Tips for Describing Your Joint Pain to Your Orthopedic Surgeon

Article featured on Arkansas Surgical Hospital

Joint pain can be debilitating, limiting daily activities and draining you both physically and emotionally.  In many instances, joint discomfort is the result of some type of arthritis.  There are various treatment options, including medications, physical therapy, injections, alternative therapies, and surgical solutions, depending on the severity of your joint pain and the damage to the joints.

Is It Joint Pain or Bone Pain?

Accurately describing your joint pain to your orthopedic surgeon can help them determine what treatment is best for you.  Joint pain is different from bone pain and can vary in sensation and severity.  Clearly explaining the feeling is crucial to appropriate diagnosis and treatment.  Bone pain is typically sharp and localized to a specific area, while joint pain tends to be more of an ache and occurs only in the affect joints, not all along a bone.  However, if the joint damage is severe, it may feel quite intense due to missing or damaged cartilage leading to bones grinding against each other.  Joint pain often increases with overactivity or too much weight on the joint.

Be Accurate When Describing Joint Pain

Saying that your joints are stiff isn’t helpful to your doctor or surgeon because it is too vague.  Pinpointing how much pain you’re in, what kind of pain you’re feeling, and how it impacts your ability to use the joints are all part of describing pain accurately.  Osteoarthritis pain tends to feel different from rheumatoid arthritis and other sources of joint pain, so be precise and thorough.  The more detailed your description is, the easier it is for your surgeon to determine the root of the problem.

Where is the Pain Located?

If you have joint pain in your knees, explain whether you feel it in the kneecap area, the back of the joint, or on the sides.  The knee’s complex ligaments and bone structure mean there is more than one kind of knee joint pain.  If you have joint pain in the hands, tell your doctor which joints are affected.  For instance, osteoarthritis is more common in the joints at the end of the fingers, while rheumatoid arthritis isn’t as likely in these joints.  Narrow down the area as much as possible.

What Kind of Pain Is It?

There are many kinds of pain, and the form it takes is critical when diagnosing and treating joint issues.  Descriptive words are helpful, as are comparisons such as, “It feels like something is caught in the joint.”  Here are some excellent descriptions you can use:

  • Crunching or Grinding.  When bones are rubbing against each other, you may feel like the joint is grinding rather than moving smoothly.  It may feel like gravel in the joint.
  • Snapping, Crackling, or Popping.  This is the sensation of something releasing or popping out of place and is often accompanied by a popping sound.  Osteoarthritis often leads to snapping or crackling in the joints.
  • Throbbing.  If the joint pain feels like it pulses, make sure your surgeon knows.
  • Dull or Achy.  Your pain can be dull (rather like a bruise) but still be severe.  Dull pain or aching can be an underlying, constant pain with periodic flares of other kinds of pain such as stabbing or burning sensations.
  • Stabbing.  Does it feel like somebody stuck a knife in your joint?  Your surgeon needs to know if the stabbing pain is consistent, periodic, or linked to any activities or other circumstances such as standing for long periods.
  • Burning.  Some patients describe burning pain as the joint burning from the inside or a hot sensation in the joints.
  • Radiating.  If you have pain that starts in one area then travels toward another, it is described as radiating pain.  Some people experience hip pain that radiates down the leg when they try to put weight on it.  This may indicate nerve involvement in addition to problems with the joint itself.

The When and Why of Joint Pain

Joint pain isn’t always constant.  It can come and go depending on what you’re doing and the time of day.  Make sure your surgeon knows if your pain seems to flare when you participate in in certain activities or gets worse during specific times.  If your pain is more significant when you wake up in the morning or is aggravated after activities, tell your doctor.  Some forms of arthritis may cause greater pain after you’ve been moving around a lot, while others may be worse after you’ve been inactive for too long.  If your joints lock up, give way, or feel weak or unstable, your doctor needs to know this, particularly if increased pain results.

The duration of your pain is another element of the “when” of joint pain.  While your knees or hips may hurt a lot when you first wake up in the morning, how long it lasts can indicate whether you have osteoarthritis or rheumatoid arthritis.  It can also help define the severity of the problem.  Does the discomfort after exercising last 30 minutes or several hours?  Is the pain worse when walking up a hill or a flight of stairs?  Details like this can aid your surgeon in a correct arthritis diagnosis.

Finally, be sure to inform your doctor of any other elements that affect your joint pain.  Pain that flares during certain types of weather, when you’re under stress, or when you are tired may help pinpoint an arthritis diagnosis or indicate other underlying issues.

The Severity of Joint Pain

Many physicians use a pain scale of 1 to 10, with 1 meaning little to no pain and 10 meaning unbearable pain.  No one experiences pain the same way others do, but the pain scale helps doctors get an idea of how severe your discomfort is and how much it impacts your life.

  • 0 = No pain
  • 1 = Occasional, minimal pain
  • 2 = Mildly annoying, not constant
  • 3 = Painful enough to distract you if not busy
  • 4 = Maybe distracting even when occupied
  • 5 = Can’t be ignored for long stretches, but you can still do things (although uncomfortably)
  • 6 = Can’t ignore your pain
  • 7 = Difficulty sleeping, concentrating, and socializing
  • 8 = Physical limitations and difficulty with normal functioning, nausea, and dizziness
  • 9 = Crying, inability to speak, possibly passing out from the pain
  • 10 = Unconsciousness

Successfully Treating Arthritis Pain

The two most common forms of arthritis, osteoarthritis and rheumatoid arthritis, generally require different approaches, making the proper diagnosis critical when you’re suffering from joint pain.  Arthritis surgery is one of many options available to minimize discomfort and increase range of motion.  Still, your surgeon will usually recommend it only after you’ve tried other treatments such as medications and physical therapy.

