.

Hello.

I'm Jennifer Bloomquist.

Welcome to HealthLine.

I'm so glad you joined us tonight.

Whether you're a regular viewer or perhaps new to our program, I guarantee you will learn something.

It's always an interesting program and we are live here in the studio which is why we have the phone number at the bottom of the screen because we have a guest tonight.

We have a foot and ankle surgeon here to answer any of your questions regarding that specialty.

So if you want to call and ask the doctor a question, that's the number to call it's (969) 27 two zero if you're outside Fort Wayne still a free call as long as you put it 866- in front of there.

>> And just to quickly remind you you have two options when you call in first of all, you'll talk to a very nice call screener.

We don't just throw you on the air and you can let the call screener know if you want to ask your question live.

I like that option the best because you can interact with the doctor.

You can talk back and forth.

He may need some more information from you to better answer your question.

So that's a great option or another one's perfectly fine if you prefer that I ask the question for you.

So just relay your question to the call screener and they will let us know what you want us to ask.

So call sooner rather than later.

I'd hate for you to miss the opportunity to get your question answered tonight.

So let's go ahead meet our guest.

He's returning which are so glad to know we didn't scare him away the first time.

This is Dr. Steven Douthat who is a foot and ankle surgeon and he bought some props with which is very helpful because a lot of us don't really think about what the inside our foot really looks like.

>> So thank you, Doctor, for coming back.

Thanks for having me.

I know to begin with and again if you have a question that's not related to this specific topic, it's OK to call in but we're going to start talking about things like arthritis of the foot and ankle and also injuries.

So I know a lot of people as they age and I can attest to this sometimes it just gets really painful to walk and it may not be every day but I've also heard a lot of people get arthritis here in the Senate if you want to talk about what causes it.

>> Yeah, yeah.

So there's there's multiple types of arthritis.

There's wear and tear arthritis which is the most common.

This is going to be the you the the patient as as they age they start to wear out some of the cartilage they develop arthritis is what it's called and that's that's the typical aging arthritis than there are different types.

>> There are autoimmune diseases like rheumatoid arthritis.

There's gouty arthritis so just different types of arthritis and then another common one in the foot and ankle is called post traumatic arthritis.

So post-traumatic arthritis is is arthritis that develops in a joint after after an injury years ago and it damages the cartilage and can wear and tear as time goes on.

>> You know, one thing I hear some older adults say is oh, you know, I played all these sports when I was younger.

>> I was so active and I feel like they say a lot of them will say now I'm paying the price for it and I know you have children.

So do I and I think oh, you know, is there something I could do to prevent them, you know, because a lot of kids are very active today and on their feet a lot.

Is that just a really common thing that you kind of quote unquote pay the price for what you did when you were younger?

>> Yeah, I mean obviously if we're if we're active when we're young, it's not going to necessarily mean that you're going to develop arthritis.

However, if you have injuries when you're younger or repetitive ankle sprains for instance, that can lead to arthritis.

You know, as time goes on, the best thing to do in those cases would be, you know, supportive wear.

So wearing proper shoes when you're doing activities instead of playing football with friends and flip flops, you're going to be wearing a shoe or if you have have sprained an ankle, you know, doing the proper rehab not just jumping back into the sport without wearing a brace or having your ankle tape, that type of thing.

>> Well, what are your options with the arthritis?

And I don't know if you want to use the model to show like can you get it in all different parts of the foot or is it more common like I've met someone who said they have it like in their toes.

>> Yeah yeah.

So arthritis is it's a it's a you know basically a disease that can happen in any joint.

However in the foot and ankle we have a lot of specific parts that that can wear out the most common joint that we see it in the foot and ankle is actually this this first joint here it's called the first metatarsal Falange old joint and that's that's the big joint essentially when we're walking about eighty five percent of your body weight goes through that little joint so any old injury or any altered biomechanics.

So if someone has a bunion where this joint is slightly deviated, you know, basically turn sideways a little bit that can lead to some wear and tear arthritis and and that's a common place to develop it.

Another place in the in the foot to develop arthritis is what we call the midfoot and it's just like it sounds so this is right in the middle of the foot.

We have a bunch of support joints in this area and they can they can wear out either from prior injuries or just wear and tear and that's another place that we see it oftentimes and in the foot itself after the ankle, would that be more typical of you to have it because of an injury so or so then wear and tear?

