Making Smart Shoe and Bag Choices

Post provided by The American Academy of Orthopaedic Surgery

Our choice of shoes and bags may be placing unnecessary stress on joints and muscles that over time may cause serious pain or injury.

“Large purses and briefcases can cause shoulder, neck, elbow and back pain, and even serious injury,” said San Francisco orthopaedic surgeon and American Academy of Orthopaedic Surgeons (AAOS) spokesperson Sara L. Edwards, MD. “And wearing poorly fitting shoes, especially those with high heels, platforms or pointed toes, can result in bunions, hammer toes, corns, knee and lower back pain and other conditions. I’ve seen many women with ACL (anterior cruciate ligament) injuries from wearing wedge sandals and high heels. I’ve also seen men with foot conditions from ill-fitting dress or work shoes.”

Fortunately, being fashionable doesn’t have to hurt. Members of the AAOS, the doctors who treat muscle and joint pain and injury, offer the following tips for avoiding shoe and bag related pain and injury.

Rethink your purse, briefcase or backpack

•  In general, your handbag should not exceed 10 percent of your body weight. This means a 150 pound person should carry no more than 15 pounds.
• When packing your briefcase or large purse, pack heavier items low and toward the center.
• Do not carry a heavy briefcase, tote or purse for long periods of time; if you must, wear your purse or bag over your shoulder (not in the crook of your arm which can strain the elbow muscles and joints) and switch sides often. If possible, carry your bag diagonally over the opposite shoulder and hip.

Buy and wear the right shoe

• Try on new shoes (both the left and the right) at the end of the day. Your feet normally swell and become larger after standing or sitting during the day.
• There should be 1/2-inch space from the end of your longest toe to the end of the shoe.
• Your toes should not feel pinched or cramped. You should be able to wiggle them freely.
• Most high heeled-shoes have a pointed, narrow toe box that crowds the toes and forces them into an unnatural triangular shape. Over time, this can cause the foot to take on the shape of the shoe causing deformities like hammer toes and corns.
• There is no such thing as a "break-in period." With time, a foot may push or stretch a shoe to fit, but this can cause foot pain and damage.
• Shoes that lace or buckle, have Velcro or some type of strapping mechanism, provide more support to your arch.

Keep your feet fit

• Routine foot and leg stretching exercises, such as rolling your foot over a tennis or golf ball or stretching your legs and feet before you get out of bed, can strengthen muscles and alleviate pain, especially as you age.
• After a long day of walking or standing, elevate your feet and legs to relieve pressure.

Meet our Rheumatologist!

Dr. Robert Koval, University of Texas alumni, was recently interviewed by The University of Texas College of Natural Sciences. Watch the video to learn more about why Dr. Koval enjoys being a Rheumatologist.

Orthopedic Surgeons' Comprehensive Approach to the Evaluation of Groin Pain

Post provided by The American Academy of Orthopaedic Surgeons

According to a literature review appearing in the September 2013 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), one in four people develop hip arthritis—damage to the surfaces in the hip joint—before the age of 85 that contributes to groin pain.

Contributing factors to the development of hip arthritis and, subsequently, groin pain may include one or more of the following:

• a sports-related injury;
• prior surgery to the hip;
• infection of bone or soft tissue;
• a defect present at birth;
• problems with growth and development, and
• traumatic occupational and recreational history, bone fractures, or a history of trauma.

The specific symptoms, and the timing/onset of those symptoms, can help your doctor recommend the appropriate tests, imaging or referrals to diagnose and treat the cause of the pain.

“Individuals experiencing sudden, onset groin pain associated with trauma or bowel/bladder dysfunction, symptoms like fevers or abdominal discomfort should promptly seek medical attention,” says Juan C. Suarez, MD, lead author of the study and an orthopaedic surgeon with Cleveland Clinic Florida. “But, those with chronic pain, despite time and conservative management, also warrant evaluation.”

Young athletes participating in activities such as endurance sports, soccer, power lifting, ice hockey, and basketball are at an increased risk of developing hip osteoarthritis (OA), the “wear and tear” arthritis because of frequent, high stresses at the joint surface. In addition to hip arthritis, female athletes participating in endurance sports also are more likely to sustain hip and pelvic stress fractures than male athletes.

A detailed medical history and examination by a physician can help diagnose and manage the source of groin pain. “It is important to have a good network of physicians from multiple specialties,” says Dr. Suarez. “In my experience, the diagnosis is not always obvious and it may require multiple visits, examinations and referrals prior to reaching the correct diagnosis. A good network facilitates this process.”

FREE joint replacement seminar this Thursday!

Learn more about non-surgical arthritis treatment options as well as total hip and total knee replacement surgery at Arthritis Camp! Refreshments are served. Bring your friends and family!

Date: Thursday, October 3rd 
Time: 5 PM to 7 PM
Location: Northwest Austin, 4700 Seton Center Pkwy, Ste. 200, Austin, 78759
Speaker: Tyler Goldberg, MD

Please RSVP by registering online or call 439-1176. If you can't make this seminar, plan to attend our next seminar on Thursday, November 7th.

Doctor of the Week

Dr. Brendan MacKay is our Doctor of the Week!