Arthritis pain may be the result of a variety of triggers, including:

  • Cracks or chips in the affected bones
  • Inflammation of the tendons and muscles around arthritic joints
  • Bone spurs
  • Muscle spasms caused by irritation from damaged bone
  • Decreased blood flow in arthritic joints
  • Loss of synovium between the bones

With so many potential causes of joint pain and a wide range of treatment options, accurately describing your pain to your surgeon is the first step in finding the best treatment for you and getting you back to doing the activities you enjoy.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Keeping Your Spine Healthy

Article featured on Brigham Health Hub

While the COVID-19 pandemic has changed our lives dramatically, back and neck problems are still as common as ever. In fact, some people are experiencing pain and other discomforts for the first time due to changes in their work locations and equipment as they moved from the office to home. The good news is that most spine conditions improve with time, physical exercise and getting back to your normal activities.

During the pandemic, Michael W. Groff, MD, a neurosurgeon and the director of the Neurosurgical Spine Service at Brigham and Women’s Hospital, had a virtual visit with a patient who was having neck pain along with tingling and weakness in an arm. The patient had undergone a previous surgery with Dr. Groff and feared he might need another.

While an MRI showed more wear and tear in the man’s neck, Dr. Groff reassured his patient that the condition would likely improve without surgery. The best course of action included physical therapy and performing exercises at home.

“I’m not one hundred percent certain that this patient won’t need surgery again,” says Dr. Groff. “But I reassured him that the path to recovery was to get moving and return to his normal routine. And neither of these things would further hurt his neck.”

Dr. Groff is co-chair for the editorial board of Journal of Neurosurgery: Spine. In this role, he and others have been distributing timely information about providing safe care for spine patients during the pandemic.

Keep your back and neck strong with an exercise routine

To keep your back and neck healthy, Dr. Groff urges his patients to perform any physical activity that helps maintain fitness, strengthens the core muscles and includes stretching. If you have back issues, the best way to stay healthy is to stretch often and keep your core strong.

Many people have found virtual exercise classes or routines that include Pilates, yoga or cardio workouts. To stay in shape, you can also use elastic bands, hand weights and/or perform isometric exercises, like planks or squats at home.

“It’s especially important to avoid being sedentary for long periods of time,” says Dr. Groff. “Being inactive can cause muscles that support the spine to weaken. This can sometimes lead to back or neck pain or exacerbate an existing spine condition.”

Getting regular exercise can have other benefits, too. It can give your day structure and help break up the monotony of staying at home for an extended time. Physical exercise can also help you maintain a positive outlook while navigating this challenging period.

When to seek care for back or neck problems

If you have an acute injury, like a pulled back or neck muscle, your pain will likely only last a few days. However, if your symptoms last 2 to 3 weeks and you have weakness or tingling in an arm or leg, contact your doctor.

For pain relief, Dr. Groff recommends ice for the first 48 hours and then alternating between heat and ice for several days after. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), can also help reduce pain and lower inflammation.

For flare-ups of back or neck pain, most spine care providers recommend only staying in bed for about 3 days. In the past, doctors used to recommend a few weeks of bedrest for flare-ups until a pivotal 2016 study showed that 3 days of bed rest is all patients need before they should return to normal activity.

“Staying in bed any longer than 3 days may lead to muscle weakening that can actually worsen a pain episode,” says Dr. Groff. “If you’re having pain, I usually recommend that patients rest and recover over a long weekend and then resume their normal activities.”

Back or neck pain usually doesn’t cause physical damage

If you have back or neck pain, how you interpret it can often impact how disabling it can become. Many patients ask Dr. Groff whether their pain is “all in their heads.” It is, he says, because all pain is experienced in our minds.

“If you’re in pain, most patients find it helpful to know that their pain is most likely not causing physical damage to their spines,” says Dr. Groff. “If you know you aren’t hurting yourself, you can feel better about exercising and returning to your routines.”

Dr. Groff hopes to help patients understand their pain from this new perspective. Doing so often removes the fear of physical activity, because getting back to normal life is a common pathway out of pain for many patients.

“The experience I’ve gained during the COVID-19 pandemic gives me the confidence to say that the Brigham is providing care that’s compassionate, technically excellent and safe for you and your family,” says Dr. Groff.

Dr. Groff can see patients both in person and through virtual visits, which allow him to stay in contact with patients who prefer to connect from home.

“I can still meet with patients and discuss their symptoms during virtual visits,” says Dr. Groff. “I can review imaging and develop a care plan that’s tailored to their unique circumstances. I can also follow up with patients to see how they’re progressing.”


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Orthopedic Soft Tissue Repair Market Projected to have a Stable Growth for the Next Few Years

Article featured on Orthogate

North America had the largest share in global orthopedic soft tissue repair market in 2014, attributed to the increase in sports injury cases due to high share of sports activity in this region.

A soft tissue injury is the damage of ligaments, muscles and tendons of hip, knee, shoulder and elbow joint. A soft tissue injury usually occurs from a strain, sprain and continuous use of a particular part of the body and it can result in swelling, pain, bruising and loss of function. To cure soft tissue injury, the soft tissue repair procedure is used. On any soft tissue injury, Protection Rest Ice Compression Elevation (PRICE) principle should be immediately applied to minimize the soft tissue damage and to reduce inflammation caused by it. One of the methods to diagnose soft tissue damage is magnetic resonance imaging (MRI).

On the basis of surgeries, the global orthopedic soft tissue repair market can be broadly segmented as vaginal prolapse, achilles tendinosis repair, lateral epicondylitis, rotator cuff repair, anterior cruciate ligament and gluteal tendon. On the basis of applications, the global orthopedic soft tissue repair market can be broadly bifurcated as hernia repair, dental, dural repair, skin repair, vaginal sling procedures and breast reconstruction repair.

The rising trend towards safe and simple persistent surgeries and growth in number active lifestyle opting patients are driving the demand of the orthopedic soft tissue repair market. Moreover, with the increase in popularity of rough and energetic sports such as football, soccer and basketball, there had been a considerable increase in the number of soft tissue damages. Some of the factors driving the growth of orthopedic soft tissue repair market are rising geriatric population, increasing obesity rate, advanced medicinal technological advancements, and lack of substitutes.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Understanding Bone Fractures: The Basics

Article featured on WebMD

What Are Fractures?