Yeah, Yeah exactly.

So about seventy five percent of the arthritis that we see in the ankle is what we call post-traumatic.

So a lot of times we see people that have sprained their ankles several times growing up they have fractured their ankle years and years ago and then that cartilage was damaged initially and then it slowly wears out and then we get post traumatic arthritis.

>> So that's that's when we get ankle arthritis.

Yeah.

Now I know it's not that it's a joke but you know, if you break a toe people are like you know, they're not going to do anything but you know, I know one time I broke a toe and it hurt like I couldn't sleep for days so I finally went to go see somebody and and yeah they didn't they told me to just tape it and they gave me like an orthopedic shoe to wear but I mean I feel like most people kind of blow it off because they they you know you'll hear someone say oh they're not going to do anything for a broken toe but does that is that true?

>> Well I mean all fractures come in different flavors if you will.

>> So even a toe fracture can be displaced enough that it needs to be what we call reduced or put back into place or if a joint is dislocated sometimes it just needs to be numbed up and put back into place.

>> So you know, even when it's a toe fracture, I think it does warrant being seen getting a radiograph or an X-ray and making sure that you're doing the proper treatment because even these little things can can really cause pain is as time goes on if you're not dealt with properly.

>> Yeah.

I mean this is years ago.

My kids are in college and high school now but I tripped over they were into garbage trucks and I was running to grab the phone.

>> This is when we had the phone on the wall, you know, not the cell phone and I tripped badly and I like I said, it was really painful.

>> So I went I went and did finally after like three days you get it checked.

>> Is there anything surgical wise that you could do for arthritis or most of it be just a medication?

>> Yeah, I don't know if it would work so obviously it's joint dependent but for instance in the big toe joint if you develop arthritis in that joint we we go through both conservative and surgical treatments.

The conservative treatments would be a shoe that's supportive and more stiff so the joints not bending as much because that that motion that wear and tear can really lead to to increase pain.

And if we've got a nice stiff shoe, the toe joint doesn't have to bend as much.

The other conservative treatments would be the classic antiinflammatory ibuprofen, that type of thing.

Yeah, injections are an option.

They typically aren't very effective in these joints because they're so small and your you're using it so often that it wears off pretty quickly and then the end result is is surgery oftentimes it depends on how bad the arthritis is.

So there's different stages of arthritis in this joint.

So if stage one or two or early arthritis sometimes we just do a cleanup's so we essentially do an incision and clean up the joint, remove the bone spurs if you will, and then keep the joint moving if it's more severe arthritis then we end up doing you know, there's two different procedures.

One is a joint replacement that can be done in very specific cases that allows for some joint motion and then the gold standard, if you will, is is to Fuze that joint.

>> So if that joint is fuzed the joint in front of it still bends just fine.

So when we're walking it still can move.

However it gets rid of the arthritis in this joint and by fuzing it the pain then goes away because it's not grinding anymore.

>> All right.

I'm really glad you brought that model.

That is very helpful.

Thank you.

I just want to remind everybody we haven't had any calls yet but this is kind of the trend.

A lot of people wait until later in the show to call but I do hope you'll call sooner so that we don't miss your question again.

We keep that phone number up at the bottom of the screen.

It's (969) 27 two zero and if you're outside of Fort Wayne it's a toll free call.

Just put it 866- in front of there we're talking about arthritis of the foot and ankle and we're going to be talking about injuries but if you have something else related to the foot and ankle, this is your guide.

Ask the question so feel free to give us a call.

>> What about like any talk about conservative remedies just even like icing or elevating creams?

I mean I know there are some arthritis creams.

>> I don't know how effective those would be on the foot.

Yeah.

Yeah.

So obviously if you have an acute flare of arthritic pain icing and anti inflammatories rest ice compression elevation is a good idea to get that flare kind of calm down.

There are topical creams so there are there are medical creams that you can use that are anti inflammatories know there are more analgesic creams so numbing agents and you know, agents that they can kind of cool the skin and that can help with with discomfort as well.

>> Sure.

All right.

Yeah.

If every step hurts you're going to think about it every day I guess.

>> Exactly what is that what is next to it you were showing that's is this the device that's next.

