Even Comedians can Rupture Their Achilles

Posted by Dr. Babak Baravarian | Apr 03, 2014

George Wallace Achilles Rupture

Photo Credit: Flamingo Las Vegas

 Comedian George Wallace is currently suing the Bellagio casino-hotel in Las Vegas after rupturing his Achilles tendon while performing at the casino. The 61-year-old funnyman suffered his injury back in December of 2007, meaning he was only in his mid-fifties at the time of the accident. It just goes to show that athletes aren’t the only ones at risk for this type of injury.

Although Wallace has described his stage routine as “very active,” it’s hard to imagine that he performs any movements that even come close to the athletes whose injuries we normally cover here. The Las Vegas Review-Journal reports that video of Wallace’s past performances show him walking around the stage, hardly comparable to the moves of, say, Kobe Bryant. And yet, Wallace still ruptured his Achilles tendon, forcing him to take some time off from the stage.

Most Achilles tendon ruptures occur as a result of doing too much too soon, or putting too much strain on the tendon, but Wallace’s injury shows that it could happen to anyone at any time. Although not a professional athlete, Wallace has been performing stand-up comedy for nearly 40 years. Without seeing the video of his performance, it’s safe to assume that the movements that caused the rupture were no different than the ones he made at every performance over that period.

Achilles tendon ruptures can be quite painful and require immediate medical attention to prevent the tendon ends from separating too much. Wallace’s attorneys claim that his injury resulted from his foot becoming entangled in some loose wires on stage. While this could cause your tendon to strain in an odd direction, the best way to protect yourself from Achilles tendon ruptures is to stretch properly and increase your physical activity levels gradually. Of course, it’s always a good idea to watch where you’re walking too.

 



Achilles Strengthening Exercises: Negative Calf Raises

Posted by Dr. Babak Baravarian | Mar 05, 2014

You lead an active lifestyle and you would like to continue to do so. But if you spend a good amount of time engaging in sports that require running, you may be putting yourself at higher risk for developing an Achilles tendon injury. Over time, small tears can form in the tendon, leading to Achilles tendonitis, Achilles tendinosis, or an Achilles tendon rupture. As we have reported on in recent months, even seasoned professional athletes can fall victim to these common injuries. Fortunately, there are steps you can take to strengthen your Achilles tendon.

Negative calf raises are a strength-building exercise that can reduce your chances of injuring your Achilles while running. If you already lead an athletic lifestyle, this exercise should be no problem for you.

  1. Stand on the edge of a step, as you would for standard calf raises.
  2. Execute a calf raise by rising up on your tip toes.
  3. Lift one leg into the air, keeping your knee bent in front of you to maintain balance.
  4. Lower yourself on your other leg until your heel is below the edge of the step. This is the key action of the exercise, the “negative” motion that builds strength in the Achilles. Try to take a full 10 seconds to complete this movement.
  5. Return your other foot to the step and return to your starting position.
Negative Calf Raises
[Photo Credit: www.becomegorgeous.com]

The “negative” motion, known as the eccentric phase of the exercise, lengthens the muscles and tendons of the lower leg. By performing this action on one leg at a time – essentially doubling the resistant – you can maximize the strength-building component of this motion. The number of repetitions and sets you perform will depend on your fitness level. Three to four sets of eight to ten repetitions each is fairly standard.

Working this exercise into your leg day can help keep your Achilles tendons strong and reduce the chance of injury.  Avoiding these injuries is also dependent on not doing too much too soon. Work new exercises and harder regimens in gradually; this is the best way to improve your conditioning without injuring your tissues.



Rudy Gay Returns from Achilles Tendon Injury

Posted by Dr. Babak Baravarian | Feb 19, 2014

Coming out of the All-Star Break, the Sacramento Kings’ Rudy Gay hopes to finish the season productively after suffering an Achilles tendon strain last month. Fans watching the game against the Houston Rockets on January 21 were likely remembered of Kobe Bryant’s injury on a non-contact play last season. In many ways, the injuries are similar.