A fracture is the medical term for a broken bone.

Fractures are common; the average person has two during a lifetime. They occur when the physical force exerted on the bone is stronger than the bone itself.

Your risk of fracture depends, in part, on your age. Broken bones are very common in childhood, although children’s fractures are generally less complicated than fractures in adults. As you age, your bones become more brittle and you are more likely to suffer fractures from falls that would not occur when you were young.

There are many types of fractures, but the main categories are displaced, non-displaced, open, and closed. Displaced and non-displaced fractures refer to the alignment of the fractured bone.

In a displaced fracture, the bone snaps into two or more parts and moves so that the two ends are not lined up straight. If the bone is in many pieces, it is called a comminuted fracture. In a non-displaced fracture, the bone cracks either part or all of the way through, but does move and maintains its proper alignment.

A closed fracture is when the bone breaks but there is no puncture or open wound in the skin. An open fracture is one in which the bone breaks through the skin; it may then recede back into the wound and not be visible through the skin. This is an important difference from a closed fracture because with an open fracture there is a risk of a deep bone infection.basic information on female sexual problemsBecause of the unique properties of their bones, there are some defined fracture subtypes that present only in children. For example:

  • A greenstick fracture in which the bone is bent, but not broken all the way through
  • A buckle fracture results from compression of two bones driven into each other.
  • A growth plate fracture at the joint that can result in shorter bone length

These fracture subtypes can present in children and adults:

  • A comminuted fracture is when the bone breaks into several pieces
  • A transverse fracture is when the fracture line is perpendicular to the shaft (long part) of the bone.
  • An oblique fracture is when the break is on an angle through the bone
  • A pathologic fracture is caused by a disease that weakens the bone
  • A stress fracture is a hairline crack

The severity of a fracture depends upon the fracture subtype and location. Serious fractures can have dangerous complications if not treated promptly; possible complications include damage to blood vessels or nerves and infection of the bone (osteomyelitis) or surrounding tissue. Recuperation time varies depending on the age and health of the patient and the type of fracture. A minor fracture in a child may heal within a few weeks; a serious fracture in an older person may take months to heal.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Is My Hand Pain from Carpal Tunnel Syndrome or Something Else?

Article featured on Spine-Health.

We all wake up sometimes with a numb and tingly hand. But ongoing hand pain and numbness can be a disabling problem that requires diagnosis and treatment.

Here are 3 of the main causes of hand pain and numbness—and tips for how you can tell them apart.

Carpal tunnel syndrome

When hand pain is experienced, it’s common to first suspect carpal tunnel syndrome. This condition is caused by the narrowing of a bony passageway in your wrist, which irritates or compresses the median nerve that runs through it.

Symptoms tend to be in the thumb, index finger, or middle finger, along the path of the median nerve. The pain may wake you up at night or be worse in the morning. In the early stages, shaking your hand may bring relief.

Rheumatoid arthritis

Another possible cause of hand pain and numbness is rheumatoid arthritis.

Hand pain from rheumatoid arthritis tends to be different from carpal tunnel syndrome in 2 main ways:

  1. It causes pain and stiffness in the large knuckles or joints of the wrist, rather than along a nerve path.
  2. Its pain is symmetrical, meaning it will affect both hands simultaneously.

Cervical radiculopathy caused by spine conditions

While it may not seem obvious, your hand pain and/or tingling may actually be caused by a problem in your neck.

The nerves that give sensation to your hands originate in your cervical spine. When one or more of the 8 nerve roots that exit the cervical spine become irritated, it causes pain and other neurological symptoms down the nerve path. This is known as cervical radiculopathy.

The most common conditions that can trigger radiculopathy include:

  • Cervical herniated disc
  • Cervical spinal stenosis
  • Cervical degenerative disc disease
  • Cervical osteoarthritis

Cervical radiculopathy pain can be mildly achy or sharp and stabbing. It can also cause numbness and/or pins-and-needles tingling sensations. Symptoms can affect different sections of the hand depending on what level of the spine is the source of the irritated nerve.

Since carpal tunnel syndrome and cervical radiculopathy can both affect the median nerve, it’s important to note one key difference: Carpal tunnel syndrome pain will only affect the hand and wrist. Cervical radiculopathy from the C6 spine level (where the median nerve originates) will often cause pain and symptoms along the arm and in the bicep, as well as in the hand.

Aside from these 3 causes, hand pain can also be caused by a variety of other conditions, including diabetes and nutritional issues.

The best way to tackle hand pain that doesn’t resolve is to see your doctor, who can diagnose the correct cause and start a treatment plan. Many conditions that cause hand pain are more easily treated if they’re caught early.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Growing Pains – Are They Real?

Article featured on Nationwide Children’s.

It’s the middle of the night and your child wakes up complaining of leg pain for the third time this week. As a parent, you worry that it might not just be the result of sports practice earlier that day. Is it something much, much worse that you could be overlooking?

“Relax,” says Elise Berlan, MD. The discomfort may simply be from “growing pains.” Medically, growing pains aren’t a big deal, but they can prompt tears, sleeplessness and concerns for all involved.

Here are some common questions about growing pains, how to help your child through them, and when it may be time to see your pediatrician.

What Are Growing Pains?

Children, from preschoolers to preteens, typically experience growing pains as a dull, throbbing ache in both of their legs or calf muscles. The pains come and go, can occur in the day or evening, and can even wake a child up from sleep.

Many people assume that growing pains start in the bones – but there isn’t any scientific evidence that the discomfort is related to bone growth. Some experts think what we know as “growing pains” could be because of a lower pain threshold to muscle strains that are caused by normal play.

Who Gets Growing Pains?

Twenty-five to forty percent of children will experience growing pains at some point in their lives, and are slightly more common in girls than boys. Growing pains seem to happen during the preschool years and again during preteen years, with most cases reported between the ages of three to five and the ages of eight to 12.

