Can Bunion Surgery Help You Lose Weight?
TV chef Nigella Lawson recently lost a lot of weight, which she attributes to her recent bunion correction surgery.
According to Lawson, following the bunion surgery it was too painful for her to walk to the fridge. As a result she had to ask people to go to the fridge to get food for her, which made her more conscious of how much she was eating.
But bunion surgery was likely not the primary reason for the weight loss, according to orthopedic surgeon Dr. Lance Silverman.
Dr. Silverman Comments
This is a cute story, but the weight loss is more due to a newfound habit, rather than bunion surgery. Lawson decided that asking others to help her eat made her more conscious of what she was eating. This enhanced understanding led to better choices during her recovery.
As for recovery from bunion surgery, the recovery is not nearly as bad as advertised, at least not with the way we manage patients at Silverman Ankle & Foot.
Elevation and strict bedrest for 23/24 hours per day is critical during the first 3 days. After that, patients use pain and swelling as their guide. A compressive dressing helps control swelling. This dressing is changed during the first week, and then a removable compression splint is applied.
Most of my patients walk immediately after surgery in a simple post operative sandal. As soon as tennis shoes or hard soled clogs will fit, they are recommended to use them. By 6 weeks, I expect bone healing and return to sport or walking.
People worry incessantly about the pain. I tell them, “This is not your mother’s bunion surgery.” Bunion surgery is painful only during the first 1-2 days after the procedure (the time we control pain with narcotic medication). After that, symptoms recede quickly.
Related Sources:
Dailymail.co.uk
Recent research has shown that forefoot running alleviate pain associated with CECS (Chronic Exertional Compartment Syndrome).
The study tested the running patterns of ten people who suffered from CECS. Each person struck with their hindfoot and each reported pain in their legs that got worse while running. As the patients trained to change their gait to strike with their forefoot, the pain decreased and running became much easier.
CECS is a muscular condition caused by exercise that causes pain (often extreme) in the limbs. The condition is most common in athletes and can be absolutely debilitating.
Surgery was thought to be one of the only successful treatments to CECS, but this study opens the door for alternative treatment options.
Dr. Silverman Comments
Chronic Exertional Compartment Syndrome (CECS) is a frustrating problem that can develop in athletes. Patients with this condition develop severe leg pain during physical activity such as running. With rest the condition resolves, but pain returns with a vengeance if the activity starts again.
It differs from acute compartment syndrome, which is a limb threatening and life threatening condition, defined as the compression of nerves, blood vessels, and muscle inside a closed space (compartment) within the body. If unchecked, this pressure leads to ischemic (lack of oxygen) tissue death.
CECS has had a dismal track record for improvement with non-surgical treatment. This study is an exciting revelation. It has bothered me for years as patients ask, “Dr. Silverman, why did I develop this condition?” I have never been able to give them a reason, but now I can. This further strengthens my resolve to support the barefoot or forefoot running style. We were not meant to hit the ground that hard on our heel and the action of absorbing that shock is what creates this problem.
I am even more excited because in the past, all I could do was offer a surgery to release the compartments. While surgery certainly works, I knew there was more to the story. The work by these doctors needs to be commended. I can’t wait to help people run for their own cure.
Related Sources:
Medscape.com
Jason Peters Re-Ruptures Achilles Tendon
Eagles Offensive Lineman, Jason Peters, re-ruptured his Achilles tendon last weekend after his Roll-A-Bout scooter malfunctioned.
Peters had surgery to mend his Achilles last month after he ruptured it on March 27th while working out. He was using a Roll-A-Bout (a substitute for crutches) last weekend when the scooter apparently malfunctioned and caused Peters to fall off and re-injure his healing Achilles. Peters plans to sue the Roll-A-Bout company.
With this latest injury, Peters will almost certainly be out for the 2012 season, and his career could be in jeopardy as well.
Dr. Silverman Comments
Nobody is asking the right question here.
Peters ruptured his Achilles on March 27th. Some reports have his surgery taking place April 2nd. If these reports are true, his Achilles was repaired almost 6 weeks ago. What was he doing non-weight bearing?
