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FDA Advises Against Certain Bone Grafts For Children

Late last week the US Food and Drug Administration announced that clinicians should avoid using certain bone graft substitutes in patients under the age of 18 because they can carry serious injury risk.

The specific bone graft substitutes in question contain recombinant proteins or synthetic peptides that mimic the bone’s natural growth. When paired with what’s known as a carrier or scaffold, these pieces work to replace or regenerate an existing bone prior to spurring new bone growth.

Bone Graft

These types of grafts are plenty safe for patients 18 and older whose bones have stopped growing, but they’ve never been approved for patients who are still experiencing bone growth. The FDA announced that these types of bone graft substitutes should be avoided for patients who are still growing, as numerous problems can occur, including:

  • Excess bone growth
  • Fluid accumulation
  • Inhibited bone healing
  • Swelling
  • Increased pressure to adjacent tissues and organs
  • Related adverse events

The FDA noted that these problems also occurred in older patients from time to time, but the threat is much greater to younger patients because of their ongoing bone growth and typically smaller stature.

FDA Lists Three Options

In order to keep patients safe, the FDA listed three alternative solutions for young patients in need of a bone graft. Instead of the graft substitute containing recombinant proteins or synthetic peptides, FDA says doctors should consider:

  • An autograft bone, which is harvested from another part of the patient’s body;
  • An allograft bone, which is transplanted from another person’s body; or
  • A bone graft substitute that is approved by the FDA for young patients which does not contain recombinant proteins or synthetic peptides.

Dr. Silverman comments

Using a one size fits all method rarely works perfectly in the healthcare field. A prescription that may work for one person may have no effect on another. A device that works well for adults may cause problems if used by children.

I’m glad the FDA is calling for more research on this device.

High Heels May Increase Osteoporosis Risk

Killer heels could kill your knees, according to a new research published in the Journal of Orthopaedic Research.

As you’re probably aware, we’re not a huge fan of high heels on this blog. We’ve written about the problems caused by high heels in the past, and although we know heels are a must for certain situations, we always advise moderation. But researchers at the Stanford University Medical Center have once again found another reason why high heels can be problematic, as they’ve uncovered evidence that it can lead to knee degeneration.

For their study, researchers tracked the walking patterns of 14 women in a variety of footwear. They noticed that when the women wore heels, their knees were forced to absorb addition strain. Over time, this abnormal stress can lead to joint damage, loss of knee cartilage and osteoarthritis.

High Heel Problems

Researchers said gait changes were found in both sets of heels they tested, one being 3.8 cm in height and the other being 8.3 cm.

The authors did note that they did not track the women over time to see if knee osteoarthritis developed, and they also cautioned that other factors like obesity or joint injuries can also lead to knee degeneration, but they stand by their findings.

“Many of the changes observed with increasing heel height and weight were similar to those seen with aging and OA [osteoarthritis] progression,” the authors concluded.

Dr. Silverman comments

Add osteoarthritis to the growing list of reasons why high heels are dangerous for your health. We now know that high heels can contribute to osteoarthritis, bunions, ankle instability, hammer toe, Morton’s Neuroma, and limited range of motion.

I get all the reasons why high heels are so popular, but please, keep your health in mind the next time you want to wear heels. Pack a pair of flats as well, and give your feet a break throughout the day.

When and When Not To Use Antibiotics

Antibiotics are great at keeping us healthy, but overuse has led to antibiotic-resistant bacteria. Sometimes antibiotics are the perfect fix, other times they can be unnecessary and ineffective. Below, using tips from the American Board of Internal Medicine, we provide some details on when you should and shouldn’t seek out antibiotics for common infections.


Respiratory Infections

Symptoms: Running nose, sore throat, cough.

Issue at hand: One size doesn’t fit all, certain infections need different antibiotics.

Pursue antibiotics if: The cough continues for longer than 14 days, or if your doctor diagnoses a specific bacterial illness, like strep throat.

Sinus Infections

Symptoms: Running nose, stuffed up feeling/congestion, pain in the face region.

Issue at hand:  Sinusitis is typically caused by a virus. In situations when bacteria is the cause, the infection usually clears without antibiotic intervention within a week.

Pursue antibiotics if: The condition persists for more than 10 days, you cycle back and forth between feeling better and feeling worse, or you develop a fever.

