and cause paralysis.
Less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.
When Should You Seek Medical Care?
If severe neck pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Medical care should be sought immediately.
Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs.
Radiating pain or numbness in your arms or legs causing weakness in the arms or legs without significant neck pain should also be evaluated.
If there has not been an injury, you should seek medical care when neck pain is:
- continuous and persistent
- accompanied by pain that radiates down the arms or legs
- accompanied by headaches, numbness, tingling, or weakness
Many patients seek orthopaedic care for neck pain because orthopaedists are specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although some orthopaedists confine their practices to specific areas of the musculoskeletal system, most treat a wide variety of diseases, injuries, and other conditions, including neck pain.
When a bone in the spine collapses, it is called a vertebral compression fracture. This injury most often happens in the lower part of the thoracic, or middle, section of the spine.
What causes a vertebral compression fracture?
Compression fractures usually occur because of too much pressure on the normally strong vertebrae. When the vertebral body collapses, the bone tissue on the inside is crushed or compressed.
There are several reasons that may lead to a compression fracture, including:
- Osteoporosis: Osteoporosis is a common cause of compression fractures in the spine. This disease thins and makes the bones brittle, often to the point where they are too weak to withstand normal pressure, even the pressure of everyday activities. In some cases of severe osteoporosis, the bones are so weak that simply bending forward, coughing or sneezing can cause compression fractures.
- Cancer: When cancer has spread to the spine, patients are more likely to suffer vertebral compression fractures.
- Trauma: A spinal injury can cause a sudden minor or severe fracture. A fall, forceful jump and car accident are some examples of trauma that can cause compression fractures.
What are the symptoms and complications of a vertebral compression fracture?
- In most cases, bone collapse is gradual, so pain is mild or there may be no pain at all until the bone actually breaks.
- If the fracture is trauma related, the patient will likely feel severe pain in the back, legs and possibly arms. There also may be weakness or numbness in these areas if the fracture injures a nerve in the spine.
- Increased chance of developing a kyphotic deformity (sometimes called dowager’s hump or hunchback) is a common disorder in elderly women who have osteoporosis and frequent fractures. This occurs when the front of the vertebrae collapse, creating a wedge-shaped vertebrae and a resulting severely stooped posture.
- Increased lung and breathing problems as the deformed spine puts additional pressure on the chest cavity.
- Neurological complications, such as spinal stenosis, caused by increased pressure on the spinal cord or nerve roots.
How is a vertebral compression fracture treated?
Treatment is based on the severity of symptoms.
A vertebral compression fracture generally responds well to non-surgical care while the fracture heals. Most vertebral fractures usually take about three months to fully heal. Treatment may include the following:
- Pain medications: The medications reduce pain but do not actually help to heal the fracture.
- Decreased activity: Avoiding strenuous activity or exercise, heavy lifting or anything else that puts stress on the spine is recommended. For some people, bed rest may be required.
- Bracing: A back brace, or orthosis, that keeps the patient from bending forward also supports the spine in a way that takes pressure off the fractured vertebra so it can heal.
Two minimally invasive treatments—vertebroplasty and kyphoplasty—are sometimes used to treat compression fractures. These are done on an outpatient basis or only involve a single night in the hospital. These two procedures use small incisions, so healing time is kept to a minimum.
- Vertebroplasty: A special acrylic bone cement is injected into the broken vertebra to improve strength of the bone. The cement hardens in about 10 minutes.
- Kyphoplasty: In this surgery, which is used to treat a kyphotic (hunchback) deformity, surgeons insert a needle into the damaged vertebra and then a slide a thin tube with a deflated balloon inside the broken bone. After the balloon is inflated to help restore the height of the broken vertebra, acrylic bone cement is injected into the cavity formed by the balloon to hold the vertebra at its correct height. The cement hardens in about 10 minutes.
Major spinal surgery to fix a vertebral compression fracture is rarely required and only undertaken if there is a serious instability of the spine. Spinal fusion surgery is used to eliminate motion between two vertebrae. This surgical procedure “welds” or fuses together two or more of the spine’s vertebrae to create a solid bone bridge between the bones.
The “Unhappy Triad” is an injury to the knee when three structures in the knee — two ligaments and the meniscus — are injured at the same time.
This injury commonly occurs in contact sports, such as football or rugby, when the knee is hit from the outside while the foot is fixed in place. This multiple injury also is seen in skiers.
