Orthopaedic specialist FAQ

Q:  Stress fracture 

Can I use the elliptical trainer (cross trainer) at gym if I have a foot stress fracture.

A:  As long as you stay away from impact you can use the cross trainer. But swimming or cycling is always the best form of low-impact exercise.

Q:  Sciatica

I have recently (last 6 months) started on a intensive cycling exercise programme. I have a nerve tingling down my left side from the buttock to the ankle. Could this be sciatica? How best is it treated?

A:  It could certainly be sciatica. Start seeing a physiotherapist, and if that fails you should see an orthopedic specialist who does spines.

Q:  Fused disc

I am 30 years old and I had a major injury playing squash.  They have advised me to fuse my disc, but I'm really not happy about this as I have heard of really negative outcomes!  What do you think, especially at my age?

A:  The indication for disc surgery should be the degree of pain you are suffering. If it is not severe, you may first have physio before disc fusion is considered. If that does not help get another opinion from a specialist orthopedic surgeon

Q:  Frozen shoulder

Is a shoulder capsulotomy sucessful or should it be treated conservatively? What about the synovitis and capsular thickening, will it just disappear?  How come the frozen shoulder will just improve by itself, and what about a intra-articular cortisone injection?

A:  Frozen shoulder can be treated conservatively in most cases.  Only when the condition really continues for so long that the patient feels that she cannot bear it any longer should surgical intervention be considered. Just remember that if one waits long enough, all cases of frozen shoulder improve.  Do look at our website and you will find some interesting information: http://www.shoulderinstitute.co.za/frozen_shoulder_overview.php

Q:  Burning sensation in lower legs.

I have a burning sensation in lower legs and BPH (enlarged prostate), is this linked?

A:  There are usually many causes for burning legs, nerve entrapment especially in the spine, medical problems such as diabetis and electrolyte disturbances such as low potassium or magnesium. BPH (if you are referring to prostate) will rarely cause burning sensation in the lower legs.

Q:  Plantar Fasciitis/Osteitis

Approximately 6 months ago I developed a pain underneath my left foot in the area of my left heel.  I couldn't walk on my foot. My orthopaedic surgeon placed my foot in a boot for ten days, and treated it with anti-inflammatories - creams, tablets, plasters, the whole lot, with no let-up from the pain.  I was then in a boot and on crutches for 6 weeks, but still no result.

At the beginning of the year had a "flikkergram" which showed a hot spot in the heel itself, but no soft tissue involvement. I was admitted for a biopsy, but went for a MRI before surgery which showed soft tissue involvement. So, diagnoses changed from Osteitis to Plantar Fasciitis and only a cortisone injection was done under general anaesthetic. I can`t in all honesty report that this helped my pain all that drastically, and three weeks after the procedure the pain is back, much worse than before!  My question is: now what? What can I expect from my follow-up appointment, and what else can be done to this pain?

A: Plantar fasciitis is very difficult to treat. I use stretches, night splints and soft heel inserts for my patients. If at 6 months the pain is persistent, either a percutaneous debridement or formal debridement might be indicated. There are other treatments available, PRP injections (growth factors) or shock wave therapy.

Q:  Back pain

I have suffered from mid to upper back painsince about 16 years of age, it is on and off.  It acts up usually every 2 months or so after some straining work or a long drive. What happens is my muscles seem to lock up. But with some anti-inflammatories, muscle relaxants and a bit of rest I'm ok within 2-3 days.

But I am now 27 and last week I spent a week solid hunched over for 7 hours a day painting. After that my back played up, but this time it's worse than ever.  I have had 2 voltaren injections, taken diazepam, lentogesic, robaxin - the lot, and I've been stretching etc, but nothing is helping.

My muscles are locked, my back is in agony. I have pins and needles along with numbness and shooting pains across my mid/upper back. I am mobile and it is a little better each day, but I can't keep on the meds. What does this sound like to you?  I'd like to know so I can research it on the net.  Where do I go from here, an orthopaedic specialist or a neurologist?

A:  You must see a doctor that specialises in spines for a proper diagnosis and treatment as your condition seems to be causing you a high level of discomfort.

Q:  Sore feet

My feet get very sore, especially when I get up in the morning or when I have been sitting. It sometimes includes the side of the ankle, but mainly the foot itself. It is more painful on the right foot.

A:  You could be suffering from a condition called plantar fasciitis, which is inflammation of the band of tissue under you heel and arch. The treatment involves stretching, rolling a ball under your foot and soft heel inserts in your shoes. If this does not help, seek advice from your GP or Orthopaedic surgeon.

Q:  Elbow pain

My right elbow is painful.  It started with a very sharp pain which lasted for about two minutes. Now I can feel the pain continuously, and it goes down to the wrist. I use my arm all the time. What could be the problem? I'm 39 years old and very healthy and slim. I work on the computer so I use my right arm all the time.

A:  The most common cause of elbow pain is "tennis elbow" which is inflammation of the tendon which runs from the elbow to the wrist. The treatment is physio, certain exercises, a splint which can be worn on the wrist (another type around the elbow as well) and cortisone injections. First see a physio or doctor to at least check the diagnosis.

Send in any questions about back, shoulders, knees, elbows, ankles and feet to the Orthopaedic Specialist forum.

Visit the Sports Injuries Centre

(Joanne Hart, Health24, March 2011)

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