What Helps Relieve the Pain?

  • Heating pads
  • Massage
  • Cuddles and distraction with a movie or toy
  • Stretching
  • Ibuprofen or acetaminophen. Ibuprofen can upset the stomach, so give it with food or milk. Never give a child aspirin because it can cause a rare reaction called Reye syndrome.

When Should My Child See a Doctor?

Growing pains never affect a child’s joints, and the pain typically only lasts a few hours at a time. If your child is complaining of long-lasting joint pain or joint pain in the morning, or if the joints look red or swollen, then go see your pediatrician. Also make a doctor’s appointment if the pain is accompanied by limping, fever, rash, changes in appetite, weakness or tiredness.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

What Is Degenerative Arthritis?

Article featured on MedicalNewsToday

Arthritis is an umbrella term for diseases that affect a person’s joints. Degenerative arthritis, also known as osteoarthritis, is a form of arthritis that develops due to aging or overuse.

Degenerative arthritis is the most common form of arthritis in the United States, where more than 32.5 million adults are living with the condition.

It is sometimes known as the “wear and tear” form of arthritis, as it often occurs due to the natural aging process. It can also develop as a result of an injury or the overuse of a particular joint.

In this article, we look at the causes, risk factors, symptoms, diagnosis, and treatment of degenerative arthritis.

Symptoms of degenerative arthritis

The symptoms of degenerative arthritis vary depending on where in the body a person develops the disease. They usually get worse over time rather than occurring suddenly, except in the case of injuries.

Regardless of which parts of the body the condition affects, common symptoms may include:

  • pain, often throbbing
  • dull aching
  • swelling
  • reduced flexibility
  • clicking or popping noises when a joint bends
  • stiffness
  • decreased range of motion

Typically, joint stiffness will present early in the morning or after periods of rest, and it will last for up to 30 minutes before loosening up again. The joint pain can either be predictable and low level, lasting for long periods, or take the form of intense unpredictable bursts of pain.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the parts of the body that OA most often affects include the:

  • fingers and thumbs
  • knees
  • hips
  • neck
  • lower back

As the condition progresses, people may find themselves unable to complete activities such as holding a coffee pot, going up steps, or walking long distances.

Causes of degenerative arthritis

People develop degenerative arthritis when the joint cartilage between bones becomes damaged or breaks down.

Often, the body activates a repair mechanism to attempt to remedy this damage. As part of this, bone spurs, or osteophytes, may grow within the joint at the end of the bone. These can then cause friction within the joint and lead to pain when the person uses it.

Risk factors

Certain factors may increase a person’s chance of developing degenerative arthritis. These include:

  • Age: Symptoms generally appear in adults over the age of 50 years, although they can occur earlier.
  • Sex: Females are more likely than males to develop OA.
  • Genetics: OA tends to run in families.
  • Weight: Having obesity can increase a person’s likelihood of developing OA, as the additional weight can place extra stress on the joints.
  • Overuse: Repetitively using the same joints, such as in sports or at work, can sometimes lead people to develop OA.

Some of these risk factors, such as weight, are modifiable, whereas a person cannot change others, such as age and genetics.

Diagnosis of degenerative arthritis

There is no single test to confirm the diagnosis of degenerative arthritis.

Instead, doctors will ask a series of questions about the person’s medical history, such as when the pain began and whether they have sustained any injuries to the affected joint or joints. They may also want to know when the pain occurs and what, if anything, makes it worse.

In addition, the doctor can use X-rays to check for bone spurs or other types of bone damage. They may also take samples of fluid from the joints to rule out infection or gout and run blood tests to exclude other possible causes.

Treatment for degenerative arthritis

Healthcare professionals may treat degenerative arthritis in various ways. Some people with the condition may receive a combination of treatments.

The main aims of treatment include:

  • reducing symptoms
  • improving joint function
  • preventing the condition from progressing further
  • maintaining or improving the person’s quality of life

Medications

Doctors prescribe medications to help reduce the pain and inflammation associated with degenerative arthritis.

Medications may include:

  • oral pain relievers, such as acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • oral anti-inflammatory medications
  • corticosteroid injections to relieve inflammation and pain
  • topical products, such as creams, sprays, or rubs, to soothe sore joints

Physical therapy

Combining physical therapy with increased activity levels can help a person manage degenerative arthritis symptoms. People should ensure that they only participate in low impact activities to prevent further damage to the joints.

Maintaining an active lifestyle may help by:

  • reducing pain
  • improving function
  • increasing muscle and bone strength
  • improving mood
  • increasing quality of life
  • preventing falls by improving balance

It can also help a person maintain a moderate weight, which experts advise people with OA to try to do.

Surgery

Some people may need surgery if other treatments prove ineffective or the damage to the joint is extensive.

This surgery could be in the form of an osteotomy, during which a surgeon removes or reshapes part of the damaged bone.

Alternatively, a person may have a partial or total joint replacement, which involves a surgeon partially or entirely removing the joint and replacing it with a synthetic one.

Nonmedical options

Maintaining a moderate weight can help remove the added stress that excess body weight can put on the joints. People can do this by following a nutritious, well-balanced diet and engaging in regular, low impact physical activity.

Hot and cold therapies may also help relieve pain and stiffness in the joints. People should alternate the application of hot and cold compresses to the areas over the affected joints.

However, a person should always wrap an ice pack in a cloth first so that they are not applying it directly to their skin.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Why Does My Elbow Hurt?

Article featured on WebMD

Your elbow lets you throw, lift, swing, and hug, for starters. You can do all this because it’s not a simple joint. And that means there are a lot of ways things can go wrong. Your elbow’s a joint formed where three bones come together — your upper arm bone, called the humerus, and the ulna and the radius, the two bones that make up your forearm.Each bone has cartilage on the end, which helps them slide against each other and absorb shocks. They’re lashed into place with tough tissues called ligaments. And your tendons connect your bones to muscles to allow you to move your arm in different ways.If anything happens to any of these parts, not to mention the nerves and blood vessels around them, it can cause you pain.Here are some of the different ways your elbow can hurt:

One-time Injuries

Some injuries, hopefully, are one-off events, like when you fall or get hit hard while playing a sport.