Rudy Gay Achilles Tendon Injury

Courtesy si.com

 

Many people remember that Bryant missed months while he recovered from his ruptured Achilles tendon. So how is it that Gay was back on the court only a month later? The difference is that Bryant suffered a complete rupture of his Achilles tendon; Gay only partially tore the tissue in his Achilles.

 

The difference in their recovery periods highlights the important differences between partial and total Achilles tendon tears. When a complete tear occurs, the tendon ends must be reattached surgically. Partial tendon tears require a different treatment.

 

“An Achilles strain means a partial tear of some fibers. It is far less of a problem than a complete tear. Recovery can be a week to a month and requires rest and therapy,” says Los Angeles podiatrist Dr. Bob Baravarian, here at the Achilles Injury Institute.

 

Whenever a player goes down on a non-contact play, you can assume that the injury is somewhat serious. Achilles tendon injuries, for instance, are usually the result of chronic wear. Fortunately for Gay, he suffered a minor tear before the full rupture came. In Bryant’s case, he was likely playing with torn tissue in his tendon for some time before the Achilles finally gave way altogether.

 

Achilles tendon injuries can be deceptively painless. If you fall inexplicably without contact, you should check with a podiatrist to assess possible damage. Although a full rupture is visible from the outside, an injury like Gay’s usually isn’t. For most people, these injuries occur when undertaking too much activity all at once. If you are planning on becoming more active, do so gradually to avoid injury. And if you do suffer an Achilles tendon tear, the Achilles Injury Institute is always here to help.



Crabtree Flexes Full Strength After Torn Achilles

Posted by Dr. Babak Baravarian | Jan 10, 2014

49ers Crabtree Returns After Torn Achilles


Those who ruled out San Francisco 49ers wide receiver Michael Crabtree out for the 2013 NFL season were shocked this past Sunday blowing up the Green Bay Packers’ defense with 125 yards in eight catches. All of which comes in just his sixth game after returning from a torn Achilles tendon he suffered last May.

In just eight months, the five-year wide out made his presence known around the football universe as he and his team approach a divisional playoff against the Carolina Panthers. With a performance like that, Crabtree shines light for other Achilles-injured athletes to make a full recovery just as he did.

When Niners coach Jim Harbaugh first confirmed the success of Crabtree’s surgery, he told reporters that Crabtree was not expected to miss the entire season. Even during one of the coldest games all season, which started at 5 degrees Fahrenheit in Green Bay on Sunday, Crabtree’s Achilles held up perfectly.

After Crabtree’s performance Coach Harbaugh applauded his young receiver, “If my life depended on it and somebody had to catch a ball, I’d enlist Michael Crabtree to do it,” per San Jose Mercury News.

Even our own foot and ankle surgeon, Dr. Bob Baravarian told San Francisco Chronicle reporters that he was thrilled for Crabtree, though not stunned as everyone else about his remarkable return.

“These guys, a lot of times, are healed, but mentally they have to be an elite level and Crabtree, it’s astounding that is at that elite level,” Baravarian said. Proving that upon eight months of rest and recovery an elite athlete must endure plenty of mental hurdles to regain pre-injury performance.

Achilles Injury Recovery

A torn Achilles is a common sports injury, affecting athletes of all ages. However, medical advances and experienced surgeons in the past decade make it possible for players to return to their sport in about six months, which in Crabtree’s case did just that last month, on Dec. 1.

If an athlete suffers a torn Achilles they must seek immediate medical attention and an Achilles specialist will determine proper treatment of rest, therapy, medication, surgery or a combination of all. Repairing an Achilles tendon tear is generally an outpatient procedure and requires time off to rest and rebuild the injury.

Years ago, Achilles tendon injuries were career threatening, now they are capable of being addressed aggressively for a full recovery. Previously the surgery would make an incision almost half a foot long, require a cast for six weeks and movement repair. Today the surgery requires an incision as small as 2 centimeters long, walking in a cast for two weeks and improved blood flow from platelet-rich plasma, PRP.

PRP speeds up the healing process by eliminating the chance of blood clots in the treated areas. Poor blood flow would require more time off for recovery but patients who need the extra attention, such as diabetics or elite athletes like Crabtree, they can return to the playing field much faster.

