Hello and welcome to HealthLine this Tuesday evening.

I'm Jennifer Almquist.

I have the privilege of hosting tonight if you're new to HealthLine this is a live show and you can call in any time during the show and ask a question.

We're doing an orthopedic program tonight.

We always have calls for orthopedic shows so please don't be shy and give us a call.

The phone lines are open now and they'll be open until just about 8:00.

So there's a number will keep it up at the bottom of the screen throughout the program it's (969) 27 two zero if you're outside of Fort Wayne it's still a free call.

Just put an 866- in front of there and when you call in they don't just throw you on the air.

You'll talk to Jim on phones and he'll get an idea of what your question is.

So you have two options you can ask it live during the show which is great.

We love that and you can interact with our doctor the guest tonight and get as much information as you need or you're more than welcome to give Jim your question and then he'll pass it along to me and we'll get it answered for you.

So those are your choices.

I don't want anyone to be nervous but we love it when you guys call in and ask the question live.

So let me go ahead and introduce our guest tonight.

This is Dr. Shaun Harper who's an orthopedic surgeon.

And just so you're not confused because when I first saw the name when I got the email, his dad , Dr. Scott Carr is also an orthopedic doctor and has been on our program before.

So we're happy tonight to have Shawn who's making his first appearance so well.

>> Thank you for having me.

I appreciate it.

Thank you.

And I always tell people you no matter if you don't have any orthopedic issues, you will learn valuable information.

>> It's wonderful to have professionals come on and help us.

>> So I hope you enjoy the show tonight.

We were going to talk about the causes of ankle pain because lower extremity is your specialty but people can have all sorts of pain around their ankle foot and sometimes it just it's not necessarily from an injury.

>> It's like all of a sudden you wake up one day and it's like this doesn't feel right or degree.

Yeah, So you know, ankle pain is one of those things that the ankle is a very complex joint even though it seems relatively simple.

It takes a lot of force and weight because it's the bottom part of the body so all of your weight goes towards your ankle and you know, a surprising thing is even people don't realize is that every time you take a step your ankle sees about four times your body weight with every step and then bigger activities like running it's ten times.

So it's a very small joint at sees a lot of force.

So there's a myriad of reasons of why it can hurt and those things can be from acute injuries meaning you know, a sports injury or you know, turn your ankle just walking in the yard which happens to a lot of people or coming up in a winter or so ice is going to be out there and we know that that could be a scary thing for people or it can be accumulative damage over time where people get arthritis just like you can have in the knee or the wrist, the shoulder any joint can develop arthritis and in the ankle it can be pretty debilitating because once that arthritis starts to kind of gain hold it can be, you know, almost crippling in a way.

>> Yeah, And then there's all the stuff below the ankle too in the foot that can kind of start to hurt or cause pain in the ankle because you're walking differently because you have a big toe or your little toes or doing something a little different and so you're changing the way your gait is and the way you walk and then your ankle starts to hurt.

>> So it's a it's a tough thing to sometimes try to figure out which is actually the most fun part about my job is I get to be a little bit of a detective sometimes to try to figure out why people have ankle pain.

But it's you know, it's not always an easy answer.

And as we all know, just because we have one problem doesn't mean we can't have lots of problems.

>> So sometimes it's ankle pain and then it's other things that are maybe causing the ankle pain.

So you know, we can't just fix one of those and hope that the other goes away.

Sometimes we're having to take care of multiple problems in the foot and ankle so well I know what scares a lot of people especially for orthopedics is it can be expensive and if you do need to have a surgery I mean you're looking at downtime.

>> So one thing many of your colleagues and I know your dad emphasizes you know you guys orthopedic doctors are always very conservative.

>> They're not just going to say oh you need surgery, you guys you know, if you want to talk about you know, you have options we do there are lots of options.

So you know, I usually breakdown treatment for my patients into three separate categories and one of the first categories is what a lot of people do before they see me, which is do nothing and live with it.

>> Yeah, which is tough because people you know, life goes on and they try to work through it and it's hard.