  • Dislocated elbow. When one of the bones that forms the elbow gets knocked out of place, you have a dislocated elbow. One of the more common causes is when you put your hand out to catch yourself during a fall. It can also happen to toddlers when you swing them by their forearms — that’s called nursemaid’s elbow. If you think you or your child has a dislocated elbow, call your doctor right away.
  • Fractured elbow: If one of your arm bones breaks at the elbow, you have a fracture. Usually, this happens with a sudden blow, as you might get in a contact sport or a car accident. And don’t be fooled if you can still move your elbow afterward. If you’re in pain and it doesn’t look right, it could be broken. You’ll need medical attention.
  • Strains and sprains: File these under, “Oof, I think I pushed it a little too far.” When muscles get stretched or torn, it’s called a strain. When it’s ligaments, it’s a sprain.
You can get a strain when you put too much pressure on your elbow muscles, like when you lift heavy objects or overdo it with sports.Elbow sprains are common in athletes who throw, use racquets, or play contact sports.Both are treated with rest, ice and — once the pain is gone — stretching and strength exercises.

Wear-and-Tear Injuries

Other injuries occur over time, as you repeat certain actions and put wear and tear on your elbow. You can injure yourself playing sports or in any number of work settings, from a factory to an office.

  • Bursitis: Often caused by repeating the same motion over and over, you can also get bursitis from an accident or infection. Bursa are small sacs with fluid in them. You have them in your joints to help cushion your bones, tendons, and muscles. They also help skin slide over bone. But they can get swollen and cause you pain. Often, bursitis is simply treated with pain medicine and starts to get better within a few weeks.
  • Tennis elbow and golfer’s elbow: These are both types of tendinopathy or tendinosis, which means you have damage in the tendons around your elbow from overuse. Despite the names, the injuries aren’t limited to golfers or tennis players. You’re just more likely to get them based on the arm motions used in those sports. The main difference between the two is that tennis elbow affects the outside of your elbow, while golfer’s elbow affects the inside.
  • Trapped nerves: You might be familiar with carpal tunnel syndrome, where a nerve that passes through your wrist gets squeezed and causes some wrist and arm issues. You can have similar problems in your elbow.
  • If you have radial tunnel syndrome, you have a similar issue with the radial nerve as it passes through the radial tunnel near the outside of your elbow. You may have burning or numbness on your outside forearm and elbow.
  • Stress fractures: With a stress fracture, you have a small crack in one of your arm bones, usually from overuse. They’re more common in the lower legs and feet, but athletes who throw a lot, such as baseball pitchers, can get them in the elbow, too. The pain is usually worse when throwing.

Diseases

Several diseases can also cause elbow pain, though it’s usually not the main symptom.

  • Arthritis: Many types of arthritis can affect your elbow, but the main ones are rheumatoid arthritis and osteoarthritis.
    • Rheumatoid arthritis is the most common type of arthritis in the elbow. When you have it, your immune system attacks your body’s healthy tissue and causes swelling in your joints. You get osteoarthritis when your elbow cartilage breaks down over time, which means the bones rub together and cause pain and stiffness.
  • Osteochondritis dissecans: Children and teenagers mostly get this condition, where a piece of bone near the elbow dies. The bone piece and some cartilage then break off, which causes pain during physical activity. It’s more common in the knees, but can happen in the elbow, as well.
  • Gout: This is actually a type of arthritis. Uric acid, normally a waste product to be sent out of your body, builds up as crystals in your tissues. If the buildup happens in your elbow, it can be very painful.
  • Lupus: This is another illness where your immune system attacks healthy parts of your body, including your joints and organs. It more commonly affects your hands and feet, but it can cause problems in your elbow.
  • Lyme disease: Carried by ticks, Lyme disease can cause serious problems if not treated early. You may have issues with your nervous system and pain in your joints, like your elbow.

When to Call Your Doctor

If you think you’ve fractured or dislocated your elbow — it hurts and doesn’t look right — go to the emergency room.

Call your doctor if you have:

  • Elbow pain that doesn’t go away with rest and ice, or pain that doesn’t go away even when you’re not using your arm
  • Intense pain, swelling, and bruising around your elbow
  • Pain, swelling, or redness that gets worse, especially if you have a fever, too
  • Problems using your elbow, such as difficulty bending your arm

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

How to Protect Your Spine When You Have Osteoporosis

Article featured on Spine-Health

In some cases of osteoporosis, one or more vertebral bones can become so weak that they cannot fully support their load and develop tiny cracks. This type of fracture, called a vertebral compression fracture, can be painful and sometimes leads to worsening symptoms, such as tingling, numbness, weakness, or spinal deformity (kyphosis). Fortunately, you can take steps to lower your risk for vertebral compression fractures, as well as seek treatment if one occurs.

Visit your doctor regularly

If you’re dealing with a chronic condition, such as osteoporosis, it’s especially important to have regular checkups to monitor how you’re doing and whether the treatment plan needs to be adjusted. For example, your doctor might recommend certain medications for osteoporosis, such as bisphosphonates, which may reduce the risk for a vertebral compression fracture.

Eat healthy and quit bad habits

Everyone needs to get plenty of calcium for bone health. If you have osteoporosis or low bone mass, your doctor might also recommend calcium supplements. In addition, it is important to get plenty of vitamin D, which helps the body absorb calcium into the bones.

If you smoke, try to quit. Smoking is known to weaken bones and can worsen osteoporosis.

Regularly drinking lots of soda and/or alcohol may also contribute to weaker bones. If you are in the habit of drinking soda or alcohol every day, try to quit or cut back.

Consult with your doctor to find a balanced diet that works best for you. While it’s important to get enough calcium for bone health, too much calcium can also potentially cause problems, such as kidney stones.