>> Oh yeah.

So this is for a broken ankle essentially OK that we're looking at there so there is a lot of anatomic hardware is what we call it.

So there are there are specific pieces of metal and plates and screws that are designed to go in in specific bones and this is just an example of a plate for an ankle fracture.

So the plate is designed to contour the morphology of that fibula, the outside bone on the on the ankle and and these little baby screws essentially hold it in place.

So when the when the bone is healing, this is kind of a buttress that that'll that'll support it.

>> Now if somebody needed to have it done with that last can that last for a long time or do you ever have to worry about having it re yeah.

>> So the goal with these these newer we call them anatomic or bone specific places is that they are less irritating and hopefully they and they can stay in forever.

>> The plates are only one to two millimeters thick now so they're very, very low profile so oftentimes you can't even feel them and if you can't feel them they're not going to rub on shoes.

>> They're going to cause that irritation and they can usually stay in.

There are cases that those plates still can cause some irritation and we remove them but the vast majority can stay in OK, yeah, nobody wants to have surgery once let alone a second time.

So yeah, we did have a gentleman call in.

I think he's going to ask the question live.

Are you on the line Fred?

I am.

Oh thank you Fred for calling.

>> Go ahead and ask Dr Douthat your question.

>> Oh go ahead Fred.

And you might want to turn the sound down on your TV because it will be a little bit of a delay.

>> OK, sorry about a hundred years ago I had a break in my left leg tibia and the severe and some years after that I developed arthritis below that break in my ankle.

>> Is that typical?

Yeah.

Yeah.

So when you when you break your tibia and your fibula which are the leg bones essentially what that can do is change the orientation of of the ankle joint so it can it can change the alignment if you will just like a car.

So if that the alignment's off in your car you're going to wear out the tires quicker.

The same thing happens with the ankle if the leg is broken higher up and it's not perfectly aligned when it heals that that alignment will will lead to wear and tear of the arthritis in that that ankle can wear out and develop you know, develop that arthritic pain that you're that you're talking about.

>> Fred, did you did you want to ask anything else?

>> No, thank you very much.

OK, thanks for calling Fred.

Yeah I didn't think about that if you broke other bones that it could impact what's below it.

>> Yeah yeah the alignments off it it definitely leads to abnormal stresses in the joints.

>> Yeah.

All right.

And again if you want to do what I did that's a great way to get your question answered.

You can talk live to Dr. Dowsett on the phone or feel free to call that number and then I can ask the question for you if you prefer to do it that way.

>> I do see a lot of people walking around with those boots on, you know, and I then I you know, you don't want to stop breathing.

Oh, man.

I wonder what happened.

That just looks like it's no fun.

Yeah.

Is that typically what a person's going to wear after having surgery on their foot or ankle and and some of them I see in a boot and they're on the crutches.

>> Yeah yeah.

So you're talking about a can boot or a fixed ankle walker and that's a it's a common device that we use to immobilize a body part while giving the patient freedom to remove it and work on some range of motion.

But but yeah a lot of a lot of injuries end up in a in a fixed ankle walker.

A lot of surgical patients end up in a fixed ankle walker and then they can they can end up in it just from, you know, the actual definitive treatment.

So there are fractures the foot and ankle that can be treated without surgery and those are those are typically immobilized in a boot walker and and then as it heals, we we advance them back into normal shoe.

>> Where do they even cas anymore really?

>> I don't see that very well yet.

We still use CAS usually that's that's a first step in severe ankle fractures or fractures or hind foot fusions that we're doing.

But but we're we're trying to get patients out of them as as quickly as safely possible.

We found that that getting joints moving if they're not fuzed or getting a body mobilized quicker is more beneficial.

>> So if you need to have surgery on your foot I in general how long of a recovery is that?

And I assume there's probably some physical therapy.

>> Yeah.

Down the road after that.

Yeah.& So it really depends on what's done.

For instance like we were talking about earlier if the big toe joint is fuzed for arthritis typically my protocol is to to let them start walking in that boot walker usually they start walking that same week in Boot Walker and we keep them in there for about six weeks.

That's what it takes for a bone generally to Fuze or to heal and then we can get them into shoe wear and and actually physical therapies not not necessary for a lot of those procedures if the patient's gait is is still thrown off or if they're they have a lot of stiffness afterwards, then then we do we do some physical therapy for that particular procedure.