Ear Infections

Symptoms: Pain in the ears, fever, drainage from the ears.

Issue at hand: Most ear infections heal on their own within a few days, especially after two years of age, and over-the-counter pain relievers can help with discomfort.

Pursue antibiotics if: Pain persists for more than three days, your child is under the age of two, or you are experiencing severe symptoms.

Eye Infections

Symptoms: Puffy eyes, eye discoloration, pain, discharge.

Issue at hand: Pinkeye is typically caused by a virus or allergy, so antibiotics don’t usually help. Bacterial pinkeye usually goes away on its own within a week or so.

Pursue antibiotics if: You have a weakened immune system, the issue doesn’t resolve within a week of no treatment or if symptoms become severe.

Urinary Tract Infections

Symptoms: Pain, discomfort or burning sensation while urinating.

Issue at hand: Sometimes bacteria are present in our urine even though we don’t have a UTI.

Pursue antibiotics if: You are an older person experiencing the symptoms, or if the symptoms continue over a few days.

Skin Infections

Symptoms: Bumps, cracks or sores in the skin, redness, fever or skin discharge.

Issue at hand: Most wounds heal well with creams, and antibiotics often won’t help.

Pursue antibiotics if: The wound is in an area where the body with a higher risk of infection, like the groin region, or if it shows signs of an infection, like drainage, pus or fever.

Related source: Choosing Wisely by the ABIM.


Help Put an End To Sexual Assault

At Silverman Ankle & Foot, we help heal your feet and ankles from everyday injuries, but for victims of sexual assault, the scars are permanent. That’s why we’re pleased to announce that we’re supporting the upcoming event, Sexual Assault: Finding Our Voices.

The event is hosted by the Maimonides Society of the Twin Cities, and they hope to spread awareness of the problem of sexual assault and violence. The event will consist of a screening of the documentary Brave Miss World, followed by an informal discussion and resource fair. The movie Brave Miss World profiles an international beauty queen who turned a terrible crime into global action by speaking out and encouraging others to speak out against sexual violence.

Brave Miss World

The event will take place on Sunday, April 19 from 1-4pm at the Humphrey School Conference Center at the University of Minnesota. The conference center is located at 301 19th Ave. S. Minneapolis, MN 55455.

Admission is free, but guests are advised to make a reservation to ensure they’ll have a spot. To make a reservation, contact Marilyn Ruby at (651) 695-3181 or at

The goals of the event are:

  • To educate members of the community in general and healthcare professionals in particular about the prevalence and severity of sexual assault and rape (SA/Rape) as a public health issue
  • To empower individuals and groups to prevent and heal the trauma of SA/rape.
  • To educate a diverse segment of the Twin Cities community regarding community resources and ways to access them.
  • To identify action opportunities (i.e., volunteering, lobbying, fundraising) to prevent and heal the trauma of SA/rape.
  • To provide skills to healthcare professionals to facilitate conversations with patients, and with other professionals to help them talk about preventing, recognizing and treating the manifestations of SA/rape.
  • To begin to address how each individual can transmit appropriate norms and values to children and to peers, to help prevent SA/rape in our community.

For more informaiton about the event, contact  Dan Lepow at or Bill Ressler at

4 Fitness-Tracking Devices to Keep You Healthy

How are you doing on those New Year’s resolutions? If you’re like most Americans, some of your resolutions have fallen by the wayside. Don’t be discouraged. Instead, make positive changes to get back in the swing of things.

If getting fit was one of your resolutions, here are four devices that can help you kick-start and keep track of your exercise.

1. FitBit – FitBits were one of the more popular gifts this past holiday season, especially among health-conscious individuals. FitBits track five essential fitness categories: Activity, Exercise, Nutrition, Weight and Sleep. Those five categories help give you a comprehensive outlook on your daily health. You can track your progress on your smartphone or computer and share your weight loss goals and success stories with your friends.

2. Apps – If your smartphone is with you all the time, why not turn it into a fitness tracker? We’ve talked about smartphone apps before, but these apps can make your regular routine more fun, which will make it easier to work out longer or more often. Other apps help you train for a 10K or marathon. Best of all, a lot of the apps are free, so you can try them out risk-free.

