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Running May Prevent Knee Osteoarthritis

Knee OsteoarthritisResearch presented last week at the American College of Rheumatology suggests that regular running does not improve a person’s likelihood of developing osteoarthritis. In fact, it may prevent the condition.

In an effort to determine causes of osteoarthritis onset in people of all ages, researchers at Baylor College of Medicine analyzed data from 2,683 participants spanning four large age groups: 12-18, 19-34, 35-49 and 50 and older. Participants asked to list their three main activities during that stage of life. If they listed running, they were classified as a runner for that age range.

After grouping the participants into runner and non-runner groups, all individuals underwent knee x-rays and asymptomatic pain evaluations. X-rays were again taken two years after the initial imaging.

Knee Results

After looking at the data, researchers concluded:

  • 22.8 percent of participants who had been a runner at some point in their life were diagnosed with osteoarthritis of the knee.
  • 29.8 percent of those who had never been classified as a runner had developed knee osteoarthritis.
  • The average age of study participants was 64.7 years old.

Researchers believe the findings show that running doesn’t lead to osteoarthritis in the knee.

“Non-elite running at any time in life does not appear detrimental, and may be protective” in regards to developing knee osteoarthritis, the researchers wrote.

Dr. Silverman comments

There have been numerous studies on both sides of this issue, with some saying running strains the knee and can lead to degeneration, while others suggest that regular runs can strengthen the knees. As long as you are using proper running form and are giving your body enough time to recover between runs (i.e. avoiding overuse and overstress), I’m all in on this study.

Overloading your knees is one way for them to wear down and become arthritic. I would not be surprised if the individuals who were never classified as a runner had a higher weight than those in the runner group. It would have been interesting if the researchers would have factored weight into the equation, because carrying that extra weight around all day certainly puts more strain on a person’s knees than an athletic person going for a 3-mile run.

Simply put, exercise is a great way to keep your body in good health. I always recommend exercise or strengthening workouts to pair with any other course of patient treatment.

Related source: Runners World

Extra-Depth Shoes Can Alleviate Pain In Seniors

Senior Foot CareA new study suggests that elderly patients who suffer from disabling foot pain should opt for shoes with a little extra depth.

A study conducted by researchers at the Lower Extremity and Gait Studies Program at the School of Allied Health at La Trobe University found that seniors with foot pain saw significant improvement after switching to custom-fitted extra-depth shoes.

Hylton B. Menz, lead author of the study, said these custom footwear options are usually recommended for seniors with diabetes, but they can be beneficial for anyone with pre-existing foot conditions because the foot undergoes structural changes as we age.

“With advancing age, there is a general tendency for the foot to exhibit increased soft tissue stiffness, decreased range of motion, decreased strength, and a more pronated posture, and to function in a more pronated position with reduced range of motion and less efficient propulsion when walking,” Menz said.

Menz added that many seniors don’t account for the structural changes when picking out a new pair of shoes.

Shoe Study

For their study, Menz and associates split 120 men and women over the age of 65 with disabling foot pain into two different groups. One group was custom-fitted for extra depth shoes, while the other group received their custom shoes at the conclusion of the study. Both groups received regular podiatry care throughout the study.

At the conclusion of four months, seniors in the extra-depth shoe group were much more likely to report that their foot pain had moderately or markedly improved. The custom shoe group also developed fewer corns, calluses and lesions than the control group. Researchers noted that corn and callus treatment make up a large portion of a podiatrist’s regular workload.

The follow up survey also revealed that the custom shoe group said foot function had significantly improved compared to the control group. Menz said it’s clear that many foot problems that plague seniors are being caused or exacerbated by poor footwear.

“Many older people wear ill-fitting shoes, and we know that ill-fitting shoes are associated with foot problems,” Menz said. “It is also important that older people with foot pain consult a podiatrist, particularly if they have diabetes or changing footwear does not alleviate symptoms.”

Dr. Silverman comments

The key here is that these seniors received custom foot care from a professional. Simply going out and buying a deeper shoe isn’t going to fix your problem without professional consultation. As the author concluded, developing a plan with your doctor or podiatrist is important, especially as we get older.

Related source: Reuters

November 25 is Our Hearts To Your Soles 2014

OHTYS 2014We are only one week away from Our Hearts To Your Soles 2014, and we couldn’t be more excited! Volunteers have been lined up, the donations have started rolling in, and everyone is ready to get this great community event under way.

