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Dietary Supplements Don’t Improve Knee Osteoarthritis

Knee osteoarthritisKnee osteoarthritis studies have been making waves lately, and the most recent research suggests that dietary supplements don’t improve the condition.

Researchers reporting in Arthritis and Rheumatology wrote that common dietary supplements like glucosamine and chondroitin don’t significantly improve symptoms or modify arthritis progression.

For their study, researchers accessed patient data from the Osteoarthritis Initiative from 2004 to 2006. Dietary supplement use was self-reported by people enrolled in the program. Patients were regularly tested to assess arthritic progression through physical tests and X-ray exams. Patients also reported their levels of pain, stiffness and physical function using the WOMAC scale.

After analyzing the data, researchers concluded that those who took dietary supplements did not show significant improvement or decreased symptoms compared to those who didn’t take supplements.

“After adjustment for potential confounders with marginal structural models, we found that treatment with glucosamine/chondroitin for 3 years did not appear to bring about relief in symptoms or retardation of disease progression,” the authors wrote “Our data join a growing body of evidence suggesting that glucosamine/chondroitin has no impact on relieving OA symptoms.”

The authors stressed that it’s important healthcare professionals continue to seek out treatment strategies for those affected by osteoarthritis, as it is the most common type of arthritis and leading cause of pain among seniors.

Dr. Silverman comments

This is a very interesting study.

I have always told people with arthritis that ask about these supplements the following two pieces of information:

1. It isn’t clear that they are going to make a difference. They can give it a try and see how their knees respond. If they don’t notice a difference after a month or so, supplement use should be discontinued.

2. I tell them the story of my sister’s 20-year-old horse who was lame until she put this supplement into his feed. Then he began to act like a little pony again.

After looking at the study, I believe there are too many variables and inconsistent factors to conclusively say these supplements don’t work. Instead, I’ll stick to a pattern of belief that has worked throughout my years of practice. If your knee feels better after taking these medications, continue with it, as there’s very little harm that can come from them. If it doesn’t, there’s no need to continue with the pills. I don’t personally sell these medications in my office for a number of reasons, but most importantly because the data that demonstrates that it definitely shows improvement isn’t there.

Our Hearts To Your Soles 2014 is Tonight!

Our hearts to your solesOur Hearts To Your Soles 2014 is tonight! The plans have been made, the donations have been delivered and volunteers and attendees will soon be heading over to the Christian Charities Dorothy Day Center for a night of fun and compassion!

For those of you who forgot, Our Hearts To Your Soles takes place tonight, November 25th at the Christian Charities Dorothy Day Center located at 183 Old 6th Street in St. Paul from 5:30pm to 7:45pm. Free parking is available in parking lot 2034, located at 212 W. 9th Street in Saint Paul. For more specific directions about the lot’s location, click here.


We’d like to give one last shout out to all those who have helped donate, sponsor or volunteer for this great cause!

Our Hearts To Your Soles – OHTYS provides less fortunate individuals across the nation with free footwear and examinations. To learn more about their cause, head over to their website.

Soles4Souls – Soles4Souls is a global non-profit that helps poverty-stricken individuals by collecting and dispersing new and gently used shoes and clothing. Their website is

Red Wing Shoe Company – Red Wing is providing the free footwear for the event. They are truly a company who cares about the community. Learn more about them here.

Dignity U Wear – Per their mission statement, Dignity U Wear “distributes clothing in a way that maximizes the impact that clothing has on lives.” They’ll be providing hats and socks to attendees. Check out their website.

Catholic Charities – Catholic Charities helps homeless individuals around Minnesota. The Dorothy Day Center hosts more than 6,000 homeless individuals each year. Here is their website.

Interstate Parking – Interstate Parking is providing free parking spaces in lot 2034 tonight. For more information on their locations in St. Paul, click here.

Doctors, Lawyers, Volunteers and Donators – You all are the lifeblood of this event. Without you, there is no Our Hearts To Your Soles 2014. Thank you for helping with this wonderful event.

I hope to see you all out tonight!


Dr. Silverman

Symptom Prevalence Best Predictor of Concussion Severity

Concussion symptomsA new study suggests that symptom prevalence and severity are the best predictors of how long it will take a person to recover from a concussion.

Researchers say other models like computerized neurocognitive testing are not as predictive.

“The bottom line is that the lower your symptoms score [on the Post-Concussion Symptom Scale] when you have your first clinic appointment, the more likely you are to recover quickly, and the higher your score, the more likely you will have a longer recovery,” said lead study author William Meehan III, MD, of the Micheli Center for Sports Injury Prevention.

Concussion Study

For their analysis, researchers examined patient data from 531 patients who visited the Sports Concussion Clinic in Boston within three weeks of their initial injury. Average patient age was 14.6 years old, and about two-thirds were male.

The PCSS test evaluates concussions on a scale of 0-132 by assigning 22 different symptoms with a grade of 0 (not experiencing symptom) to 6 (severe). The average patient scored a 26 on the PCSS test. After comparing symptoms and PCSS data, researchers found:

  • 86 percent of patients with a PCSS score of 13 or less saw their symptoms relieve within 28 days.
  • 65 percent of patients with a PCSS score of 14 or more saw their symptoms relieve within 28 days.
  • 21.1 percent of patients lost consciousness during their injury, 33.1 percent experienced amnesia, and 34.7 percent revealed they had previously suffered a concussion.

Dr. Meehan said individuals with a low PCSS score should allow for a period of physical and mental rest before returning to sport and intense schoolwork, while those with severely high PCSS scores (over 100) need to be prepared “for the possibility of a long recovery,” said Dr Meehan.

“You let them know so they can tell their teammates and their coach,” he concluded.

Dr. Silverman comments

Stop the presses!

You’re telling me that a player who sustained an injury to his head and has a higher grade of injury as documented by increased number of symptoms has a longer recovery time? This obviously isn’t surprising.

What I did find interesting is the fact that the symptom grading system was a much better predictor of recovery time than computer models. This isn’t to say MRIs aren’t helpful during diagnosis, but symptom expression seems to be the best indicator of how long a recovery the patient may face. I hope we continue to build on computer models so they can be used in conjunction with symptom expression.

Related source: Medscape

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