Health wearables

3. The Jawbone – Similar to the FitBit, the Jawbone tracks your movement, caloric intake and sleep quality so you know where you need to make improvements. Another unique aspect of the Jawbone is its soundless alarm. Sleep quality is important, and if you share a bed with someone who sets their alarm for a different time, one person is always going to have their sleep interrupted by the other’s alarm. That won’t happen with the Jawbone. The Jawbone has a silent, vibrating alarm that allows the user to wake up without a radio or alarm noise blaring in their ear. Just like the FitBit, the user wears the device on their wrist, and can sync their data to a computer or smartphone.

4. Smart Shoes – While most companies are focusing on wearable wrist technology, others are focusing on your feet. The Lechal Smart Shoe – which translates to “take me along” – is one of the first smart shoes that keeps track of all your daily movements. The shoes track your workout, the calories you burned, the pace you set and much more. It also responds to voice commands, so you won’t need to take off your shoes work your device. Like the other products on this list, you can pair your shoes with your smartphone or computer for a complete workout tracking experience.

Badgers’ Jackson Out 6 Weeks After Foot Surgery

The #7 Wisconsin Badgers are expected to be without senior Traevon Jackson for six weeks after the point guard injured in his foot in the second half against Rutgers on Sunday, the team announced.

Jackson will undergo surgery on his broken right foot on Thursday. He said he has faith that the team can grow in his absence.

“I’m just trying to enjoy the process, learn from this and trust in Christ,” Jackson said in a release. “I know my teammates will come together and be stronger because of this.

Jackson injured his foot with 12:20 remaining in the second half. Jackson went up to contest a shot, and it appeared he landed on the shooter’s right foot. Jackson crumpled to the ground in obvious pain.

The university announced that Jackson’s initial rehab would begin two to three weeks after surgery. The loss of Jackson looms large for the Badgers, who are the favorites to win the Big Ten conference and looking to make waves in March. Jackson said he’s still set on achieving those goals.

“I’m looking forward to coming back mentally stronger than ever and more prepared to win championships and finish off the year and the seniors’ careers the right way.”

Traevon Jackson

Jackson is averaging 9.4 points, 2.9 assists and 1.1 steals so far this season. If he misses exactly six weeks with the injury, he’ll sit out a total of 11 conference games before returning prior to the March 1 contest against Michigan State. Although some suspect the injury will heal in six weeks, head coach Bo Ryan did note that the injury was “pretty severe.”

Sophomore guard Bronson Koenig is expected to fill the void left by Jackson, and reserves Duje Dukan, Vitto Brown and Zak Showalter are also expected to see an increase in playing time.

Dr. Silverman comments

Jackson most likely sustained a 5th metatarsal fracture. There are multiple types of 5th metatarsal fractures, and any significantly displaced break will need surgery. Any shaft fractures that show instability in the sagittal plane will need to be stabilized to get the best results.

Finally, Jones fractures (those that involve a certain section of the bone that has poor blood supply) need surgery. The rate of healing in these fractures without surgery is so poor that most patients would never opt to spend multiple months on crutches only to find out they have upwards of a 40 percent chance that it doesn’t heal correctly.

These doctors should also be aware of instability associated with this type of injury. Like the announcer said, “he rolled his ankle,” he may have pre-existing ankle instability that let this roll happen. The doctors need to look for hindfoot instability as well. Sometimes, rarely, the fifth metatarsal doesn’t fracture, instead the 5th tarsometatarsal joint sprains. Regardless, he’s going under the knife to get the injury corrected. I wish him the best of luck in recovery, and hope he’ll be back to full health by the conference tournament.

Related source: Milwaukee Journal Sentinel

The Importance of Vitamin D Tests

Because medical knowledge is always advancing, doctors and healthcare providers are able to detect potential problems earlier than ever before. We also have the ability to screen for certain indicators that suggest we need to start eating healthier, or more of a certain vitamin or mineral. While cancer and blood pressure screenings make the headlines, one test that often falls by the wayside is the Vitamin D screening.

Vitamin D screenings are important for two main reasons. First, Vitamin D deficiency increases a person’s risk of bone fractures, and it can also lead to kidney and other organ issues. Secondly, screenings are important because most people don’t get enough Vitamin D on a regular basis. That said, Vitamin D tests aren’t always necessary, so today we look at the pros and cons of Vitamin D tests.

Vitamin D

Why You Should Get Screened

Vitamin D deficiency weakens the body’s bones and internal organs, so people with the following conditions should consider getting screened.