The “unhappy triad” occurs when the force of the blow to the leg rotates the leg, causing the medial collateral ligament (MCL) to tear. If the MCL tears, the medial meniscus will likely tear because it is attached to the deep layer of the MCL. The force of the blow then continues to the anterior cruciate ligament (ACL), which also tears.
In cases of combined injuries to the knee, such as those in the “unhappy triad,” surgical repair of the MCL and meniscus at the same time of ACL reconstruction is usually the preferred solution.
Total knee replacement surgery, also known as total knee arthroplasty, is a surgical procedure that helps relieve pain and restore function in severely diseased knee joints. During the procedure, an orthopedic surgeon cuts away damaged bone and cartilage from the thighbone, shinbone and kneecap, and replaces it with an artificial joint, or prosthesis. The new, artificial joint replicates the knee’s natural ability to roll and glide as it bends. The goal is to improve mobility by relieving pain and improving function of the knee joint.
What causes the knee to become damaged?
The most common cause of chronic knee pain and disability is arthritis.
- Osteoarthritis occurs when the cartilage cushioning the bones of the knee wears away and the bones rub directly against each other, causing pain and stiffness.
- Rheumatoid arthritis is a chronic inflammatory disease that causes joint pain, stiffness, and swelling.
- Post-traumatic arthritis follows a serious knee injury when the bone and cartilage do not heal properly. The irregularities lead to more wear on the joint surfaces.
A knee joint also may need replacement because of an injury or normal wear and tear.
Who is a candidate for total knee replacement surgery?
The decision to have total knee replacement surgery is a joint one made by the patient, the patient’s primary care doctor, the patient’s family and an orthopaedic surgeon. Recommendations for surgery are based on the extent of the patient’s pain, disability and total health status.
Patients may benefit from knee replacement surgery if
- their severe pain limits everyday activities, including walking, going up or down stairs, and getting in and out of chairs.
- they are unable to sleep at night because of the pain.
- they receive little relief from non-surgical treatments, such as physical therapy, cortisone injections, other surgeries or anti-inflammatory drugs.
- they suffer side effects from pain medications.
- they have chronic knee inflammation and swelling that doesn’t improve with rest or medications.
- they have significant stiffness which limits the knee’s ability to straighten or bend.
- their knees have significant instability and constantly give way.
- they have a significant knee deformity, such as a joint that bows in or out.
Most patients who undergo total knee replacement are usually age 60 to 80, but orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on a patient’s pain and disability, not age. Patients as young as age 16 and older than 90 have undergone successful total knee replacement.
What are the benefits of total knee replacement surgery?
It’s important to know that an artificial knee is not a normal knee, nor is it as good as a normal knee. However, most people who undergo knee replacement surgery experience a dramatic reduction of knee pain and significant improvement in their ability to perform common activities. Most patients with stiff knees before surgery will have better motion after a total knee replacement. Remember, though, that total knee replacement won’t make an individual into an athlete or allow someone to do more than he or she could before the knee became arthritic or damaged. Following surgery, most patients are told to avoid some types of activity for the rest of their lives, including jogging and high impact sports.
How does knee replacement surgery work?
During a total knee replacement, surgeons reshape the knee joint. First, diseased bone and cartilage are removed. This includes the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the backside of the kneecap (patella). These surfaces are replaced with a metal shell on the end of the femur, a metal and plastic trough on the tibia, and if needed, a plastic button in the kneecap. Doctors usually secure the new knee joint components to the bones with surgical cement. The artificial knee then mimics natural knee motion and function.
The procedure usually takes about two hours to perform.
Most patients begin exercising their knee the day after surgery. A physical therapist will teach specific exercises to strengthen the leg and restore knee movement to allow walking and other normal daily activities soon after surgery.
Full recovery from the surgery takes three to six months, depending on the type of surgery, the overall health of the patient, and the success of the rehabilitation.
In some cases, doctors are able to use special tools and a smaller incision for a minimally invasive surgery when replacing the knee. Generally, recovery time is less and pain is lower when using this type of surgery.
With normal use and activity, every knee replacement develops some wear in its plastic cushion. Excessive activity or weight may accelerate this normal wear and cause the knee replacement to loosen and become painful. However, with appropriate activity modification, knee replacements can last for many years.