This article is featured on Humpal Physical Therapy & Sports Medicine Centers
Plantar fasciitis is a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes called a heel spur. Plantar fasciitis is the correct term to use when there is active inflammation. Plantar fasciosis is more accurate when there is no inflammation but chronic degeneration instead. Acute plantar fasciitis is defined as inflammation of the origin of the plantar fascia and fascial structures around the area. Plantar fasciitis or fasciosis is usually just on one side. In about 30 per cent of all cases, both feet are affected.
ANATOMY
Where is the plantar fascia, and what does it do?
The plantar fascia (also known as the plantar aponeurosis) is a thick band of connective tissue. It runs from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps support the arch of the foot by acting something like the string on an archer’s bow. It is the source of the painful condition plantar fasciitis.
The plantar fascia is made up of collagen fibers oriented in a lengthwise direction from toes to heel (or heel to toes). There are three separate parts: the medial component (closest to the big toe), the central component, and the lateral component (on the little toe side). The central portion is the largest and most prominent.
Both the plantar fascia and the Achilles’ tendon attach to the calcaneus. The connections are separate in the adult foot. Although they function separately, there is an indirect relationship. If the toes are pulled back toward the face, the plantar fascia tightens up. This position is very painful for someone with plantar fasciitis. Force generated in the Achilles’ tendon increases the strain on the plantar fascia. This is called the windlass mechanism. Later, we’ll discuss how this mechanism is used to treat plantar fasciitis with stretching and night splints.
CAUSES
How does plantar fasciitis develop?
Plantar fasciitis can come from a number of underlying causes. Finding the precise reason for the heel pain is sometimes difficult.
As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This is just how the string on a bow is stretched by the force of the bow trying to straighten. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body.
As this process of injury and repair repeats itself over and over again, bone spur (a pointed outgrowth of the bone) sometimes forms as the body’s response to try to firmly attach the fascia to the heel bone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem.
As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate padding on the heel. With less of a protective pad on the heel, there is a reduced amount of shock absorption. These are additional factors that might lead to plantar fasciitis.
Fat Pad
Some physicians feel that the small nerves that travel under the plantar fascia on their way to the forefoot become irritated and may contribute to the pain. But some studies have been able to show that pain from compression of the nerve is different from plantar fasciitis pain. In many cases, the actual source of the painful heel may not be defined clearly.
SYMPTOMS
What does plantar fasciitis feel like?
The symptoms of plantar fasciitis include pain along the inside edge of the heel near the arch of the foot. The pain is worse when weight is placed on the foot. This is usually most pronounced in the morning when the foot is first placed on the floor.
Prolonged standing can also increase the painful symptoms. It may feel better after activity but most patients report increased pain by the end of the day. Pressing on this part of the heel causes tenderness. Pulling the toes back toward the face can be very painful.
DIAGNOSIS
How do health care providers diagnose the condition?
When you first visit medical care, the doctor will typically examine your foot and speak with you about the history of your problem. Diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions.
Some patients may be referred to an additional doctor for further diagnosis. Once your diagnostic examination is complete, treatment options will be offered that will help speed your recovery, so that you can more quickly return to your active lifestyle.
TREATMENTS
Non-surgical Rehabilitation
Nonsurgical management of plantar fasciitis is successful in 90 per cent of all cases. When you begin physical therapy, Physical Therapists will design exercises to improve flexibility in the calf muscles, Achilles’ tendon, and the plantar fascia.
Treatments will be applied to the painful area to help control pain and swelling. Examples include ultrasound, ice packs, and soft-tissue massage. Physical Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine, prescribed by your doctor, into the sore area.
There may be customized arch support, or orthotic, designed to support the arch of your foot and to help cushion your heel. Supporting the arch with a well fitted orthotic may help reduce pressure on the plantar fascia. Alternatively, we may recommend placing a special type of insert into the shoe, called a heel cup. This device can also reduce the pressure on the sore area. Wearing a silicone heel pad adds cushion to a heel that has lost some of the fat pad through degeneration.
Your Physical Therapist will also provide ideas for therapies that you can perform at home, such as doing your stretches for the calf muscles and the plantar fascia. We may also have you fit with a night splint to wear while you sleep. The night splint keeps your foot from bending downward and places a mild stretch on the calf muscles and the plantar fascia. Some people seem to get better faster when using a night splint and report having less heel pain when placing the sore foot on the ground in the morning.