Though Crabtree’s aggressive recovery is so far deemed a success, others who suffer an injury of this caliber often require additional time off to perform at an elite level. Dr. Baravarian said that it is Crabtree’s mental toughness that has helped him climb back to the top of his game.

“What’s very, very dramatic is the fact that he’s back at an elite level at eight months,” Baravarian said. “That sometimes can take anywhere from an additional four to six months to get back to the point where you’re really kind of kicking butt. And he’s doing that.”

ESPN reports that Crabtree’s Achilles is holding up just fine and that he is nursing a slight sprained wrist suffered after making one of his eight catches last Sunday. He is listed as probable for this week’s playoff round at Carolina, hoping to make a return to the NFC championship round.



Barefoot Running

Posted by Dr. L. Mae Chandler | Dec 05, 2013

When Patients Inquire About Barefoot Running

Running Barefoot

Podiatrist Dr. L. Mae Chandler in Santa Barbara Discusses Barefoot Running

Since the release of Christopher McDougall’s book “Born to Run” (published 2009) there has been a significant increase in the hype of barefoot running and minimalist shoes.

When I am confronted by a patient inquiring on my thoughts of them trying barefoot running or minimalist shoes, I first ask the patient their underlying motivation for doing so. Most common responses are fueled by the hype, a history of chronic injury, or the desire to run faster and more efficiently.

Whether or not I recommend barefoot running depends on several factors.

Initially I begin by taking a thorough running history of the patient. Pertinent questions include:

• What types of running-related injuries the patient has sustained in the past?
• Whether the patient has any current injuries?
• What types of surfaces the patient runs on?
• The patient’s age?
• What types of shoes the patient currently runs in, and types of shoes worn in the past?
• Whether the patient has attempted barefoot/minimalist running in the past?

I will then assess the patient’s running biomechanics to judge whether the runner has feet stable enough to handle barefoot running.

I am unlikely to recommend barefoot running to the following categories of runners who are predisposed to running-related injuries:

• Beginners
• Older runners
• Heavier runners
• Those that are habitually shod

Contrast the following categories of runners that may well tolerate barefoot running and reap some of its benefits:

• Experienced long distance runners
• Younger runners
• Normal body weight
• Frequently barefoot

One of the key differences between barefoot/minimalist running and the “traditional” running shoes is that you land more on the forefoot in barefoot/minimalist shoes. Though this acts to decrease the stress placed on the knees, it shifts a greater amount of stress to the ankle and foot, especially in the Achilles and the metatarsals.

It is of utmost importance to emphasize to patient’s interested in trying barefoot/minimalist running that this should be a very gradual transition. The transition will alter a runner’s form and function, which necessarily causes previously dormant muscles and joints to fire. These muscles and joints need time to strengthen gradually so it is imperative those runners making the barefoot/minimalist transition ramp up their mileage slowly to avoid overstress and injury.

This trend is on the rise and therefore much of the definitive scientific evidence on the subject is still out for debate. The sports medicine podiatrist is a perfect place to begin when considering transitioning to barefoot/minimalist running.

For an appointment with one of our doctors at one of our 8 Southern California locations please call 877-677-0011 or visit us at www.achillesinjuryinstitute.com



Achilles Surgeons Weigh In On Kobe’s Achilles Injury

Posted by Dr. Babak Baravarian | Nov 22, 2013

Stephen Curry Likely to Play, Kobe Still Sidelined with Achilles Injury

While many speculate that the five-time NBA champion, Kobe Bryant will make his first appearance of the season tonight against the Golden State Warriors, we still feel that the Los Angeles Lakers shooting guard is not 100 percent to perform on the court just yet. His Achilles tendon has made a radical recovery, following his seven month-old injury. The impression he left his team and coaches with in his first two, full-contact practices was that he has hardly lost a step and could start his comeback campaign any day now.

Though the Achilles pain is catching up to him, Bryant sat out of Thursday’s practice, due to soreness in his injured, left foot.