Stay active but use good judgment

The phrase “use it or lose it” is especially true when it comes to your bones. Weight-bearing activities help to build and maintain bone mass. On the other hand, being inactive allows the bones to thin and weaken.

In general, it is good for people to stay active and exercise regularly. If you’ve been diagnosed with osteoporosis or low bone mass, check with your doctor regarding which activities may or may not be right for you. A supervised physical therapy program that focuses on safe resistance exercises may be recommended to help build muscle strength and bone density. Research continues to show that resistance training can strengthen both muscles and bones, even in older people, which may also lower the risk for osteoporotic fractures.

Most people with osteoporosis are encouraged to do some form of weight-bearing exercise as a way to better maintain bone mass, but some activities may be discouraged. For example, your doctor might advise against heavy lifting, doing sit-ups, or bending over to touch the toes, which could put undue stress on the spine.

Don’t ignore a compression fracture

Any time you have back pain that lasts more than a week or two, it is important to see the doctor. Ignoring back pain and potential vertebral compression fractures may lead to bigger problems down the road, such as increased pain, tingling, numbness, weakness, and severe spinal deformity.

Most vertebral compression fractures are treated nonsurgically, such as with rest, pain medications, or applying ice and/or heat while the fracture eventually heals on its own. If the pain cannot be successfully managed with nonsurgical treatments, surgery may be considered. A couple of surgical options for vertebral compression fractures include:

  • Vertebroplasty. This minimally-invasive procedure involves carefully placing a needle through the back and into the compression fracture, delivering bone cement to fill the cracks and re-stabilize the vertebra.

  • Kyphoplasty. This procedure is similar to vertebroplasty, except that a small balloon is inserted and expanded into the compression fracture to help restore the collapsed vertebra closer to its original height before injecting the bone cement.

Some studies have found that both vertebroplasty and kyphoplasty have been effective at reducing pain from vertebral compression fractures, especially when done within 2 months of sustaining the fracture.

By following these tips, you’re well on your way to protecting your spine and successfully managing osteoporosis.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours

Rheumatoid Arthritis of the Foot and Ankle

Article featured on OrthoInfo

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. It most often starts in the small joints of the hands and feet, and usually affects the same joints on both sides of the body. More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease.

Description

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.

How It Happens

The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes an overactivity of this lining. It swells and becomes inflamed, destroying the joint, as well as the ligaments and other tissues that support it. Weakened ligaments can cause joint deformities — such as claw toe or hammer toe. Softening of the bone (osteopenia) can result in stress fractures and collapse of bone.

In RA, the lining of the joint swells and becomes inflamed. This slowly destroys the joint.

Rheumatoid arthritis is not an isolated disease of the bones and joints. It affects tissues throughout the body, causing damage to the blood vessels, nerves, and tendons. Deformities of the hands and feet are the more obvious signs of RA. In about 20% of patients, foot and ankle symptoms are the first signs of the disease.

Statistics

Rheumatoid arthritis affects approximately 1% of the population. Women are affected more often than men, with a ratio of up to 3 to 1. Symptoms most commonly develop between the ages of 40 and 60.

Cause

The exact cause of RA is not known. There may be a genetic reason — some people may be more likely to develop the disease because of family heredity. However, doctors suspect that it takes a chemical or environmental “trigger” to activate the disease in people who inherit RA.

Symptoms

The most common symptoms are pain, swelling, and stiffness. Unlike osteoarthritis, which typically affects one specific joint, symptoms of RA usually appear in both feet, affecting the same joints on each foot.

Anatomy of the foot and ankle

Anatomy of the foot and ankle.

Ankle

Difficulty with inclines (ramps) and stairs are the early signs of ankle involvement. As the disease progresses, simple walking and standing can become painful.

Hindfoot (Heel Region of the Foot)

The main function of the hindfoot is to perform the side-to-side motion of the foot. Difficulty walking on uneven ground, grass, or gravel are the initial signs. Pain is common just beneath the fibula (the smaller lower leg bone) on the outside of the foot.

As the disease progresses, the alignment of the foot may shift as the bones move out of their normal positions. This can result in a flatfoot deformity. Pain and discomfort may be felt along the posterior tibial tendon (main tendon that supports the arch) on the inside of the ankle, or on the outside of the ankle beneath the fibula.

Midfoot (Top of the Foot)

With RA, the ligaments that support the midfoot become weakened and the arch collapses. With loss of the arch, the foot commonly collapses and the front of the foot points outward. RA also damages the cartilage, causing arthritic pain that is present with or without shoes. Over time, the shape of the foot can change because the structures that support it degenerate. This can create a large bony prominence (bump) on the arch. All of these changes in the shape of the foot can make it very difficult to wear shoes.

Rheumatoid arthritis of the midfoot

This x-ray shows signs of RA of the midfoot. Note that the front of the foot points outward and there is a large bump on the inside and bottom of the foot.

Forefoot (Toes and Ball of the Foot)

The changes that occur to the front of the foot are unique to patients with RA. These problems include bunions, claw toes, and pain under the ball of the foot (metatarsalgia). Although, each individual deformity is common, it is the combination of deformities that compounds the problem.

The bunion is typically severe and the big toe commonly crosses over the second toe.

Illustration of bunion and claw toe

People with RA can experience a combination of common foot problems, such as bunions and clawtoe.

There can also be very painful bumps on the ball of the foot, creating calluses. The bumps develop when bones in the middle of the foot (midfoot) are pushed down from joint dislocations in the toes. The dislocations of the lesser toes (toes two through five) cause them to become very prominent on the top of the foot. This creates clawtoes and makes it very difficult to wear shoes. In severe situations, ulcers can form from the abnormal pressure.

Severe claw toes can become fixed and rigid. They do not move when in a shoe. The extra pressure from the top of the shoe can cause severe pain and can damage the skin.

