BIPEDAL

Instead of understanding a flexible flatfoot as a single condition, it should be understood that it is in fact multiple simultaneously occurring conditions resulting in mechanical failure. And since there are multiple components: The surgeon should ask themselves "What component of the deformity am I correcting?" Every operation has a purpose. Every procedure corrects a different deforming force....

There are three types of cartilage in the human body, although the one we most commonly pay attention to is hyaline cartilage since this makes up the articulation between bones. The gliding and shock absorbing function of type 2 collagen makes hyaline cartilage particularly suited for absorbing force. It is arranged in a very specific manner to absorb forces and maintain structural integrity under...

Symptomatic OLTs represent one of the most common causes of persistent pain following ankle injury. The condition is often missed due to the volume of ankle sprains seen in clinics that are routinely imaged with plain film X-ray only. These lesions not only do not appear on xray unless there is obvious bone involvement but sometimes evolve over time after the initial insult. Therefore the foot and...

The lateral collateral complex is made up of the ATFL, CFL and PTFL. The ATFL is probably one of the most commonly injured ligaments in the human body, due to the relative weak nature of the ligament and anatomic position on the outside of the ankle joint. Along with the CFL they are poor resistors of inversion since the torque of the body over these small structures can easily overwhelm their abi...

Achilles tendon rupture is a potentially catastrophic injury. However modern repair methods can restore the integrity of the tendon complex regardless of age or extent of injury. It is the rehabilitation protocols afterwards that are the best predictors of complete recovery, not the ability to put the tendon back together.  I have repaired tendons on relatively sedentary patients, weekend warriors...

There is debate among orthopedic and podiatric surgeons regarding operative and no operative repair of ruptured Achilles tendons. Why the debate? Because outcome studies have shown satisfactory results when comparing each treatment. These studies focus on strength restoration, pain scores, and quality of life. Unfortunately, we cannot directly compare individual patient outcomes, since a patient c...

Hallux limitus and rigidus are a spectrum of a disease involving progressive degeneration of the first metatarsophalangeal joint (MTPJ). There are multiple causes known to cause this condition, from biomechanical (elevated first metatarsal, elongated first metatarsal, etc.) to medical (gout, rheumatoid arthritis, infections, etc.)  As a surgeon, I have to determine the condition of the joint at th...

Most fixation failures are not really implant failures. They are failures of the interaction between biology, mechanics and time.  When assessing broken bones (or fusions, osteotomies, etc) we have to appreciate that achieving the result of bone healing is a balance between mechanical and biologic forces. Too much or too little of either is not beneficial, and occasionally is deleterious. Modern o...

A fracture heals biologically. But biology is governed by mechanics. Bone cells are mechanosensitive. They respond to motion, strain, compression, shear, and tension. And that means one central truth: The surgeon is not simply fixing bone. The surgeon is engineering the conditions under which biology can succeed. Strain in terms of bone healing describes the amount of motion relative to the fractu...

Understanding internal fixation is critical to our later discussions on surgical techniques for a variety of conditions. We started in Episode 1 of Season 2 discussing bunion surgery. This was meant to be an introduction to how we approach realignment and repair of bone segments. Everything we have learned about fracture fixation in emergent conditions, we have refined and honed to use in our reco...

Bone is a Living Tissue. It is formed of living cells in a matrix designed to withstand load and to constantly replace and repair itself. When injured, bone immediately begins the repair process, with dedicated cells immediately taking over and beginning a complex signaling event that ultimately results in complete restoration.  Because healing is phase oriented, certain systems must in place at t...

There is no simple solution to a complex problem. This is true in life, and in bunion surgery.  A bunion is a complex condition resulting from either structural anomaly or biomechanical instability, and often both. Careful evaluation of the condition is required; no two bunion deformities are identical. Mistakes are made when patient expectations are unrealistic, physician capabilities are limited...

The bones of the foot are arranged to not only provide stability and absorb impact, but to provide maximal efficiency in movement. Beginning with their axes of motion, which are purposefully arranged to allow motion in a specific sequence as the body's weight transfers over the foot from posterior to anterior. The ankle allows dorsiflexion, the subtlalar and mid tarsal joints allow pronation (shoc...