Achilles tendon protocols call for early protected weight bearing. Early weight bearing makes the tendon heal stronger and faster. A Roll-A-Bout beyond 2 weeks is not part of my orthopedic rehab plan.
My patients, athlete or not, all follow the same post operative protocol:
- 2 weeks non-weight bearing in a splint until the wound heals.
- 4 weeks of weight bearing as tolerated in a walking boot with a quartered 1″ heel lift (each week 1/4″ of the heel lift is pulled away).
- 6 weeks after surgery the last heel lift is removed. Patients wean out of the boot by 8 weeks while they begin physical therapy.
- Therapy continues for 12 more weeks.
- Sprinting and rapid acceleration/deceleration begins 4.5 months (18 weeks) after surgery.
This protocol has been incredibly successful.
Peters’ physician was being cautious and this caution may have been warranted with a 328lb offensive lineman. However, sometimes caution comes back to bite as it has in this case. Who could have foreseen a Roll-A-Bout breaking?
As for the revision Achilles repair, that is not fun and the results will definitely not be as good. Tying knots to connect torn scar to torn scar is a challenge. In the non-professional athlete, using the great toe flexor to augment the repair makes this case simpler, but weakness is present forever. Peters needs a chance at as close to normal as possible and a revision repair is the only shot he has.
Related Sources:
Philly.com
Aimee Copeland, a 24-year-old grad student, is currently in the hospital battling deadly flesh-eating bacteria called necrotizing fasciitis.
A few weeks ago, Copeland cut open her leg after falling off a homemade zipline. The wound was initially closed with 22 staples, but grew worse and worse until Copeland had to be hospitalized. She was soon after diagnosed with necrotizing fasciitis, and has since had most of her left leg amputated to stop the disease from spreading. She will likely lose her fingers and part of her other leg as well.
Necrotizing fasciitis is a fast acting and deadly bacteria that attacks the deeper layers of the skin, giving it the moniker “flesh-eating bacteria.” Necrotizing fasciitis is quite rare, but is fatal if not treated quickly with aggressive antibiotics and surgery.
Dr. Silverman Comments
Thankfully I’ve only had to deal with necrotizing faciitis once.
I was consulted on a patient in the hospital with severe leg pain and other flu-like symptoms. There was a crunchy painful sound when I squeezed the patient’s leg. An MRI showed infection within the fascial planes. In my training, I had seen a handful of patients with varying forms of this disease, but in all my years of private practice I had not yet needed to treat it. In Orthopedics there are few true emergencies. Here are some examples:
- Compartment Syndrome
- Fractures or Dislocations with Arterial Injuries
- Necrotizing Fasciitis
Once I recognized the necrotizing fasciitis I called the OR and bumped every doctor ahead of me. This patient needed surgery immediately.
As they wheeled the patient back, I called Hennepin County’s Trauma team and asked for emergent communication with the on-call surgeon. I opened the patient’s leg through long incisions and excised the leg diseased fascia. I applied a wound vac to the open wounds to help drain the infection. During surgery, I talked to the doctor at Hennepin County Medical Center and explained the case. HCMC has a hyperbaric oxygen chamber and doctors familiar with this condition.
As I finished the surgery, the Lifeflight Helecopter landed at the hospital and whisked the patient away. I felt charged and excited like I had just won the battle but the victory was hollow. I knew I would never see this patient again, and that they would be lucky to keep the leg, much less live through this disease. I never received follow up on the patient from the doctors or family. I could only take solace in the words of the surgeon to whom I spoke on the phone, “You are doing everything right.”
Related Sources:
CBSnews.com
Derrick Rose Surgery – What is ACL Repair?
This weekend, Derrick Rose underwent surgery to repair his torn left ACL.
Rose had a season full of injuries, the most recent of which happened on April 28 during the Bulls’ first playoff game against the 76ers. Rose came down hard on his leg and collapsed in pain.
We’ve already reported on how this injury was likely the result of longstanding ankle instability. Now that the surgery is over, let’s discuss what an ACL repair consists of.