For those of you who missed our initial post or our press release, Our Hearts To Your Soles is set to take place on November 25 at the Christian Charities Dorothy Day Center in St. Paul. The center is located at 183 Old 6th Street in St. Paul. The event will take place from 5:30 to 7:45pm.

So many wonderful sponsors have stepped up to provide supplies and other necessities for the event. We’d like to say “thanks” to Soles 4 Soles, Red Wing Shoe Company, Dignity U Wear, Catholic Charities and all the individual volunteers who are helping ensure this event will be a success.

Another reason I wanted to do a second post on Our Hearts To Your Soles is because we’ve had another generous donation! Interstate Parking has donated a parking lot so attendees and volunteers can park for free near the Dorothy Day Center. Interstate Parking has donated the parking spots in lot 2034 to those attending Our Hearts To Your Soles 2014. The lot is located at 212 W. 9th Street in Saint Paul, and you can get directions to the lot by clicking here. Thanks again to Interstate Parking for making those spaces available.

The goal of Our Hearts To Your Soles is to ensure area homeless and financially burdened individuals have access to foot care and footwear ahead of the cold winter months. We were able to outfit 445 individuals with a new pair of shoes at last year’s event, and we are hoping to top that number this year. Local doctors and lawyers will also be on hand to provide foot exams and legal consultation for those who need extra health or legal care.

We can’t wait to see you all in a week! If you have any questions before the big day, send me an email at!


Dr. Lance Silverman



Patients Must Take Active Role in Treatment and Recovery

Patient ResponsibilityEach week, authors at MedPage Today ask a handful of doctors about a health topic in a column called Friday Feedback. Last Friday they discussed the changing sentiment of the phrase “patient responsibility.” You can check out what the doctors had to say before diving into Dr. Silverman’s take below.

Old Phrase

Not long ago patient responsibility referred to the part of the medical bill the patient needs to pay directly (rather than the insurance company). Now patient responsibility means that patients need to take an active role in treating their condition. This is a unique twist on what had become a commonly used phrase in the medical billing office.

The term used to be thrown around the medical billing office when attempting to collect payment from a patient. When a person is simply unable to pay for their treatment, doctors are said to be “writing off the patient responsibility.” This year, with more people than ever before having very large deductibles, there has been a significant increase in patient responsibility.

New Meaning

As we mentioned above, patient responsibility has taken on a new meaning in the medical community. Patient responsibility also means that a patient needs to actively work to improve their condition, be it by eating right, sticking to their rehab, or adhering to doctor instructions. The vast majority of patients aren’t going to get better if they are just popping a pill and sitting on their couch eating pizza.

At Silverman Ankle & Foot, we believe patients should be very involved in their care. That said, I have never been the paternalistic doctor who tells the patient what to do at every turn. Instead, we provide patients with the same three choices and follow up discussions every time that they want to address a problem:

1. Live with it and do nothing (We also discuss the consequences of this choice).

2. Treat or manage it non-surgically (How it does or fails to alter the natural history of the disease).

3. Treat it surgically (How surgery alters the natural history of the disease and the risks).

We make recommendations, but we never make choices for the patient. We’ll guide them through all their options, but ultimately it is up to the patient to decide their course of action. Visits take longer, but patients are more involved with the process and we both live with the decisions. After the decision is made, both the doctor and the patient need to discuss how they’ll go forward with the choice and lay out expectations of each party. Sure, the doctor is responsible for fixing the broken ankle or removing the bone spurs, but the patient is also responsible for advancing his or her rehab.

Calcaneus Fractures: The Problem With Avoiding Surgery

Calcaneus FractureA reader recently sent me the following question when discussing calcaneus fractures and treatment.

“Dr. Silverman, I had calcaneus fracture 5 months ago and my heel is somewhat deformed. In your opinion, how long should I wait to do the reconstruction operation or arthrodesis?”

With so much pressure exerted on our heels on a daily basis, it’s easy to see how a calcaneal fracture can inhibit your gait, and that imbalance can prevent the injury from healing perfectly. Simply put, an unreconstructed calcaneus is in a tilted inward position that creates abnormal weight bearing to the outside of the heel and foot. Non-surgically treated calcaneus fractures can develop many problems, including:

  • Your heel can widen, making it difficult to fit in shoes.
  • Improper healing can cause peroneal tendon dislocation.
  • Development of a fibular abutment (a situation where the heel bone pushes against fibula).
  • The joint can develop arthrofibrosis, otherwise known as a stiffening of the joint.
  • Arthritis can set in.

