HJBR-2020-jul-aug

HEALTHCARE JOURNAL OF BATON ROUGE  I  JUL / AUG 2020 37 Catherine Johnson Riche’, MD Othopaedic Surgeon Baton Rouge Orthopaedic Clinic neus stress fracture. This is more com- mon in runners than walkers because of the increased impact. What differentiates it from plantar fasciitis is swelling, pain that is present with every step, and pain that is relieved by rest. X-rays are usu- ally negative for the first two weeks, and the fracture may never show up on plain films. On physical exam, the pain is higher than plantar fasciitis pain, and more over the bone. These patients usually require boot immobilization, and even a period of non-weightbearing with the use of crutch- es or a knee scooter. They can no longer exercise, and must rest to improve. Other stress fractures that I have been seeing over the past few weeks are meta- tarsal stress fractures. Again, very com- mon in people who have ramped up their activity over a short period of time. These happen in both runners and walkers, and can be associated with tightness in the posterior leg as well. These are character- ized by pain and swelling in the forefoot. On physical exam, the patient is tender directly over the bone, and the tenderness usually can be isolated to a single metatar- sal, although the swelling is more diffuse. Again, X-rays are usually negative for the first two weeks, and may remain nega- tive. The patient can usually be treated in a post-op shoe, with some restriction in activity. I allow them to walk any amount that doesn’t hurt. These usually take four to eight weeks to improve, depending on the patient’s activity level; the less activity the better. Usually, I will not allow these pa- tients exercise, except possibly swimming. If there is not significant improvement by four weeks, or complete improvement by eight weeks, and X-rays are still negative, I order an MRI. I start all my stress fractures on vitamin D3 2000 IU/day if they are not already on it. Also, if there are no contrain- dications, calcium 800 mg/day. Achilles tendinitis has also been com- mon recently. A close relative of plantar fasciitis, the pain is on the posterior aspect of the heel, rather than the plantar aspect of the heel. Treatment varies, depending on the patient’s symptoms and physical exam. Symptoms can vary from discom- fort only during, or immediately after ex- ercise, to pain with every step. Early treat- ment is stretching, ice, anti-inflammatory medication, and activity modification. If symptoms are worse, the patient could require boot immobilization. If the tendon is damaged, the patient could even require surgery. I think it is very important to educate patients on how to start an exercise pro- gram, especially if the person has been mostly sedentary prior. Stretching is in- credibly important. Making sure the pa- tient maintains flexibility, especially in the hips, knees, and ankles is very important to prevent injury and pain. We emphasize iliotibial band, hamstring, quad, and gas- trocsoleus stretching. Sometimes patients have to be educated that exercise (walking, running, lifting), or range of motion are not equivalent to actual static stretching. In addition, patients should start with a small amount of low impact exercise, then grad- ually increase the duration and severity of exercise. This action, with the addition of calcium and vitamin D, will help prevent stress fractures. We don’t always get the chance to educate patients prior to an ex- ercise program, but given the chance, we have the ability to prevent these injuries before they happen. As always, an ounce of prevention is worth a pound of cure. n Catherine Johnson Riche’, MD is a board certified orthopaedic surgeon at Baton Rouge Orthopaedic Clinic in Baton Rouge.Born and raised just outside of Boston,Massachusetts,Dr.Riche’graduated summa cum laude fromDartmouth College, with a major in chemistry. She attended Cornell University Medical College in NewYork City, graduatingAOA. She com- pleted a residency at Harvard CombinedOrthopaedic program,and a fellowship in foot and ankle surgery at Baylor in Dallas,Texas.Dr.Riche’has been practicing in Baton Rouge for almost 11 years, and has had the honor of being named one of the “Best Doctors in America”for the past five years. “Stretching is the mainstay of treatment with heel lifts, icing,andanti-inflammatorieshelping relieve pain, while the patient stretches out. “