Dr. Silverman Comments
Rose did not undergo an ACL repair. No one repairs the ACL. You cannot sew a ligament like the ACL back together as it will never heal. Instead, doctors take allograft (human donor tissue) or autograft (the patient’s own tissue) and recreate the major function of the ACL to prevent abnormal movement about the knee joint.
An ACL reconstruction is most commonly done arthroscopically, where small cameras and instruments are placed through small incisions in the skin. Metallic or absorbable screws are placed in the bone tunnels to hold the grafts rigidly in place. After surgery, pain is controlled with strong narcotics. Weight-bearing and rehabilitation through range of motion of the knee joint can start immediately after surgery.
Rose will undergo intensive physical therapy to return him to his best. He has every potential of playing again despite his other problems (ankle instability and chronic turf toe/hallux rigidus). The question on everyone’s mind is: “When will Derrick Rose return to basketball?” The answer is about 6 months after surgery.
The bone blocks heal in 6 weeks. Rehabilitation of the knee may take about 3-4.5 months at the most. So why are athletes held for 6 months? Because the ligament itself needs to strengthen. It needs to be completely replaced by new tissue. That takes anywhere from 18 to 24 months.
I hope his rehabilitation includes ankle stabilizing exercises and better bracing if the doctors choose not to fix his ankle ligaments. Unlike ACL surgery, ankle ligament reconstruction allows patients to return to sport 8-12 weeks post operatively.
Related Sources:
ChicagoTribune.com
Turf Toe vs. Hallux Rigidus
Turf Toe is a sprain to the large joint of the big toe. This most commonly happens when the big toe over-extends. Turf toe is divided into three different grades depending on the severity of the sprain:
- I – a mild sprain
- II – a severe sprain
- III – a toe dislocation
Mild to moderate turf toe is treated non-surgically with protection and rest. Grade III is best treated by surgically repairing the ligaments.
Hallux Rigidus, or a stiff big toe, is commonly caused by Turf Toe injuries. The hallmark of this condition is a slowly increasing bump on the top of the big toe joint with progressively decreasing range of motion. Hallux Rigidus has four clinical stages of variable motion and x-ray findings.
- Stage 1 – minor loss of range of motion
- Stage 2 – greater loss of range of motion, as well as cartilage
- Stage 3 – significant cartilage loss
- Stage 4 – severe loss of range of motion and cartilage loss
Early Hallux Rigidus is treated with shoe modifications (wider toe box) and rigid off the shelf inserts. Later stages are treated with spur excision, joint replacement, and sometimes even fusion of the great toe.
If you have any questions about Turf Toe or Hallux Rigidus, please post them in the comments section below.
Actress Kristen Stewart allegedly punctured her foot during recent reshoots for the highly anticipated Twilight: Breaking Dawn part 2.
The injury occurred last week when Stewart and co-star Robert Pattinson were in Vancouver shooting hunting scenes for the final Twilight film (coming to theaters this fall).
Stewart revealed the injury on her recent Tonight Show appearance, where she wore flats instead of heels because of a “puncture wound” she had sustained on set.
Whether the injury is legitimate or simply a marketing ploy for the upcoming Twilight movie, it gives us an opportunity to talk about what happens with these types of foot injuries.
Dr. Silverman Comments
A puncture to the bottom of the foot is quite painful. These wounds heal eventually but a number of complications can occur that require medical attention.
The first thing to consider is what punctured the foot (e.g. a piece of wood, a rusty nail). Preventing infection is the prime concern. A Tetanus booster should be given if the patient hasn’t had one in the last 5 years. Antibiotics like Cipro or Levaquin can also be considered as those drugs are the best to treat Pseudomonas aeruginosa.
The next step is to determine what structures were punctured. An injury to bone can cause an infection such as Osteomyelitis. But the most troublesome problem is when the puncturing object enters a joint. That is a surgical emergency. Debridement of that joint is required but sometimes, it’s hard to tell if the joint has been punctured. That is where Orthopedics becomes an art and an experienced surgeon is your best option. Knowing when you have to operate is just as important as when you don’t.
Related Sources:
Eonline.com