  • If you’re at-risk or have developed osteoporosis, as that condition further weakens bones and may leave you very susceptible to fractures.
  • If you have a condition that affects your internal organs or your body’s ability to use Vitamin D, like bowel disease, celiac disease, kidney disease, liver disease or pancreatitis.

Additionally, if you are curious about your Vitamin D levels or are experiencing symptoms that could be attributed to Vitamin D deficiency, talk to your doctor. If your doctor suggests a Vitamin D test, it’s probably worth your while.

Why You’d Skip The Test

The tests are important for some, but for others they just add extra cost. Here are some reasons why you can consider skipping a Vitamin D screening:

  • If you feel healthy. This isn’t to say that as long as you feel healthy, your Vitamin D levels are perfect, but few people actually have seriously low levels of Vitamin D. Simply being cognizant of your intake or reaching for healthier food options can boost your levels without the need for an extra test.
  • Vitamin D tests won’t show anything new if you’re at risk for conditions like diabetes or heart disease. Instead, following your doctor’s advice, eating right and maintaining an active lifestyle are your best bets.
  • Overtreatment. Again, unless your levels are at a dangerously low point, simple lifestyle changes can get you back to an appropriate level. Sometimes supplements and natural Vitamin D intake can lead to too much Vitamin D, which can also be damaging to the body.

We’ve talked about the importance of Vitamin D on the blog numerous times before, so use the above criteria to determine if you should have your levels tested. Or better yet, make positive lifestyle changes to naturally increase your Vitamin D intake.

Optimism Good For Overall Health


We’ve discussed the power of positive thinking on the blog before, but a new study suggests that an optimistic outlook on life may have significant health benefits.

Researchers at the University of Illinois said optimists have a higher correlation with heart health than pessimists.

“Individuals with the highest levels of optimism have twice the odds of being in ideal cardiovascular health compared to their more pessimistic counterparts,” said Rosalba Hernandez, lead author of the study. “This association remains significant, even after adjusting for socio-demographic characteristics and poor mental health.”

Researchers tracked seven metrics of more than 5,000 adults for the study. They measured:

  • Blood pressure
  • Body mass index
  • Fasting plasma glucose
  • Serum cholesterol levels
  • Dietary intake
  • Physical activity
  • Tobacco use

These seven metrics are the same metrics used by the American Heart Association to define heart health. Participants were graded on a 0-2 scale on each metric, with 0 representing poor, 1 representing intermediate and 2 representing ideal health. In addition to the metric scores, participants took a survey that assessed their mental health and levels of optimism.

After comparing the data, researchers found:

  • Participants who were the most optimistic were twice as likely to have ideal cardiovascular health.
  • Optimists were 55 percent more likely to have a total health score in the intermediate range.
  • Optimists had significantly better blood sugar and total cholesterol levels, and they also tended to be more physically active, have better BMIs and were less likely to smoke.

Hernandez said the findings were significant, and physicians should stress the importance of physical and mental well-being.

“At the population level, even this moderate difference in cardiovascular health translates into a significant reduction in death rates,” Hernandez said. “This evidence, which is hypothesized to occur through a biobehavioral mechanism, suggests that prevention strategies that target modification of psychological well-being – e.g., optimism – may be a potential avenue for AHA to reach its goal of improving Americans’ cardiovascular health by 20 percent before 2020.”

Dr. Silverman comments

Pairing physical health with mental health is very important. Seeing the glass as half full won’t automatically lower your blood pressure, but it will put you a the right frame of mind to make positive lifestyle choices, like exercising or eating right.

Related sources:, TIME

Youth Sports Injuries: Is Rugby Worse Than Football?

We’ve documented the current concussion crisis plaguing the sport of American football in the past, but British doctors are saying another popular sport needs to be reexamined amid health concerns. That popular sport is rugby.

Although not nearly as popular in America as it is ‘across the pond,’ more rugby clubs continue to sprout on high school and college campuses. The sport is gaining traction, and British researchers said flawed techniques while learning the sport can lead to serious injuries, and even death.

“Rugby sidesteps many safeguards intended to ensure pupil wellbeing,” said Michael Carter, a pediatric neurosurgeon at the British Royal Hospital for Children.”The fundamental impediment is the lack of any comprehensive, systematically acquired and nationally coordinated dataset of injuries acquired during children’s rugby, and of the will to set one up.”