>> And then the second category is everything I have in my toolbox to make you feel better and hopefully get you back to life and doing the things you need to do but isn't surgery and it's our responsibility as surgeons to make sure we exhaust all those options before moving to some of the more invasive stuff which is surgery now you know the middle category doesn't always work for everybody but there's lots of things that we can try and work through before we say OK, now it's time for the big surgery.

>> Yeah, yeah.

And I know and some people can appreciate that I you can only take so much ibuprofen, you know, before you just you know, once a month it doesn't work sometimes you start considering other things.

So I just want to remind everybody that doctor car is only with us until just about eight o clock and so far our phone lines are wide open but we have not had anyone call in.

So he does specialize in lower extremity.

We're talking about the ankle and foot tonight but he can answer other orthopedic related questions so please don't be shy.

Give us a call again.

The number is (969) 27 two zero .

Looks like we're getting a call in right now but we're going to talk to for a couple of minutes.

Well that while they're getting that through.

So if somebody comes to see you, are you almost always going to have to do some kind of testing?

>> I would think like an X-ray or MRI or something.

Usually our first test is always an X-ray one because we want to make sure and look at the structure of the bones in the foot in the ankle.

It's not just that we're looking at the bones a lot of time the positioning of the bones can be very important X rays don't really show us the soft tissues so they are in essentially the tip of the iceberg.

But if there's something wrong with the bones that can give us a lot of intuition on something else that's going on and some of the advancements especially in orthopedic for an ankle has been weight bearing films which a lot of people don't realize are very important.

>> Then we take when we take your x rays we take them standing if you can put weight on and of course and that gives us because that's the way your foot lives.

It doesn't live out in space and just without exactly if it did it probably wouldn't hurt but yeah.

>> So taking those those type of x rays really helped give us an idea of what's going on in the foot and then if we need more information that's when we move to things like MRI or even CT scans which give us very detailed look in the bones and then MRI is give us ideas of soft tissue and the things we can't see on x ray.

But initial steps is usually always an x ray because we're bone doctors.

So essentially I mean we're soft tissue surgeons as well but the bones are kind of the base structure and everything builds off of that.

>> All right.

We're going to talk more about ankle pain and how to resolve some of those issues.

But let's turn to the phone lines because John did have the courage to call in although I always tell people you're not going to hurt you when you so thanks for calling, John.

>> Go ahead with your question.

Yes, I have several swollen joints right fingers right elbow right foot and left sternoclavicular joint.

>> And John, did you want to ask Dr. Carr was this just something that you just happened or did you have an injury or something like that?

>> I know injuries.

I've had right.

Right.

Fingers have been swollen for five years right elbow for a couple of years sternoclavicular joint generally been slow for about nine months.

What's going on there?

I had a CT scan of it but it did not show anything about nine months ago.

>> OK, John, have you followed up with your primary care doctor about it?

Because a lot of times when multiple joints are involved in the body it's usually not like you said it's something that you've dealt with for a lot of years.

It's usually not something that's an acute injury or necessarily even a localized problem to the joint but often times can be systemic or within the whole body and can be things like we know people have things like rheumatoid arthritis or there are other types of arthritis or other conditions that can affect multiple joints.

And so it's important that your primary care doctor knows about these two because there are blood tests and things like that that they can draw first before necessarily sending you to an orthopedic surgeon because it might be someone that you better be treated by a rheumatologist or an endocrinologist or there are lots of other specialties that sometimes deal with these type of multiple joint issues because surgery necessarily on all these joints might not fix the problem.

So it's better that we know where to send your first which is the best.

It's never bad to get an evaluation by an orthopedic surgeon but we might not be the ones to be able to help all these joint problems at once and it better to be looked at by someone who can send you to the right person first, which is usually the start with your primary care doctor.

>> John, did you want to ask Dr. Carr anything else?

Yeah, I already had a blood test.

It shows I don't have arthritis and the main concern of me was external clavicle joint.

>> Right.

So I mean it's been that way for nine months.

You know, there are other conditions.