We find that many times it takes a combination of different approaches to get the best results for patients with plantar fasciitis. There isn’t a one-size-fits-all plan. Some patients do best with a combination of heel padding, medications, and stretching. If this doesn’t provide relief from symptoms within four to six weeks, then we may advise additional Physical Therapy and orthotics.
Finding the right combination for you may take some time. Don’t be discouraged if it takes a few weeks to a few months to find the right fit for you. Most of the time, the condition is self-limiting. This means it doesn’t last forever but does get better with a little time and attention. But in some cases, it can take up to a full year or more for the problem to be resolved.
Post-surgical Rehabilitation
Although recovery rates vary among patients, it generally takes several weeks before the tissues are well healed after surgery. The incision is protected with a bandage or dressing for about one week after surgery. You will probably use crutches briefly, and your Physical Therapist can help you learn to properly use your crutches to avoid placing weight of your foot while it heals.
The stitches are generally removed in 10 to 14 days. However, if your surgeon used sutures that dissolve, you won’t need to have the stitches taken out. You should be released to full activity in about six weeks.
Surgical release of the plantar fascia decreases stiffness in the arch. However, it can also lead to collapse of the longitudinal (lengthwise) arch of the foot. Releasing the fascia alters the biomechanics of the foot and may decrease stability of the foot arch. The result may be increased stress on the other plantar ligaments and bones. Fractures and instability have been reported in up to 40 per cent of patients who have a plantar fasciotomy.
Throughout your post-surgical recovery, your Physical Therapist will note your progress and be watchful for the development of fractures and instability.
PHYSICIAN REVIEW
Your doctor may order an X-ray to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation.
Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter’s syndrome, or ankylosing spondylitis. These are diseases that affect the entire body but may show up at first as pain in the heel.
A cortisone injection into the area of the fascia may be used but has not been proven effective. Studies show better results when ultrasound is used to improve the accuracy of needle placement. Cortisone should be used sparingly since it may cause rupture of the plantar fascia and fat pad degeneration and atrophy, making the problem worse.
Botulinum toxin A, otherwise known as BOTOX, has been used to treat plantar fasciitis. The chemical is injected into the area and causes paralysis of the muscles. BOTOX has direct analgesic (pain relieving) and anti inflammatory effects. In studies so far, there haven’t been any side effects of this treatment.
Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It’s possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.
Clinical trials are underway investigating the use of radio frequency to treat plantar fasciitis. It is a simple, noninvasive form of treatment. It allows for rapid recovery and pain relief within seven to 10 days. The radio waves promote angiogenesis (formation of new blood vessels) in the area. Once again, increasing blood flow to the damaged tissue encourages a healing response.
SURGERY
Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas:
- remove the bone spur (if one is present)
- release the plantar fascia (plantar fasciotomy)
- release pressure on the small nerves in the area
Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision.
Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present that is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.
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
8:00am – 4:30pm
Weak Hip Flexors: Signs, Symptoms, and How to Treat Them
in Hip ConditionsArticle featured on MedicalNewsToday, medically reviewed by Gregory Minnis, DPT — Written by Lois Zoppi on February 27, 2021
Weak hip flexors can cause the surrounding muscles to overcompensate, which can cause pain and difficulty walking. Treatment for weak hip flexors includes physical therapy and exercises.
The hip flexors are muscles that connect the lower back to the hips, groin, and thigh bone. This muscle group includes the psoas muscle, which helps push the top of the leg upward.
The hip flexors stabilize the lower spine. They play a major role in walking, postural alignment, joint mobility, flexibility, and balance.
This article explains what symptoms and risks can come with weak hip flexors and how a person can strengthen them.
Symptoms
The symptoms of weak hip flexors can affect a range of different areas in the body.
General symptoms may include:
These symptoms occur because the joints try to compensate for weak hip flexors, which leads to them overworking.
Pain in the hip flexor area may be the result of a hip flexor strain. This is different from weak hip flexor muscles, although weakness can cause a strain to occur.
Difficulty when walking
The psoas muscle is responsible for swinging the leg forward while walking. If this muscle is weak, a person may have to exert more energy and rely on other muscles — the rectus femoris muscle in the thigh and the hamstrings. These muscles may overcompensate during walking, which might put excess strain on them and cause discomfort.
A person may also find climbing stairs difficult as it may be hard to lift the leg.