>> But fractures and other injuries definitely require physical therapy afterwards.

Yeah, that's the timelines usually about six weeks to to immobilize someone then kind of get them moving from there.

>> I assume the younger you are the faster you're going to.

Yes.

You know it seems like when you get to be my age it starts to take a longer time for that stuff to take place do and then a lot of times with somebody I'll see people also on those I don't know the specific name for it.

t's like a car.

Yeah.

So what what would be the benefit of that versus just maybe being on crutches.

Yeah.

>> So I don't know if you've used crutches recently but they re for a long time there are no yeah yeah.

So that really hurts your arms after doing that all day at school or yeah yeah yeah.

So I tell my patients that after 30 years old crutches are just they're miserable.

The knee scooter allows patients to move around a lot quicker, a lot more efficiently and usually safer than than with crutches.

>> The crutches are still handy in tight quarters if you're trying to navigate through your home.

>> But the knee scooter is just it's just a better way to get around and it's it's a newer thing.

I was going to say you never used to see this before.

I mean kids I really think they're fun.

I remember seeing like sometimes would be one of our kids all games a grandparent who needed it and then when they're sitting there the kids running around with the scooter.

Yeah.

Yeah.

So it's kind of the break off age is about thirty.

>> That's that's my own personal always aguacate.

Yeah.

yeah yeah yeah.

>> No crutches or definitely no fun.

They are friendly to you.

Sure yeah well there have been a lot of advancements too so it used to be you'd have a long hospital stay we you a surgery like that and now I don't even know would you even have an overnight stay typically are typically most of the foot ankle procedures that we do.

>> Almost all of them are our outpatient or day surgery so the patient will go home the same day and they won't require any type of hospitalizatin for these for these procedures if there's other health factors that that are playing and then yes, an admission may be necessary but it's it's it's quite rare.

>> I was just writing an article about Jessey expansion well explosion of ambulatory surgery centers.

You know, now there's so much especially in orthopedics where they just want you know, it's just a one day thing.

Yeah.

And they were talking about all the things like it's it's less expensive.

Yeah.

And it's just easier on the patient and I think, you know, they they kind of had the mindset that everybody who works in these places, they just are tight knit and it's just you know, it's a really well oiled machine.

>> So you know, if it's a facility that specializes in nothing but orthopedics, that's all you know.

Yeah.

Yeah.

Some of my partners are doing outpatient joint so the patient has a knee or a hip replacement and can go home the same day in certain cases and that's that's pretty remarkable.

>> Yeah.

I think most people would much recover at home and in the hospital for sure.

So we want to welcome your questions again so we we have less than ten minutes believe it or not the show goes quickly so it's nine , six nine to seven to zero again still a free call if you dial 866- in front of there.

We only have Dr.

Doubt that a few more minutes we could still squeeze in a question or two .

And in fact we are getting one right now from a woman named Barbara.

>> Let's see she wanted to know if there are any surgical procedures with foot drop.

>> Yeah.

Now what is foot drop?

Yeah.

So foot drop is typically caused by an injury to the nerves that that lift up the foot.

>> So it's just like it sounds it's it's when a patient can't lift their foot when I walkedprd it's it's a tripping hazard and there are both surgical and non-surgcal options for those patients.

The non-surgical option would be a brace called AFO or Ankle Foot Orthotic and it basically kind of holds the foot up a lot of them are carbon fiber and have almost like a spring built in.

So they the foot kind of recoils upwards and then there are surgical options for those patients as well.

The patient would need a different muscle or tendon in the foot to to still work.

So a lot of times I end up taking a tendon called the posterior tibial tendon which is generally used to support the arch.

>> But in those patients that muscle still fires and I can reroute it from one side of the foot around the back and then into the into the front of the foot and it then fires to lift the foot upwards.

It's it's not as strong as as someone's native tibial interior or the the muscle that lifts up that foot.

But it is it is a life changing procedure for those patients that have been kind of dragging the foot and and when that's a possibility it works well I yeah I and it seems like it's I usually see older adults with the foot and having my uncle just out of the blue.

>> Yeah.

He ended up having surgery for it.

I'm not exactly sure this is years ago a lot of times it's like a bulging disk or a creative disk that leads to it.