That said, plenty of people can fully recover from a calcaneal fracture without surgery so long as they stick to their doctor and physical therapist’s recommendations and no abnormalities cause the foot to heal incorrectly.

Reconstructing the Calcaneus

Reconstruction is challenging and the operation has three main goals.

1. Solid arthrodesis (fusion) to treat the arthritis.

2. Narrow the heel to reduce the peroneal tendon and make shoewear fit better.

3. Heel height and alignment: The most difficult goal to obtain as it involves recutting the fracture and/or spreading the joint apart with a distraction arthrodesis.

The choice to do the fusion surgery after a calcaneus fracture requires a fair amount of planning and a lot of intra-operative work. Non-surgical management includes bracing, injections, and weight-bearing monitoring. Generally, people with calcaneal fractures that still hurt after six months and are showing no signs of improvement are candidates for surgery. As the reader said, his heel is still somewhat deformed. If pain or discomfort is present, a visit with a foot specialist or surgical consultation could provide more answers.

For more information on calcaneus fractures, check out the original blog post our reader commented on.

Preventing Blisters While Running: Does Taping Work?

UltramarathonRunners and marathoners are always looking for ways to keep their feet in pristine shape, and blisters are often one of the more common issues that develop in regular runners. Some try to mitigate their risk of blisters by taping certain areas of their foot, but is that technique effective?

According to an interesting study published in Wilderness and Environmental Medicine, scientists believe taping does decrease blister development, but they can’t prove it.

For their study, researchers equipped 90 ultramarathoners with pieces of 3M Micropore paper tape to their foot. One foot was taped, while the other was not. Dr. Grant Lipman, a surgeon at the Division of Emergency Medicine at Stanford, said the tape was developed to adhere to high pressure areas of the skin.

“(The tape) is easy to apply to the toes, heels, or anywhere else on the foot that is at risk of getting a hot spot or blister,” Lipman said.

Once outfitted with the tape, the 90 participants then proceeded to complete a 150-mile marathon over the course of a few days. All participants had developed blisters by the end of the ultramarathon, and most responded that the blisters developed in the first two days of racing.

After analyzing blister development, researchers found no significant difference in the number of blisters that had developed between the two feet, but surprisingly, 84 percent of participants said they would use the Micropore tape in the future. Lipman said the ultramarathon may have been too intense an atmosphere for the tape to work effectively.

“Our methods may have been too rigorous, and we were unable to solve the question we set out to answer,” Lipman said.

Follow Up Study

Based on their belief that the previous study didn’t use optimal methods, researchers conducted a second study. This time they applied the tape to only the areas of the foot prone to blister development, instead of just covering the whole foot. Lipman said this produced much improved results.

“This second study over this past year was similar, but applied the tape to people just where they typically got blisters (rather than the entire foot), and it worked amazingly well,” he said. “By making the study methods more specific to the individual, we were able to show what the majority of those study participants in PreTAPED (and) I already knew – it works.”

Dr. Silverman comments

It really boils down to whether or not you’re comfortable running with tape on your feet. Does it appear to be preventing blisters, or are you just undergoing the placebo effect?

I wish the doctors had gone into more detail about exactly how the second study proved the tape was effective in use, not just in perceived effectiveness.

Overuse Arm Injuries In Youth Baseball Players

Youth baseball injuriesAn in-depth study published in the American Journal of Sports Medicine found that many youth baseball players are being encouraged to play through arm discomfort.

Lead author Christopher S. Ahmad, MD, said the increase in youth baseball injuries is likely tied to overuse while the body is still developing.

“Both nationally and internationally, we’re witnessing a troubling increase of elbow and shoulder injuries in young baseball players,” said Dr. Ahmad, MD. “The likely explanation is that they’re throwing too much, too early, putting increasing demands on their bodies that their bodies are not ready for.

Dr. Ahmad added that the increase is concerning, especially since youth leagues have instituted regulations to prevent kids from pitching too often.

“Despite current guidelines and precautions—for example, limiting pitch counts and emphasizing off-season rest—many players are still sustaining overuse injury to their throwing arm,” said Dr. Ahmad. “Thus, it’s vital that we develop better ways for coaches, parents, and clinicians to identify players at risk so we can prevent irreversible injury and season-ending surgery.”