The big thing that we would worry about and something I thought about having examined or seen what exactly is going on in the other joints as well is there can be swelling and especially in the sternoclavicular joint because you can have bacteria that can accumulate in joints, bases and things like that and there are certain tests that may be your primary care doctor hasn't tested yet that can tell us if there's generalized inflammation going on the body or maybe your body's trying to fight infection.

But the sternoclavicular joint is one that's pretty rarely injured unless there's a acute injury like a car wreck or a big fall because it's a very usually stable joint and doesn't usually just get injured without some big traumatic accident.

So I would definitely say that you probably need to look into this a little more but it would take some definitely sleuthing or some detective work by an either orthopedic surgeon or or at least have them rule out some probably more serious things before we start.

You know, making some conclusions about what's going on.

>> All right, John, it sounds like we just have to maybe and I think that's probably a good advice.

I've heard from other docs on the show they just out with your primary care doctor.

Usually you have a long relationship, a long standing relationship with that doc and kind of go from there and then maybe be referred to a specialist like yourself.

>> Absolutely.

It sounds like OK, well John, we wish you well.

That sounds very uncomfortable.

>> I'm sorry to hear about what you're going through.

We're going to turn our attention now to Deborah who has also called to ask you a question.

>> So go ahead, Deborah .

Hello.

I wanted to ask on what he thought about I have a I was born with a double gene mutation of the m t h s r double gene mutation the T cells which doesn't allow the small blood vessels to get blood to my bone and I was diagnosed with multifocal Austrian necrosis of multiple bone.

I was wanting to know like they're telling me to try to keep my muscles strong as they can still hold my bones together before the ones in my toes.

They said that they'll collapse the bone will near and like I was wearing a walking boot and there for the longest time they started messing with my hip on the other side.

Are you for walking boots or just like tape up your food but you know they hold it together, you know?

Have you ever heard of that DaGian Yes, dear.

I have heard of that mutation and you know there are a number of conditions also that do affect the blood supply to bones and a lot of them unfortunately we don't have great interventions for things that fix it.

>> But in regards to your questions about walking boots, they can be used for acute conditions.

>> But oftentimes we do find that they are different levels meaning that you wear the walking boot.

It raises you up a lot higher than your normal shoe and there are products that you can buy to put on your normal side to kind of level you out.

But we usually don't recommend wearing a fixed ankle walker for a lifetime.

It's not a something that you would say would be a chronic use or something you use forever to try to fix a problem.

It's usually more for a set period of time while we're trying to either have you heal for something or let your body heal something when we start looking at life long type of braces and things like that, they're usually a little more custom especially in the foot and ankle.

There are a number of orthopedic devices that orthopedic surgeon can prescribe to have made and we do it for people with foot deformities because of , you know, a variety of conditions one being yours if they have collapsed within the foot there are things called crow boots which can help cover the entire foot and they're custom made to help basically give your foot which is unique and special especially if it has some problems with some of the blood supply to the bone to help protect it and those are the ones that we would probably say you need for a lifelong if you're going to pursue that route and sometimes that's a a reasonable choice rather than surgery especially because sometimes surgery can't fix everything.

So I would say if the if the walking boot is starting to cause your hip pain and I know they can cause people back pain and all kinds of stuff I would say would be something you'd go in and talk to your orthopedic provider and come find someone that maybe can help get you to something that's maybe a little more protective a little more comfortable for the long term.

>> Deborah , did you want to ask Dr. or anything else?

I wanted to tell them they put me on arginine when they found us out and when I told you that my hip got affected from me within walking it help it wasn't gone that far in my hip narcosis and reversed it and using the arginine it opened my blood vessels and got the blood flowing.

I just went to my hip doctor Dr.

Going sat down in the end he said Did you heal this?

>> And I said Oh yes that's wonderful.

I'm so happy for that.

Thank you.

And do you guys make stuff he said I will get your address or something just blew up on the Internet because I was kind of looking for sleep maybe so oftentimes as Earth pictures we don't make the product specifically but we know what needs to be done.