Brendan J. MacKay, MD is a Board Eligible Orthopaedic Surgeon and Fellowship trained Hand Surgeon. Dr. MacKay is Board Eligible by the American Board of Orthopaedic Surgery and is a Candidate Member of the American Society for Surgery of the Hand. He has an interest in minimally invasive/endoscopic carpal tunnel surgery, complex hand reconstruction including microvascular and peripheral nerve surgery, sports injuries, joint replacement, and orthopedic trauma treatment.

 

Dr. MacKay is a native of Long Island, New York. He graduated Magna Cum Laude from the University of Notre Dame with a Bachelor of Science in Premedical Studies and Economics. Dr. MacKay attended the Northwestern University Feinberg School of Medicine and completed his residency in orthopaedic surgery at the New York University Langone Medical Center Hospital for Joint Diseases. He was selected as an Executive Chief Resident in his final year of training by Dr. Joseph Zuckerman, past President of the American Academy of Orthopaedic Surgeons. After graduating from residency, he completed a fellowship in hand, microvascular, and peripheral nerve surgery at The Hand Center of San Antonio and the University of Texas Health Science Center under the auspices of Drs. David P. Green and William C. Pederson, internationally recognized authorities in hand surgery.

 

Dr. MacKay has co-authored several peer reviewed scientific articles and has presented at national orthopaedic meetings, including the American Academy of Orthopaedic Surgeons and the American Society for Surgery of the Hand.

 

He currently serves as team physician for the McNeil High School football team and participates in the care of the American Hockey League Texas Stars.

 

In his free time, Dr. MacKay enjoys traveling to pursue downhill skiing, scuba diving, and golf.

What is the Societal Value of Total Knee Replacement?

Post provided by American Academy of Orthopedic Surgery

With all the attention on the cost of health care, an important factor is being overlooked: the impact on society resulting from the treatment of a particular condition. Comparing that impact when both surgical and nonsurgical treatments are available is particularly important in a specialty such as orthopaedics, which focuses on restoring mobility and health.

“A number of studies have already looked at the cost-effectiveness to individual patients for certain orthopaedic procedures, including total hip and total knee arthroplasties,” said AAOS Past President John R. Tongue, MD. In outlining the goal behind “The Direct and Indirect Costs to Society of Treatment for End-Stage Knee Osteoarthritis,” a study published in the Aug. 21 issue of the Journal of Bone & Joint Surgery, Dr. Tongue noted, “We wanted to examine the cost-effectiveness of orthopaedic procedures from a societal point of view.

“For example, if you’re a 55-year-old teacher and you need a total knee arthroplasty (TKA) to keep teaching, and you undergo the procedure, you’re going to continue to work; you’re going to continue to pay taxes. If you don’t, you’re more likely to sit around, developing other comorbidities, gaining weight, having poor quality of life, and collecting disability.”

Applying a new model
Inspired by published research that attempted to quantify the societal impact of deaths and injuries from roadway trauma, Dr. Tongue contacted an economist friend to see if it might be possible to similarly quantify the impact of orthopaedic procedures.

The economist, John Duffield, PhD, proposed conducting a literature search to identify previous work that may have covered similar ground, then building on that research to develop a new methodology that could be applied to specific medical conditions. To carry out this objective, AAOS engaged KNG Health Consulting, LLC, and its research partners at IHS Global, Inc., and Duke University.

$12 billion in savings
To estimate the societal value of TKA, the research team generated results based on adults age 40 years or older who underwent TKA during 2009. According to the authors, the study population accounted for 99 percent of all TKAs performed in the United States that year.

The researchers calculated direct costs, quality-of-life, and most importantly the lifetime indirect cost of TKA. These indirect costs components capture the effects of surgery on a patient’s ability to work, patient earnings, disability payments, and missed work days. For modeling purposes, the researchers conservatively assumed that all patients retire at age 75.

The research team found that, compared with nonsurgical treatment, undergoing TKA increased direct costs per patient by an average of $20,635 (based on 2009 dollars). Those costs were offset by societal savings of an average $39,565 per patient based on reduced indirect costs, producing an estimated $18,930 in lifetime savings to society per patient.

Overall, the researchers found that 85 percent of the societal savings were associated with increased employment and earnings. The remaining 15 percent were linked to fewer missed work days and lower disability payments.

Based on the more than 600,000 TKAs performed in the United States during 2009, the study authors estimated a lifetime societal savings of approximately $12 billion for the single year studied.

“When we submitted the study, there was some concern among reviewers that the findings could be interpreted as, ‘everyone should get surgery,’” said Dr. Koenig. “It’s important to understand that is not the conclusion of the study. The conclusion is that, for the cohort of people who have surgery, there are—on average—societal savings. For many reasons, some patients don’t undergo surgery. Our analysis was based on the cohort of patients who actually underwent surgery.”

Further research
The TKA study is the first of five similar research papers planned for publication, each examining the value of a different orthopaedic procedure.

“We chose a variety of conditions based on high economic impact and to demonstrate the breadth of our specialty,” said Dr. Tongue. “We have already submitted for publication papers on rotator cuff repair and anterior cruciate ligament repair, and two more studies—one looking at hip fracture and one on lumbar diskectomy—are in the works.”

“What I find most exciting about this research,” said Dr. Tongue, “is that it changes the conversation from how expensive orthopaedic procedures are, to how valuable they are. You don’t have to try to stretch any estimates, because the value for each procedure is tremendous.”

Doctor of the Week

Dr. Greg Westmoreland is our Doctor of the Week! Watch the video to learn more about Dr. Westmoreland.