Understanding biomechanics is essential to diagnosing and treating vague symptom descriptions such as metatarsalgia.  If you remember back to our discussion on pronation and supination - the foot first must pronate when loading then convert into a supinated, rigid lever for propulsion. This occurs when the body weight moves over the center of the foot, tightening posterior structures and placing t...

Painful burning, stinging, electrical shocks and possibly numbness in the plantar foot, especially with weight bearing and activity may be tarsal tunnel syndrome. This is an often misdiagnosed condition since the symptoms overlap with many other pathologies.  Diagnostic testing such as MRI, CT, ultrasound and EMG/NCV studies are not consistently diagnostic, leading to many alternate theories for p...

Key diabetes statistics in the United States:  Total Prevalence: Approximately 40.1 million people (diagnosed or undiagnosed) have diabetes, about 12% of the US population. Diagnosed vs. Undiagnosed: Of the 40.1 million, roughly 29.1 million are diagnosed, while 11 million are undiagnosed. Prediabetes: An estimated 115.2 million American adults aged 18 and older have prediabetes. New Cases: Every...

Equinus, or a tight heel cord, is a major contributor to foot pathology. In some cases it is subtle and the body can compensate to the point where it is unnoticeable. However over years the compensatory motion that is "borrowed" from other joints becomes apparent as either pain in areas such as the Achilles insertion or the plantar fascia, or structural changes such as collapse of the arch or buni...

Nerves play a critical role in how we experience pain, balance, and movement. Nerves are two-way messaging electrical conduits that carry signals for motor function from the brain to the periphery, and sensory input, carrying information from the periphery to the brain. When there is a disturbance either mechanically or chemically in the signal pathway, symptoms can emerge.  Systemic conditions su...

In this episode of BIPEDAL , we explore one of the most common deformities of the forefoot—hammertoes. These toe deformities affect millions of people and often develop gradually due to biomechanical imbalance in the foot. A hammertoe occurs when one of the lesser toes—most commonly the second, third, or fourth toe—becomes bent at the middle joint, creating a characteristic hammer-like appearance....

Beginning with early primates more than 50 million years ago, the episode examines how primitive feet functioned primarily as grasping tools for arboreal life, featuring a divergent big toe, long toes, and a flexible midfoot. As environmental changes pushed early hominins toward life on the ground, the foot gradually adapted to support bipedal locomotion. Key fossil discoveries—including Ardipithe...

In this episode of BIPEDAL , we take a comprehensive look at arthritis of the foot and ankle, a common condition that can significantly affect mobility and quality of life.  Foot arthritis is actually quite common, particularly in adults over the age of 50, while ankle arthritis is less frequent but often more debilitating when it occurs. Osteoarthritis is the most common joint disease worldwide,...

Approximately 10% of all fractures in the human body occur in the foot and ankle. It is a load bearing, highly stressed region of the body whereby forces are continuously being applied. Move the foot suddenly in the wrong direction, and these forces can overwhelm the ability of the bones to stay intact. However, all injuries resulting in fractures do not have to be the result of sudden movement or...

The great toe joint is just that - it's great! Until it's not. Stiffness and immobility are very common conditions. Some studies show that over 60% of people will develop arthritis in this joint at some point in their life. Patients will report initially with occasional pain with bending, or when performing certain activities such as jumping or stooping. As the condition progresses, limitation of...

Gout is a term we use to describe the intense inflammatory episode that occurs when elevated uric acid levels in the blood - a condition called hyperuricemia - cause crystal deposition in the joints. Very often this occurs in the foot since this is a cooler area of the body. Patients will remark that even the sheets touching the joint elicits intense pain.  Clinically, we often see the great toe j...

Ankle sprains are very common orthopedic injuries. A sprain is stretching or tearing of ligaments. Since there are multiple ligaments holding the ankle complex together, there is a myriad of injury patterns that can result from "rolling" your ankle.  On the outside of the ankle there is a ligament complex called the lateral collateral ligaments. These are the most commonly injured in a typical ank...