It pinches the nerve that provides you know, that motor function to the foot and ankle believe it or not.

And sometimes that damage is permanent that has happened to the to the nerve at the back end and in those cases we do the tendon transfer if the if the spine surgeons are not able to to you know, get it get it to you know, returned to normal function again.

>> Sure.

That's just horrible to think you know to have to walk like that to it looks so cumbersome.

>> Yeah.

So we do have one more question here from Pat wanted to know can hurt Comtel Toes hurting be a sign of arthritis.

>> Yeah yeah definitely a lot of patients with arthritis specifically the toes would have a sensation of the toes being you know, really, really stiff.

>> They don't bend very well anymore and and a lot of people will describe the pain as almost like a toothache but in the toe so it's like a kind of a deep aching pain that's sharp and and it usually starts to subside when when the joint really gets moving and then flares up after the really active again in that type of thing.

>> Do you know would you notice anything on the exterior of your toes if you had arthritis?

I don't know they swell or look yeah.

If they look how things that when they're infected kind of look kind of red.

>> Yeah.

So it depends on the joints pobviously the the toes are very very small small body parts with with not a lot of soft tissue so any type of bone spur just basically makes a prominence right on top of the on the top of the toe and you can see that a bone spur is essentially a buildup of of of bone that happens from the grinding and a lot of times we'll see that on the big toe joints so we will look at that patient and you know, before the patient even will tell us what's going on, you'll see the big hump on top of the toe joint and it's an obvious sign.

>> Yeah, that's that's where it's coming from.

So yeah.

And it can be erythematosus or inflamed and red swollen that type of thing when it's when it's really, really bothered.

>> What what options did you have for that bone spur then what would they yeah.

So typically surgical is to treat it I mean that's really going to be trying to avoid pressure.

So in lacing your shoes you can skip a couple of laces if it's on the middle of the foot and try to try to prevent pressure in the area.

But unfortunately that bone spur doesn't go away until until someone removes it in in the case of arthritis.

>> OK, all right.

I didn't know if there was something a little easier.

No, no not not a not a good cure to get rid of it other than avoiding pressure for those cases and you we just had a little bit of time left maybe like a minute.

Any advice to people about buying shoes because we've had we've had a foot specialist come on here probably some of your cohorts and and they're just like don't look what I'm wearing but flip flops are they yeah.

They don't like it when they see me walk in here and flip lives but there I think people put you know the look of the shoe in front of the function for sure.

>> Yeah yeah my my go to is essentially you're not married to a shoe so you can you can wear your your flimsy shoes when you're at home and you just want to kind of lounge around so typically if you're going to be active I would wear a a an athletic style shoe that is not flexible.

>> One of the first things that I do not like like a cross country type.

Yeah yeah.

>> Just a nice sneaker.

OK, one of the first things I do when patients come in and they've got pain as I look at their foot or sorry at their shoe wear and if I can take that shoe and fold it in half with just a couple of fingers it's not supportive enough.

>> It's just putting too much pressure through the through the foot.

OK, all right.

>> And sometimes those supportive shoes are more expensive but I guess you get what you pay for .

Yes, exactly.

Yes.

Yes.

I'm going to try and quickly take a call from from a gentleman who's who called in a Bruce and he said come walking long distances contributed contribute to developing arthritis.

>> You know, I guess at the extreme level.

Yes, but but walking is actually good for your joints.

It's it's a low impact activity generally walking itself is not going to wear out joints so I don't I don't think that that would be something to worry about.

Obviously if there's a lot of hills or uneven surfaces and you roll your ankle or if you're walking beyond the point of your of your body really, really holding up then yes, that can be it could be bad >> But but that's that's a rare instance.

So so walking would be good for arthritis.

Yeah.

All right.

Yeah I know there's that big move to get people on the go keep in motion is lotion.

Yeah that's true.

>> All right well thank you so much Dr. Steve Doughton.

I really appreciate you both.

Excuse me.

Thank you so much for coming on the show.

I appreciate it.

Thank you so much for bringing the models.

I think it's exceptionally helpful so and we hope that you'll join us again next week.

There'll be another HealthLine same time same place.

I'm Jennifer Brown.

Please take care.

>> Have a great night and have a good rest of the week.

Bye bye