Study Insights

As part of their data collection, researchers asked 203 youth baseball players to report whether they “always,” “often,” “sometimes,” or “rarely” experienced arm pain when throwing.

After looking at the survey results, researchers uncovered:

  • 74 percent of players said they have experienced arm pain while throwing. Only 26 percent said they never experienced arm pain.
  • 80 percent reported pain the day after pitching.
  • 82 percent reported “arm fatigue” during a game or practice.
  • 75 percent said arm pain prevented them from throwing the ball faster.
  • 54 percent said arm pain limited the number of innings they could pitch.

As you can see by the statistics, pitchers are especially susceptible to arm fatigue.

“These pitchers likely represent one of the higher-risk groups for incurring a future overuse injury and thus warrant particularly high monitoring,” said Dr. Ahmad.

Dr. Ahmad concluded by saying that nearly half of all baseball players have been encouraged to play through the pain, which he likened to concussion protocols in amateur and professional football not too long ago.

“It’s alarming that so many young baseball players are encouraged to play with pain,” said Dr. Ahmad. “Years ago, prior to concussion protocols, we observed something similar in football, where players who suffered a concussion were routinely sent back into the game after ‘recovering’ for a few minutes. The initial concussion lowered the threshold for another concussion, and the repeated concussions put the player at risk for permanent damage. I think we’re seeing a similar problem in baseball, where playing with arm pain is setting the stage for more serious injury. We need to come up with more individualized throwing programs and better ways to detect which players are at risk for injury.”

Dr. Silverman comments

Clearly there are some players who have abnormal biomechanics. Proper throwing should make your arms sore but not painful. Soreness is your body’s way of regenerating and building muscle and strength, while pain is a sign that something is mechanically wrong.

As in most athletic activity, improper technique leads to injury. The key is to improve player monitoring and techniques. Many youth coaches are the players’ parents, meaning they might not be the most qualified to teach the proper fundamentals or recognize injuries. Also, pitchers are throwing curveballs at earlier ages, which puts unnatural stress on developing joints. We need to take a step back and realize there’s more to a player’s development than winning a tournament by overthrowing as a 9-year-old.

Related source: AJSM

Rubio Out 7-8 Weeks With Severe Ankle Sprain

Ricky RubioThe Minnesota Timberwolves will be without Ricky Rubio for at least a month after the guard suffered a severe left ankle sprain in the second quarter of Friday’s game against the Orlando Magic.

The injury occurred when Rubio drove down the lane with 2:28 left in the quarter. Rubio planted his left foot in an effort to launch himself towards the hoop, but his left ankle rolled outward. He stayed on the floor in obvious pain and had to be helped off the court by teammates and trainers. You can see video of the injury below.

X-rays on the ankle came back negative, but that doesn’t mean Rubio will be back on the court within a few days. Jeff Zillgitt, an NBA reporter for USA Today, said a team source told him Rubio has a significant sprain and could miss 7-8 weeks with the injury.

Timberwolves head coach Flip Saunders said he knew the injury was severe because it swelled up quick, but he knows Rubio will stick to his rehab and work hard to get back on the court as quickly as possible.

“It swelled up high. You’re always concerned about the possibility with high ankle-type sprain,” said Saunders. “I know that Ricky, he’ll do whatever he has to do to try to get back. He has an unbelievable work ethic.”

Rubio was seen leaving the locker room with his left ankle tapped heavily, and he was also sporting a pair of crutches.

Dr. Silverman comments

An ankle sprain with significant swelling like the situation described above is at least a Grade 2 if not a Grade 3 sprain. This injury will keep him sidelined for several weeks. The timetable mentioned in the article seems appropriate, but it’s probably closer to 6-10 weeks as he’s still dealing with significant swelling and you never really know exactly how an injury will respond to treatment.

Ankle sprains are common in basketball, but the goal is to decrease the recurrence rate. Thankfully Rubio doesn’t have a history of any foot/ankle injuries, although he did tear his ACL in the same leg two years ago, so trainers will focus on getting his leg muscles back to full strength so neither leg has problems because one is compensating for the other.

I wish him a speedy recovery. He is one of the most entertaining players to watch on the Wolves, and his presence will be missed.