Doctor Examination

Medical History and Physical Examination

After listening to your symptoms and discussing your general health and medical history, your doctor will examine your foot and ankle.

Skin. The location of callouses indicate areas of abnormal pressure on the foot. The most common location is on the ball of the foot (the underside of the forefoot). If the middle of the foot is involved, there may be a large prominence on the inside and bottom of the foot. This can cause callouses.

Foot shape. Your doctor will look for specific deformities, such as bunions, claw toes, and flat feet.

Flexibility. In the early stages of RA, the joints will typically still have movement. As arthritis progresses and there is a total loss of cartilage, the joints become very stiff. Whether there is motion within the joints will influence treatment options.

Tenderness to pressure. Although applying pressure to an already sensitive foot can be very uncomfortable, it is critical that your doctor identify the areas of the foot and ankle that are causing the pain. By applying gentle pressure at specific joints your doctor can determine which joints have symptoms and need treatment. The areas on the x-ray that look abnormal are not always the same ones that are causing the pain.

Imaging Tests

Other tests that your doctor may order to help confirm your diagnosis include:

X-rays. This test creates images of dense structures, like bone. It will show your doctor the position of the bones. The x-rays can be used by your doctor to make measurements of the alignment of the bones and joint spaces, which will help your doctor determine what surgery would best.

Computerized tomography (CT) scan. When the deformity is severe, the shape of the foot can be abnormal enough to make it difficult to determine which joints have been affected and the extent of the disease. CT scans allow your doctor to more closely examine each joint for the presence of arthritis.

Magnetic resonance imaging (MRI) scan. An MRI scan will show the soft tissues, including the ligaments and tendons. Your doctor can assess whether the tendon is inflamed (tendonitis) or torn (ruptured).

Rheumatology Referral

Your doctor may refer you to a rheumatologist if he or she suspects RA. Although your symptoms and the results from a physical examination and tests may be consistent with RA, a rheumatologist will be able to determine the specific diagnosis. There are other less common types of inflammatory arthritis that will be considered.

Nonsurgical Treatment

Although there is no cure for RA, there are many treatment options available to help people manage pain, stay active, and live fulfilling lives.

Rheumatoid arthritis is often treated by a team of healthcare professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.

Although orthopaedic treatment may relieve symptoms, it will not stop the progression of the disease. Specific medicines called disease-modifying anti-rheumatic drugs are designed to stop the immune system from destroying the joints. The appropriate use of these medications is directed by a rheumatologist.

Orthopaedic treatment of RA depends on the location of the pain and the extent of cartilage damage. Many patients will have some symptom relief with appropriate nonsurgical treatment.

Rest

Limiting or stopping activities that make the pain worse is the first step in minimizing the pain. Biking, elliptical training machines, or swimming are exercise activities that allow patients to maintain their health without placing a large impact load on the foot.

Ice

Placing ice on the most painful area of the foot for 20 minutes is effective. This can be done 3 or 4 times a day. Ice application is best done right after you are done with a physical activity. Do not apply ice directly to your skin.

Nonsteroidal Anti-inflammatory Medication

Drugs, such as ibuprofen or naproxen, reduce pain and inflammation. In patients with RA, the use of these types of medications should be reviewed with your rheumatologist or medical doctor.

Orthotics

An orthotic (shoe insert) is a very effective tool to minimize the pressure from prominent bones in the foot. The orthotic will not be able to correct the shape of your foot. The primary goal is to minimize the pressure and decrease the pain and callous formation. This is more effective for deformity in the front and middle of the foot/

For people with RA, hard or rigid orthotics generally cause too much pressure on the bone prominences, creating more pain. A custom orthotic is generally made of softer material and relieves pressure on the foot.

Braces

A lace-up ankle brace can be an effective treatment for mild to moderate pain in the back of the foot and the ankle. The brace supports the joints of the back of the foot and ankle. In patients with a severe flatfoot or a very stiff arthritic ankle, a custom-molded plastic or leather brace is needed. The brace can be a very effective device for some patients, allowing them to avoid surgery.

Ankle brace

A custom-molded leather brace can be effective in minimizing the pain and discomfort from ankle and hindfoot arthritis.

Steroid Injection

An injection of cortisone into the affected joint can help in the early stages of the disease. In many cases, a rheumatologist or medical doctor may also perform these injections. The steroid helps to reduce inflammation within the joint. The steroid injection is normally a temporary measure and will not stop the progression of the disease.

Surgical Treatment

Your doctor may recommend surgery depending upon the extent of cartilage damage and your response to nonsurgical options.

Fusion. Fusion of the affected joints is the most common type of surgery performed for RA. Fusion takes the two bones that form a joint and fuses them together to make one bone.

During the surgery, the joints are exposed and the remaining cartilage is removed. The two bones are then held together with screws or a combination of screws and plates. This prevents the bones from moving.

Because the joint is no longer intact, this surgery does limit joint motion. Limited joint motion may not be felt by the patient, depending on the joints fused. The midfoot joints often do not have much motion to begin with, and fusing them does not create increased stiffness. The ankle joint normally does have a lot of motion, and fusing it will be noticeable to the patient. By limiting motion, fusion reduces the pain.

Fusion can be a successful technique. However, because patients with RA also show damaged cartilage and loose ligaments, the success rate of this type of surgery is lower in patients with RA than in patients without RA. The use of newer generation medication can slow the progression of the disease and impact the type of surgeries that can be performed successfully.

Other surgeries. The front of the foot is where there are more surgical options for some patients. Surgeons can now perform joint sparing operations to correct the bunion and hammertoes in some patients. Your surgeon will review the most appropriate options for your case.

Ankle

Ankle fusion and total ankle replacement are the two primary surgical options for treating RA of the ankle. Both treatment options can be successful in minimizing the pain and discomfort in the ankle. The appropriate surgery is based upon multiple factors and is individualized for every patient.