Carter added that schools, clubs, medical leaders and governing bodies need work together to ensure players are taught the right techniques and injury risk is mitigated.

Rugby injuries

“It is vital that schools, clubs, medical facilities, and, most importantly, regulatory bodies cooperate now to quantify the risks of school rugby. Failure to do so will inhibit the development of rational policies around the sport, put junior players at risk, and may ultimately threaten the survival of rugby in its present form.”

Contact Problems

British schools teach rugby on a much more regular basis than we do in America, and some schools start “contact” rugby as early as age 10. Children are still growing and developing at this age, and physical contact significantly increases the risk of injury. Additionally, young players are less likely to practice the proper tackling techniques to reduce injury likelihood, and even worse, at such a young age, oftentimes these kids are taught the game by someone with a limited knowledge of the sport, like a volunteer parent or teacher.

Carter also cautioned that children are at all different stages of development between the ages of 8 and 18, leading to large size and weight discrepancies. He added that rugby players at the youth level should be grouped by weight, not age.

In the last decade at least 20 children have needed neurosurgical consultation or intervention as a result of a rugby injury, and there have been at least two adolescent deaths, four or five serious spinal fractures and several significant brain injuries. Carter said the culture of rugby and those who support the violent nature of the game are setting a dangerous precedent.

“Schools, coaches and parents all contribute to a tribal, gladiatorial culture that encourages excessive aggression, suppresses injury reporting and encourages players to carry on when injured.”

Dr. Silverman comments

Rugby is a very violent sport where players clash with one another with very limited protective gear. Young kids typically aren’t moving fast enough to cause a massive injury, but slamming your head on the ground can be particularly dangerous at such a young age. As players get fast and stronger, the risk intensifies.

Mandatory protective gear, certified training and strengthening programs and professional injury assessment/treatment are needed to help keep the game safe.

Related source: Medscape

5 Tips For Treating Heel Pain

My posts on heel pain and calcaneal fractures are by far my most popular blog posts because heel injuries come in all different shapes and sizes. Whether you missed a step while walking down a flight of stairs or you received a stone bruise from stepping on an object during a walk, there’s so many different problems that can plague your feet.

I try to provide the best advice I can to those looking for guidance with their heel injury, but HIPAA laws and my inability to see the injury firsthand limit my ability to provide the most accurate forecast. So while I generally recommend you seek out a foot and ankle specialist if your symptoms continue or worsen, here are five tips for treating heel pain.

1. RICE - You’ve probably heard that you should Rest, Ice, Compress and Elevate a heel bruise in the days after the injury, and the simple advice works for a lot of people. Resting the injury keeps you from continuing to stress the injury, and the other aspects help cut down on bruising and swelling. More often than not, RICE is the best method for minor heel bruises.

2. Crutches or Knee Scooters – A heel bruise is a painful injury. Bruises don’t heal when you continue to contuse the tissue. For example, NFL players have prolonged healing from thigh bruises, as they continue to contuse the affected area. Sitting out a football game is easy, but staying off your feet is much harder. At Silverman Ankle and Foot, we provide crutches and rolling scooters for heel bruise and calcaneal fractures to keep patients from weight-bearing on the limb for a set amount of time. Consider crutches or knee scooters if you have to get around.

Heel Pain

3. Let Healing Run Its Course - Sometimes the hardest thing to do is wait, but you have to be patient with heel injuries. Healing takes time, especially if it is a deep tissue bruise. Continue to find ways to keep from stressing the injury, and let the healing process run its course, even if it’s taking longer than you had hoped.

4. Massage and Exercise - If, over time, you begin to notice sensory changes in the bottom of your foot, you might be dealing with another condition that developed out of the heel bruise. Sometimes Tarsal Tunnel Syndrome or nerve entrapments can cause problems after a stone bruise. Along with RICE, massages and range of motion exercises can alleviate scar and nerve adhesions. Cortisone treatments and surgery to correct the problem are also options if conservative options fail.

5. See a Specialist - Going to the doctor isn’t always fun, but neither is walking around in constant pain. If your injury is significant enough, symptoms worsen or RICE just isn’t doing the trick, swing on into a orthopedic specialist. They have all the tools to figure out exactly what is wrong with your foot.