Related source: ESPN

Fear of Judgement Keeping Women From Regular Exercise

Women ExerciseA new study out of England uncovered that some women don’t exercise as regularly as they would like out of fear of being judged by others.

Going to the gym can sometimes be an intimidating experience, especially for beginners. Developing a workout routine can be difficult for adults in all walks of life, but researchers at Sport England wanted to find out why two million fewer women than men participate in regular exercise and sporting activities. After conducting research and analyzing the data, sport scientists came up with three key reasons, and they all revolve around perceived judgment from others. The three key factors are:

  • Concerns over their appearance.
  • Concerns about their fitness levels or ability.
  • Fear of, as mothers, being judged for putting themselves before their children.

“Women do less sport and exercise than men, but most say they would like to do more,” said Jennie Price, chief executive of Sport England. “We found out by talking to women of all ages up and down the country that what’s stopping them is fear, fear of judgement: whether that’s about how they look, whether they’re any good at it, or feeling guilty about spending time on themselves.”

More on the Study

It probably comes as no surprise that the majority of people would like to exercise more, but a whopping 75 percent of women said they would like to exercise more, but don’t because of their fear of being judged. Furthermore, the prospect of being judged affects women at all ages levels. The study asked the question to 9.4 million women between the ages of 14 and 40, and more than 7 million stated they would like to exercise more, and the most popular response as to why they didn’t was the fear of judgement outweighed self-confidence.

Many women’s groups are trying to build awareness and promote self-confidence in the wake of the study’s findings. The “This Girl Can” program is set to launch a targeted campaign to inspire more women to kick their fear and go out and exercise. They hope to do this by showing women that they are not alone and that they should give that gym or sport club another chance.

Dr. Silverman comments

We all make excuses to justify skipping a workout here and there, but these findings are concerning. In today’s social media crazy world, the prospect of being belittled on Twitter for using a wrong lifting technique or because you’re not as fit as others at the gym is a real problem. The fear of being judged is real, and now that we know just how many people it affects, it’s time to do something about it.

There are many ways to get over your fears of being judged while exercising. Bring a friend to help with any spotting or to just keep you company while you work out, or opt for a more private workout in your home or outside in a relaxing setting like a park or a nature trail. Get creative! Another tip is to remember this study. You’re not alone. Many people have concerns about their appearance or their fitness ability, so don’t think you’re the only one without a perfect stride. Finally, the last tip is to just go for it. After you go to the gym once, you’ll find it easier to go the next day or the day after. You’ll feel good physically and emotionally after a workout, and use that feeling to motivate yourself to exercise regularly. You can do it!

Related source: Daily Mail

Exercise Really Is The Best Medicine

Exercise and Heart HealthResearchers at Texas Presbyterian Hospital conducted a study that revealed exercise truly is the best medicine for heart health.

For their study, researchers asked 12 “ordinary Joes and Janes” to partake in a year-long exercise program. The 12 participants were classified as sedentary individuals prior to taking part in the study. Participants were asked to do 30 to 45 minutes of brisk exercise each week, which was classified as walking, jogging, swimming or cycling.

After a few months of regular exercise researchers asked participants to gradually increase their exercise intensity and duration. Nine months into the trial researchers asked the 12 individuals to add a long run to their weekly exercise routine. Participants also received frequent MRI scans and underwent cardiac catheterization at the beginning and end of the study.

At the end of 12 months, researchers were astounded by what they saw, especially in regards to heart health. Researchers said the right and left ventricles underwent structural changes similar to what is expressed in elite-level athletes. Right ventricle mass and volume increased significantly and immediately. Researchers noticed a similar change in the left ventricle after participants began increasing their duration and intensity. At the end of the study, 10 of the 12 formerly sedentary individuals completed a full marathon, one individual completed a 100-mile cycling event, and the final person completed a triathlon.

Dr. Silverman comments

Simply put, there is no better prescription than regular exercise. There’s not a pill in the world that you can take for a year and then be able to complete a marathon or triathlon. If you put in the work, you’ll see fantastic results in terms of your health.

I commend the researchers and the participants for conducting and taking part in the study. There are plenty of studies on the benefits of exercise, but few increase duration and intensity throughout the study, and even less have participants set an end of study fitness goal. It’s great that all 12 participants were able to complete their end of study goal. If they can do it, you can too.

Related source: Medscape