Warriors point guard Stephen Curry, coming off a mild concussion from a wild face slam with the court on Monday night’s victory over Utah, is cleared to play and highly likely to make his presence known from beyond the three-point line.

Curry was sidelined on Wednesday’s loss, but he has made the trip to L.A. and practiced in light drills with the team. The bruised left ankle he suffered with earlier this month does not appear to be affecting him either.

In an interview with Los Angeles Daily News, Lakers’ head coach Mike D’Antoni, described Bryant as a little tired following Wednesday’s practice. Bryant said that he felt limited on his explosiveness, which can affect his lateral movement and jump shot should he attempt to play tonight.

Our foot and ankle surgeon, Dr. Bob Baravarian told San Francisco Chronicle reporters that Bryant is an elite athlete which is why his aggressive approach is driving him quickly in his recovery process.

Physical therapy is often required for a quick recovery from an Achilles injury.

Physical therapy is often required to regain strength following an Achilles injury.

Dr. Baravarian worries that if Bryant’s ankle and Achilles is strong enough to make that first explosive step that he usually takes as he drives to the basket. His ability to create space and push off for his fade away jumper is needed when he evades defenders. Bryant’s Achilles may not be strong enough for him to do that just yet.

Bryant was medically cleared to play just days ago, which means he is going to be in the spotlight once again in the fourth quarter, scrambling to make that winning shot, soon. For now, the 18-year veteran can rest, allow his Achilles to recuperate and continue on his recovery plan.

 



Barry Church Returns After An Ruptured Achilles

Posted by Dr. Babak Baravarian | Sep 30, 2013

Barry Church’s Return to the Field after a Ruptured Achilles

At the end of the third game in the 2012 NFL season, Dallas Cowboys’ safety, Barry Church did not doubt himself one bit to make a recovery to the football field after going down with a season-ending ruptured Achilles. The Achilles rupture occurred on a non-contact play on Sept. 23 against the Tampa Bay Buccaneers. Church went down, but his team was not let down as he underwent surgery and missed the remainder of the season. Now he has regained full strength and is moving a lot faster than he was a year ago, making a huge impact on the Dallas defense.

Church’s Return from Ruptured Achilles

After the injury in 2012, Church told himself that in order to make a full recovery he would have to remain upbeat and positive. The successful surgery and rehabilitation program enabled him to pick up right where he left off. In the first game this season, Church racked in a team-leading seven tackles on defense and scored a touchdown on a fumble recovery, helping the Cowboys defeat the New York Giants 36-31, on Sept. 8. He earned the team’s weekly boxing gloves award, earned by the most outstanding player of the game. Church regained the respect from his teammates after making a successful return from his Achilles injury.

Achilles Tendon Basics

Ruptured Achilles

Ruptured Achilles Diagram

The Achilles tendon is a band of tissue that connects muscle to bone along the back of each leg on the lower half. Its purpose is to connect the calf muscle to the heel bone that ensures the ability to walk and helps raise the heel off the ground. A ruptured tendon, whether complete or partial tear occurs when the tendon is overstretched during a person’s physical activity, such as running, tripping and falling.

What Can Be Done to Repair the Achilles Tendon Rupture?

The ruptured Achilles can be repaired with a variety of options in Achilles tendon treatment. After evaluation from skilled podiatrists, such as the professionals at the University Foot and Ankle Institute, the patient will either go through a series of conservative treatment plans or surgical repair. The goal of surgical treatment is to stimulate healing and remove damaged tissue.

What Achilles Injuries Are Most Common?

There are two types of injuries that most athletes such as, Barry Church, can suffer from. The two main Achilles ruptures are acute Achilles tendon tear and chronic Achilles tendon tear. After an acute tear, podiatrists recommend to visit a specialist immediately to prevent further tearing and instruct on treatment options. Chronic tears usually begin as a partial tear and then eventually ruptures. If chronic tears are left untreated they cannot be reattached very easily as they are with acute tears, so a special graft will be used to fill in the gaps between the two ends.

What Will Surgery Do to Help Regain Achilles Strength?