So we'll often write you a prescription that you can take and there are a couple of vendors here in Fort Wayne that do make specialty orthopedic devices.

So we tell them what you need and how to do it and then you have you go to them and they have a process of fitting you and sometimes it takes a couple of trips to make sure it fits right and make sure it's doing the same thing so you're not back and forth at my office all the time to get it fit.

But you have they're called orthotics and you have a good relationship with them to make sure that it fits well and then I see you and follow up to make sure that it continues to work well for you.

But oftentimes we'll give you a prescription and you take that to somebody else.

>> Yeah, no, that's and we've also had some podiatrists on the show too.

So I know some folks have worked through podiatrist or prescription type of footwear.

So there's fortunately we're blessed that we have a wonderful medical community and and a lot of you don't have to go out of town necessarily to get some of these issues resolved.

So Deborah , we wish you all the best.

Thank you.

That was a that was a lot to ask you a lot of questions.

>> So thank you, Dr. Carr.

We have a couple of folks who called in wanted me to ask the question to you for them.

>> So we had Barb call and this is interesting because I never thought about this.

Can you get Planter's Fashi this more than once?

>> I thought once you had it you were kind of stuck with it but does it actually go away?

It can go away yeah actually I would say probably you know if we look at our literature when we when we talk about evidence based medicine or treatment of plantar fasciitis, 90 percent of it will go away with non operative management.

Very small percentage of them actually need surgery to fix.

>> OK, but just because we can treat it and it goes away, it can come back can rear its ugly head again and you can get it multiple times.

Oftentimes the prevention for plantar fasciitis isn't something that you know you you do once and it goes away and you never worry about again.

Sometimes it's something you need to kind of you start feeling the pain again.

You go back to those exercises or the things the physical therapist can give you.

>> So help keep that pain kind of at bay sometimes.

Yeah.

And sometimes I've heard of people having that we mentioned, you know, getting prescription footwear or like inserts for your shoes I've heard does that sometimes help?

>> It can sometimes help and then that's totally dependent on how the foot looks and why and you know the plantar fasciitis that type band tissue that's underneath the foot and can hurt you can't hurt and it usually hurts right at the heel and it can be sharp and it almost feel like a knife stabbing to the bottom.

I mean it's it's terrible but we know now too that a lot of that the like I said the foot is a complicated thing and it's tied to the ankle and this is one of those problems that there's a lot of speculation not speculation but pretty close scientific theory that it's actually a little connected to the tightness of your Achilles tendon in the back of your leg and that oftentimes we don't think about that.

But ah, if we're not stretching every day it's very common that we have tight Achilles tendons and what that does is when the ankle can't come up leg it needs to do it starts to flex through the foot and that causes that band of tissue to pull and it can cause that inflammation that's plantar fasciitis.

>> OK, it's usually a good idea I would think to have a doctor look at that.

>> Yeah, absolutely.

Your family doctor.

Yeah.

Yeah.

Take their lead.

All right.

Well thank you, Barb.

A couple more folks have called in and this is Jill who wants to ask her question live so Jill, are you still there?

>> Yes, I'm here.

Oh, thanks for your patience.

Go ahead.

I was just wondering I've had both my hips have been replaced because I had arthritis so they have both been replaced.

However, I had had like about 25 year history of bursitis in both my hips as well.

And my question is can a doctor somehow remove the bursitis after you've had hip replacements and bursitis from that area still be removed?

>> So that's a great question Jill.

And bursitis so burse just to go through some of what a birthday is a versus a sack of kind of fluid that forms around areas that move within your body and they form the Bursa so we can remove any Bursa in the body but it oftentimes ends up coming back.

It's a normal physiologic structure when it gets inflamed.

That's what the itis is when you get bursitis and after a total hip you can still get that on the side of the hip and it can be painful treatment still oftentimes not surgery for those you can do injections into these bursts but with hip replacements are usually very careful about what we stick near metal implants because any time you introduce anything from outside the body to inside the body there's always the small risk of possibly getting joints infected.