Ankle fusion and ankle replacement

This patient had arthritis of the hindfoot. It was treated by fusing all three joints of the hindfoot (triple fusion). An ankle replacement was also done in order to improve mobility and avoid the severe stiffness that would result from another ankle fusion. The ankle replacement implants can be seen here from the front and the side.

Patients with severe involvement of other joints around the heel or patients who have previously undergone a fusion on the other leg, may be more suited for ankle replacement. In addition, patients who have fusions within the same foot may be more suited for an ankle replacement.

Newer generation ankle replacement implants have shown promising early results. Ankle replacement implants have not yet been shown to be as long-lasting as those for the hip or knee, due to the fact that the newer generation of implants have not been available long enough to determine how long they will last.

Ankle fusion

These x-rays show an ankle fusion from the front and the side. The number and placement of screws and the use of a plate are dependent upon the surgeon’s technique.

Following ankle fusion, there is a loss of the up and down motion of the ankle. The up and down motion is transferred to the joints near the ankle. This creates a potential for pain in those joints, and possibly arthritis.

Patients are able to walk in shoes on flat, level ground without much difficulty after an ankle fusion, despite the loss of ankle motion. The joints in the foot next to the ankle joint allow for motion similar to the ankle joint, and help patients with fused ankle joints walk more normally.

Arthritis in subtalar joint

Over time, the increased stress that is placed on the rest of the foot after an ankle fusion can lead to arthritis of the joints surrounding the ankle. This patient had pain in the subtalar joint (arrow) and required an additional fusion of that joint to minimize the pain. Increased stress on other joints is the most concerning problem following ankle fusion.

Hindfoot (Heel Region of the Foot)

A fusion of the affected joints of the hindfoot is the most common surgery used to treat patients with flatfoot or arthritis of the hindfoot. A triple arthrodesis is a fusion that involves all three joints in the back of the foot. Occasionally, the joint on the outside of the foot is not fused if there is minimal to no involvement of that joint (this is at the surgeon’s discretion). This type of fusion eliminates the side-to-side motion of the foot, while preserving most of the up and down movement.

If RA is only in one joint, then a fusion of just that affected joint may be all that is needed.

Ankle fusion

(Left) In this x-ray, two of the three joints in the hindfoot have been fused. (Right) Just the subtalar joint is fused in this x-ray.

Any fusion of the hindfoot will limit side-to-side motion of the foot. This will affect walking on uneven ground, grass, or gravel. There is no method to replace the joints of the hindfoot.

Midfoot (Middle of the Foot)

Fusion is the most reliable surgical method to treat RA of the midfoot joints. If the shape of the foot is not normal, surgery is designed to help restore the arch and minimize the prominences on the foot.

There are joint replacement implants available for joints on the outside of the midfoot. This may preserve some midfoot motion. However, the use of these implants is at the surgeon’s discretion. These implants are not available for the joints on the inside of the midfoot.

Although the foot cannot be returned to a normal shape, the goals are to reduce pain in the foot and improve the potential for the patient to wear more normal shoes.

Reconstruction of collapsed arch

(Top) This x-ray shows RA of the midfoot that has collapsed the arch. (Bottom) The surgical reconstruction involved a fusion of the middle of the foot with plates and screws.

Forefoot (Toes and Ball of the Foot)

The choice of treatment for patients with a bunion or lesser toe deformities (hammer or claw toes) depends on a number of factors.

If the disease is very mild, joint-sparing procedures that preserve motion can be considered. The decision is dependent on the medication that the patient is taking and the amount of damaged cartilage that is present. A fusion of the great toe may be recommended despite that fact the bunion is very mild. If there is damage to the cartilage of the great toe joint, correcting the bunion will not minimize the arthritic pain.

If the RA has progressed and the lesser toes (two through five) have dislocated, a complex operation to minimize the pain and restore the shape of the foot may be recommended. The operation involves fusion of the big toe and removing a portion of bone of each of the metatarsals. This surgery removes the prominent bone on the bottom of the foot that is a source of the pain and allows the toes to re-align into a better position.

Occasionally, the lesser toe metatarsals can be preserved by shortening them to allow the toes to resume their position within the joints. This is not always possible, however, and the joint may have to be removed.

RA of the forefoot before and after fusion

(Left) RA of the forefoot. The big toe is deviated and crosses over the second toe, a typical appearance of a bunion. The lesser toes (two through five) are dislocated, resulting in painful and severe claw toes. (Right) This x-ray taken immediately after fusion of the big toe shows that the prominent bones on the ball of the foot were removed and the claw toes were corrected. The pins hold the toes in place while the soft tissues heal. The pins are removed in the office after 4 to 6 weeks with minimal discomfort.

To fix the bend in the toes themselves, the surgeon may suggest cutting a tendon or removing a small portion of bone of the toes to allow them to straighten. Pins that stick out of the foot are temporarily required and will be removed in the office after healing takes place.

There are some newer implants available that can be buried within the toes, which avoid the need for pins sticking out of the foot. These implants may not work if the bone is soft, or if significant destruction of the joints has occurred.

This operation puts a lot of stress on the blood vessels and skin of the foot. In severe cases, the toes may not survive the operation and may require amputation of a portion or the entire toe. This operation can provide the patient with a high level of function and the ability to enjoy a wider variety of shoewear.

Footwear

Reconstruction of the foot does not mean that a patient will be required to wear bulky and unappealing shoes every day. The patient shown here had both feet reconstructed. She is able to wear sandals and mild heels without difficulty. Although these types of shoes are not recommended all the time, they can be worn from time to time. Not all patients will achieve such an excellent result.

Preparing for Surgery

Many of the medications that help with RA also affect the ability of the body to heal wounds and fight infection. Your surgeon will work with your rheumatologist or medical doctor to review which of your medications will need to be stopped prior to surgery. Once the wounds are healed, the medication is typically resumed.

This period of time can be very difficult for patients with other areas of the body that are affected by RA. Many fusions require at least 6 weeks of time where no pressure can be placed on the foot. Making appropriate preparations to ensure you have help at home is crucial for success after surgery.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday