This is the bone stimulator I primarily use with patients. Many insurance companies will only cover if the fracture healing is delayed (past 3 months). But, since it works from day one of a fracture, some hard to heal fractures like Jones Fractures of the 5th metatarsal, any metatarsal fracture that has broken through both sides, sesamoid fractures, navicular fractures, calcaneal fractures, and talar neck fractures would be greatly helped with the bone stimulator if it could be started early. I am hopeful insurance companies will see the logic in this.
Showing posts with label Calcaneal Fracture. Show all posts
Showing posts with label Calcaneal Fracture. Show all posts
Thursday, January 8, 2015
Saturday, August 30, 2014
Calcaneal Fracture: Email Advice
Hi Dr. Blake,
Eight years ago I had two calcaneal fractures and plates and screws on the outside of both heels. About two years ago, my left foot became very supinated, and I had to quit bicycling because of the overloading on the outside of my foot. I recently had the painful left heel plate removed, and it was discovered one or both of the peroneal tendons was diseased and torn (rubbing on the plate).
Regards,
Bill (name changed)
Eight years ago I had two calcaneal fractures and plates and screws on the outside of both heels. About two years ago, my left foot became very supinated, and I had to quit bicycling because of the overloading on the outside of my foot. I recently had the painful left heel plate removed, and it was discovered one or both of the peroneal tendons was diseased and torn (rubbing on the plate).
Dr Blake's comment: When the peroneal tendons, which pronate the foot at the heel, are injured it creates an imbalance with the tendons that supinate the foot, and the foot goes into supination/inversion. This is a pathological situation and must be corrected.
The strange thing is that two weeks ago, my right foot was not supinated, until I started doing calf raises in order to rehab the left foot. Almost overnight, the right foot became very supinated. Could this extreme supination be caused by damaged or irritated peroneal tendon(s) becoming tight or shortening? Thanks.
Dr Blake's comment: Definitely, the calf raises were probably the straw that broke the camel's back. The peroneal tendons are accessories to the calf muscles to lift the heel off the ground. If you get into a situation were the calf muscles are fatigued, the peroneals try to help, and if already injured, they are vulnerable to tearing.
The strange thing is that two weeks ago, my right foot was not supinated, until I started doing calf raises in order to rehab the left foot. Almost overnight, the right foot became very supinated. Could this extreme supination be caused by damaged or irritated peroneal tendon(s) becoming tight or shortening? Thanks.
Dr Blake's comment: Definitely, the calf raises were probably the straw that broke the camel's back. The peroneal tendons are accessories to the calf muscles to lift the heel off the ground. If you get into a situation were the calf muscles are fatigued, the peroneals try to help, and if already injured, they are vulnerable to tearing.
Regards,
Bill (name changed)
Thursday, August 8, 2013
Post Calcaneal Fracture: Email Advice
Hi Dr. Blake,
You helped me once before with advice regarding Neuro Eze cream for my feet. If you don't mind, I had a question about peroneal tendons/muscles. I broke both my heels 7 years ago and had plates/pins installed. Over the years my feet have gradually become more and more supinated, to an extreme point where management with orthotics is impossible on my left foot. I'm 5'6" and weigh 145 lbs. It's occurred to me that I'm sore right where the peroneal tendons run, and I can't put my big toe on the ground. I didn't start out this supinated. Is it possible that I have a peroneal injury from the plate or accident that is making me more supinated?
You helped me once before with advice regarding Neuro Eze cream for my feet. If you don't mind, I had a question about peroneal tendons/muscles. I broke both my heels 7 years ago and had plates/pins installed. Over the years my feet have gradually become more and more supinated, to an extreme point where management with orthotics is impossible on my left foot. I'm 5'6" and weigh 145 lbs. It's occurred to me that I'm sore right where the peroneal tendons run, and I can't put my big toe on the ground. I didn't start out this supinated. Is it possible that I have a peroneal injury from the plate or accident that is making me more supinated?
Dr Blake's comment: Thanks for the email. Since the supination is on both sides, you have to think first of mechanical causes. The most common is gradually peroneal weakening since the surgery somehow disrupted their normal function. You could have peroneal nerve problems, originating from your back, since you are supinating too much. Supination is one of the biggest causes of low back dysfunction. The plates also can be loosening up around the lateral side of your foot irritating the tendons, shutting them off from normal function.
On my left foot, there's a 3/4" inch gap between the big toe and the ground. I've seen a lot of podiatrists and orthopods, and no one has mentioned the peroneals. They've suggested options like calcaneal osteotomy and/or plantar flexory first ray osteotomy. Do you have any other ideas for treatment? (I used to bicycle a lot but can't use a cycling shoe now.) Thanks so much for any advice.
Regards,
Regards,
Dr Blake's comment: Please have someone tell us if you can get your heel straight to the ground. This video below may help you understand this.
I would not consider a surgery unless the peroneal tendon function is evaluated by a physiatrist/neurologist and a physical therapist. The MDs will perform a Nerve Conduction Test with EMG (muscle test) and the PT will be more practical about muscle strength and function. A bone scan or MRI should be done if there is questions about loosening of the plate on the lateral side of your foot. Any surgery like this should be pre investigated with a fine tooth comb to understand why this is happening, not just how to fix it. The fix may be simple, and have nothing to do with surgery. I hope this is in your case. And, I hope this helps you. Rich
PS Please review all my posts on excessive supination, one of my most favorite topics, to get a strong handle on some of the conservative options, but also so you can ask those treating you the best questions.
I would not consider a surgery unless the peroneal tendon function is evaluated by a physiatrist/neurologist and a physical therapist. The MDs will perform a Nerve Conduction Test with EMG (muscle test) and the PT will be more practical about muscle strength and function. A bone scan or MRI should be done if there is questions about loosening of the plate on the lateral side of your foot. Any surgery like this should be pre investigated with a fine tooth comb to understand why this is happening, not just how to fix it. The fix may be simple, and have nothing to do with surgery. I hope this is in your case. And, I hope this helps you. Rich
PS Please review all my posts on excessive supination, one of my most favorite topics, to get a strong handle on some of the conservative options, but also so you can ask those treating you the best questions.
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