>> We don't want any of that but usually it's pretty safe to treat bursitis with a cortisone injection into the Bursa to have it just decrease the inflammation and then there's lots of things that people do in physical therapy and things like that to try to decrease the incidence of it coming back but surgically removing the Bursa usually is not the treatment for that because the person just reforms and whatever is triggering the inflammation oftentimes comes back.

>> Jill, did you want to ask Dr. Carter anything else?

Well, I guess not.

I I've heard several things.

I've heard that there was surgery for it.

I've also heard that there's not surgery for it.

But I guess my only hope at this point in time would be cortisone I suppose cortisone is not a not a bad idea, Jill, because it depends on where it is.

Just like I said, birthers are all over the body.

They're in lots of different places so depends on which one we're talking about in the different treatment most common one in the hips on the outside kind of on outside of your hip you feel it and that's the most common place and usually we don't do surgery for that unless becomes infected and usually if it's just inflamed it usually cortisone treatments are pretty good at knocking it out and keeping it from coming back.

>> So it sounds like maybe she would need to go back and see somebody and definitely talk to your orthopedic surgeon to replace your hips because he's probably the one that can help with that.

All right, Jill, thank you.

So she I guess I do the same right.

So I'm not politically correct.

It's too much effort.

My brain doesn't work like that anymore.

OK, we had a couple of folks who had called in earlier.

Dr. Carr wanted me to ask the question for them.

So John called a few minutes ago.

He wanted to know the difference between an orthopedic surgeon and a podiatrist and we've like I said before, we've had some podiatrist on our show and you know, they can do a lot too.

>> Yeah, absolutely.

And podiatrists are great colleagues but there is a difference obviously was why we're called different things.

So as an orthopedic surgeon I went to medical school and then from medical school I did my five years of orthopedic surgical training and then a lot of us now spend an extra year of training specializing in a body part so we could come to residency and become general orthopedic surgeons.

But now in today's age there's so much we can do that we really like to focus in on one area and I did my fellowship in foot and ankle surgery podiatrist they go to podiatry school which is similar to medical school after going to undergrad after I'm sorry and then they go to medical school and then just like yeah I did four years in medical school they do four years and podiatry school and then they oftentimes do a resident where it's you know I think I think most of them are three years they're changing podiatry is has been evolving over the years as they've been, you know, evolving their surgical practice to and being able to do more.

So the training is a little different for every podiatrist and there are non-operative in there are operative podiatrists but we definitely have different training kind of after that initial medical training where we go to orthopedic residency, they go to podiatry residency I've been through there so I'm not 100 per cent familiar and what they do but they mostly focus on just the foot and ankle and podiatry like conditions and not all of the orthopedics like like we do in our five years of surgical training.

>> And I'm sure if you're in a situation where you're not sure who to go to again primary care doctor absolutely.

That's that's the person to probably start with.

So I don't know if you have like thirty seconds to answer this next question.

>> Somebody wanted to know Deb wanted to know is it can you get a bone spur on the top of your foot?

Yes, absolutely.

Yeah yeah you can get bone spurs anywhere in the body you can get them on the bottom on the top around the ankle on the toes.

Yeah they can pretty much form anywhere.

It's just your body's natural reaction sometimes to form bone spurs and some bone spurs are normal and people haven't been for you know, just normal reasons and no no pathology is there.

>> They just form.

So yes, you can get them anywhere.

All right.

And everybody's unique.

>> So although one thing I would say they probably all hurt is they can really hurt, you know, the that's true.

All right.

Dr. Carr, this has been such a pleasure to tell your dad we said hello.

I will absolutely.

Hopefully both either both of you or at least one of you come back.

>> Be great.

I appreciate all the help they absolutely.

Thank you.

Thank you.

Thank you to all of you who called in great questions and we wish all of you the best and some of you out there having some difficulty in some pain.

>> So we certainly will be thinking of you and I want to make sure you remember to tune in next week again there'll be another HealthLine to watch and I will see you again next month.

So take care.

Have a good night.

>> Bye bye.