|Craig C. Young|
ALBUQUERQUE, N.M. — The average pedorthist is unlikely to examine an emergency patient. Instead, Craig C. Young, MD, orthopedic surgeon, University of Wisconsin, Pedorthic Footwear Association (PFA) Medical Advisor, told the audience at the PFA Annual Symposium and Exhibition that pedorthists are more likely to treat foot urgencies.
“I categorize urgencies by calling and making a special appointment for the patient on a Monday even if the pedorthist is booked,” Young said.
In his lecture, Young described some of the more challenging urgent cases pedorthists diagnose on a daily basis. The first urgency Young discussed is one that is frequently missed upon initial examination.
“About half the time people miss the lisfranc joint injury,” Young said. “The lisfranc injury is something that should be treated in the first week, but the average time of diagnosis is about 3 months.”
The lisfranc is located between the first and second metatarsals in the mid-foot. Gymnasts, dancers and divers are often diagnosed with lisfranc injuries, which are caused by a hard blow to the foot. Sprains are cast and the patient is placed in a walking boot with full arch support for 4 to 6 weeks. Higher grade sprains, such as a grade three sprain, require surgery. On Sunday, Nov. 13, Houston Texans quarterback, Matt Schaub suffered an injury to his lisfranc tendon after running a quarterback sneak in a game against the Tampa Bay Buccaneers. His injury will require surgery and he will miss his team’s remaining seven games. According to Young, orthotics are given to patients with chronic lisfranc pain. Left untreated, a sprained lisfranc joint will continue to tear until it becomes a grade three injury.
Another common urgency pedorthists commonly treat is fractures.
“You want to treat fractures within the first week because in 2 weeks the bone will freeze in that position and it will become more difficult to treat,” Young said. “If you see the patient 3 or 4 weeks later, you are generally stuck with what you have.”
The most common fracture is a break of the fifth metatarsal. Young highlighted the fifth metatarsal in his lecture because it is one of the few fractures that may not heal correctly. Dancers commonly break their fifth metatarsal, according to Young.
Young also discussed stress fractures. He commonly treats runners who complain of pain in a specific area in the foot which is an indicator of a small break.
“Think of your bone as a paper clip,” Young said. “There are two ways to break a paperclip. The first is to get a wire cutter and clip it. The second is more subtle — overuse or stress fracture. That is like bending the paperclip back and forth until it gets weaker and then it finally breaks.” — by Anthony Calabro
For more information:
Young, C. Foot problems in athletes. Pedorthic Footwear Association Annual Symposium and Exhibition. Albuquerque, New Mexico. Nov. 10-12.