After surgical treatment and rehabilitation the patient decreases the likelihood of re-rupturing the tendon, increase the push-off strength, improves muscle function and movement of the ankle.

Depending on the severity, the muscles will need to regain strength and full range of motion. According to Mayo Clinic, the best treatment for a ruptured Achilles tendon depends on the patient’s age, level of activity and severity of injury. Mostly younger and active people opt for surgical repair and older patients will recover with non-surgical treatment. Whether the Achilles is repaired surgically or not the patient will require at least four to six months of a rehabilitation program that will strengthen the muscles and tendon.

Ultimately the surgeon decides which surgical technique suitable for each patient. As well as recommending the level of activity the patient can endure following procedure.

In Barry Church’s case he underwent surgical repairs and enabled a speedy recovery which had him on track to meet his team for strength training camp the following season, seven months after injury.

Achilles tendon injuries can be surgically repaired and treated for when the patient has the right attitude and professionals on their side. If you are experiencing Achilles pain or suffered an injury to the lower leg, visit the foot specialists at the University Foot and Ankle Institute. They are California’s best board certified podiatrists and they can get you back to your physical form quickly. Call and book your consultation today.



Achilles Tendon Injuries

Posted by Dr. Babak Baravarian | Jul 31, 2013

Achilles Tendon Injury: When to See the Achilles Specialist

The Achilles tendon is the strongest tendon in the body. It connects the calf muscle to the heel bone. Even though it is the strongest tendon, it is still one of the most commonly injured body parts, especially in athletes. Although some injuries to the Achilles tendon require surgery, most of them heal on their own.

The Achilles tendon is the biggest tendon in the body, measuring at 15 centimeters. It runs down the back of the lower part of each leg. The Achilles allows the body to rise up on the toes and is built to withstand a large amount of force with movement. It is a tough tendon, but it is vulnerable to injury due to its lack of blood supply and extreme tension that it faces. When a tendon is stretched past its limit, a tear or a rupture can occur.

When the tendon is torn, the individual may feel a pop or snap. Some can even hear an audible popping sound. Following the pop, a sharp pain runs along the back of the ankle or the leg. Typically, the ability to walk properly is hindered until the tear is treated. Achilles tendon surgery is often recommended by foot and ankle doctors for a torn Achilles.

Contact an Achilles Specialist if these Symptoms Develop:

  • Pain, sometimes severe and swelling near the heel
  • Inability to bend or push off the leg while walking
  • Inability to stand on the toes of the injured leg
  • Popping or snapping sound during the initial injury

According to the Mayo Clinic, treatment for a torn Achilles tendon depends on the age of the patient. Younger and more active people usually resort to surgical repair, while older patients are more inclined to nonsurgical treatment.

Non-Surgical Achilles Treatment

Be sure to see a Achilles tendon specialist for proper diagnosis and treatment plan. There are a variety of methods of treatment your foot and ankle doctor may suggest with or without surgery:

  • RICE therapy: Rest, Ice, Compression with bandage or medical wrap, and Elevation.
  • Pain medication such as Tylenol, Ibuprofen and Aleve can diminish the mild pain. Prescription medication can treat severe pain.
  • Heat therapy can be alternated with ice to improve the pain near the tendon.
  • Proper footwear is needed to improve mobility. Shoes that provide good support or medical boots help avoid injury to the tendon.
  • A physical therapy program will provide proper stretches and exercises to rehabilitate the tendon.
  • Immobilization of the ankle joint is for moderate and severe injuries and may require the patient to wear a boot or cast for several weeks.

Achilles Tendon Surgery

Surgery to correct the tear or rupture is often recommended for healthy individuals, especially for athletes and dancers. In this case, the surgery is done as soon as possible after the injury to avoid retraction or spread of the gap in the tendon ends. The Achilles specialists at University Foot and Ankle Institute of Southern California use the latest technology and surgical technique to help you get back on your feet sooner.

Watch a Real Achilles Tendon Repair Surgery!    

It is necessary not to smoke or use tobacco products, because they will slow down blood supply and hinder tissue repair. It is recommended by foot and ankle doctors to continue the rehabilitation program to strengthen the tendon. This will help prevent from further injury and extensive pain.

See an Achilles specialist after the incident or if there is a sharp pain in the heel. Most people do not know they have torn their Achilles tendon at all. Be sure to pay attention to pain in the heel while walking and/or irregular pain when bending the foot or leg which are signs of a torn tendon. If you are experiencing this or any other type unusual pain in the foot, ankle or heel, be sure to contact your local foot ankle and doctor.

The University Foot & Ankle Institute of Los Angeles provides their patients with care for acute and chronic Achilles issues. They specialize in surgical repairs and treatment to restructure the tendon. Stop living in pain and make your appointment with an Achilles Specialist today!



Foot/Ankle Surgery Considerations

Posted by Dr. Babak Baravarian | Jun 14, 2013

Considerations for Foot & Ankle Surgery

Many people are not sure when they should consider elective foot or ankle surgery, or even what it is. The purpose of this discussion is to help clarify some of the common questions surrounding elective foot surgery. Elective foot surgery is any surgical procedure to correct a foot or ankle condition or deformity. It includes cyst removal, bunion or Tailor’s bunion correction, hammertoe repair, Tailor’s bunion correction, excision or decompression of a Morton’s neuroma, addressing an arthritic joint, etc. Elective only indicates that it is not a critical issue or trauma related problem that must be fixed to restore normal function urgently.

“When should I consider elective foot surgery and/or ankle surgery?”

Most foot and ankle conditions are treated or managed with conservative methods. Relatively high success rates are achieved with many foot problems with traditional conservative treatments, such as shoe modifications, orthotics or arch supports, injection therapy, oral medications, activity changes, physical therapy, PRP injections, etc. Some conditions prove to persist in spite of thorough conservative management and the pain and/or deformity continues. We usually recommend the following conditions be met prior to considering elective foot surgery:

• Condition present for a sustained period of time.

• Conservative treatments have been attempted and have not been successful.

• Pain or discomfort is present.

• A correctable or improvable condition is anticipated with the chosen surgical procedure.

“Does ‘elective’ mean it won’t be covered by my insurance?”

The majority of elective ankle and foot surgeries that we perform are covered by insurance plans. Pre-authorization is sometimes necessary, but insurance will typically cover a percentage of the surgery. Our surgery managers do verify insurance coverage prior to scheduling the desired surgery.

“I can’t miss work, so I continue to put off considering surgery. Any advice?”

Many of the elective surgical procedures that we perform allow you to return to work a short time following the surgery, often within 3-5 days. We use a protective walking boot or shoe for many of our elective surgeries, and they allow for some weight bearing following surgery. While every procedure is different in terms of recovery and restrictions following surgery, a quick return to work can often be accommodated. If crutches are required, a knee scooter could be used to make it easier to cover longer distances. Rather than assuming you can’t fit it in your busy life and delaying the fix for your painful condition, consider consulting with one of our surgeons to get a good idea about the real recovery following surgery.

“What’s the downside to just living with my problem?”

If the pain is minimal and the problem is adequately managed with conservative treatments, elective surgery can usually be avoided and/or delayed. However, if your desired activity level is limited and the pain and deformity are worsening, we recommend you consider having the problem fixed. Living with a deformity that progresses usually makes the surgical fix more complex and involved. A misaligned or unstable joint will show progressive arthritic changes that could have been avoided with an earlier surgical correction. Consider asking yourself the following questions to help decide if you should proceed with elective surgery:

· Am I less active because of my foot problem?

· Do I opt out of activities because of my foot problem?

· Are shoes hard to fit and wear comfortably?

· Is this affecting my lifestyle and quality of life?

· Is this condition going to get worse over time?

The surgeons at University Foot & Ankle Institute are dedicated to providing advanced and comprehensive management of simple and complex problems of the foot and ankle. Internet research is very helpful, but it’s difficult to correlate to your specific individual case, lifestyle, and needs. Consider consulting with University Foot & Ankle Institute to get some real answers to your questions and to understand if elective surgery is the appropriate solution to your foot problems.



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