Gait
Stiff knee gait is when a person walks with limited knee flexion, or bend, in the knee. Weakness in the hip flexors can lead to a stiff knee gait.
A 2016 study involving 47 people with severe hip arthritis revealed a correlation between hip flexor strength and gait. Participants in the study with the strongest hip abductors and hip flexors had a better gait than those with weaker muscles in that area.
However, other factors in the study that led to better gait were lower pain levels and better quality of life. Scientists concluded that muscle strength does play a moderate role in improving gait.
Posture
A person may experience lower back pain if they have a weak hip flexor, as the hip flexor is an important spinal stabilizer.
According to a recent article weakness in the hip flexors can make it difficult for a person to maintain a straight posture. Weak hip flexors can also cause the pelvis to tilt, which can affect posture and cause lower back pain.
Risks
Weakness in the hip flexors could result in injury, as well as the symptoms above. An injury could occur to the spine, legs, and knees if they have to overcompensate for weakness in the hip flexor muscles.
What causes weak hip flexors?
There are many different possible causes of weak hip flexors. These include:
Lack of exercise
Not partaking in regular physical activity can lead to weak hip flexors. Underuse of the hip muscles can cause the muscle to degenerate and become weak, which is known as muscle atrophy.
Sitting for long periods
Staying seated for extended periods can cause weakness in the psoas muscle. This is because the muscle does not work as hard as if the person were standing.
Osteoarthritis
Osteoarthritis in the hip can also cause weak hip flexors. It can also cause weakness in the knees, hamstrings, and buttock muscles.
Lateral transpsoas surgery
Lateral transpsoas surgery, a type of operation on the spine, can often leave a weakness in some hip flexor muscles.
Cerebral palsy
According to an article in the Journal of Ultrasound Medicine, people with cerebral palsy may experience weakness in the hip muscles. Cerebral palsy can also increase the risk of hips coming out of joint during childhood.
Tight or weak hip flexors?
Weak hip flexors are not the same as tight hip flexors. Sitting for prolonged periods could cause the hip flexors to become tight, as well as weak. Symptoms that come with tight hip flexors include lower back pain and hip pain.
How to test for weak hip flexors
A person can see whether they have weak hip flexors using resistance tests and simple exercises.
Seated knee raise
A person with weak hip flexors will not be able to resist the added pressure on the leg.
Lying knee raise
Lie down flat on the back, bringing one leg to the chest, using the hands.
If it is difficult to keep the leg up close to the chest after letting go of it, a weak hip flexor may be the culprit.
How to strengthen weak hip flexors
Exercises can be useful to prevent or strengthen weakness in the hip flexor muscles. Some people also find stretching useful for tight hip flexors.
The following exercises could help reduce weakness in the hip flexors:
Ankle weights
Doing this exercise from a standing position can also be effective.
Mountain climbers with floor sliders
This exercise uses sliders, which are small discs that a person can place underneath the feet to slide them across the floor without friction.
The mountain climber pose involves the following:
Lunges
Wall psoas hold
Skater squats
Resistance band training
A 2016 study on 33 people involved one group carrying out strengthening exercises using an elastic resistance band for three 10-minute periods each week for 6 weeks. They progressed the repetitions of the exercises they were doing over the 6 weeks. The control group did not carry out these strength exercises.
The scientists concluded that using exercise bands in this context can significantly strengthen the hip flexors.
The following is an example of an exercise that uses an elastic exercise band to strengthen the hip flexors:
Summary
Underuse of the muscles or sitting down for extended periods can cause weak hip flexors. Conditions such as and osteoarthritis can also cause weakness in this muscle group.
A person with weak hip flexors may experience lower back or hip pain and may have difficulty doing certain activities, such as walking or climbing stairs.
Weak hip flexors can affect a person’s posture and the way they walk.
To remedy weak hip flexors, a person can try a range of strengthening exercises that target the hip flexors.
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
8:00am – 4:30pm
Are You Ready for a Marathon?
in Prevention, Sports Related InjuriesArticle featured on Summit Orthopedics
If you are a runner, running a marathon may be on your bucket list. We share some advice for you to consider before you commit to your first marathon.
In the summertime race events are plentiful. Runners can include the whole family in a day of fitness fun by signing up for a family run, race to raise money for worthy causes, or set their sites on the race that tests their endurance as a runner: the marathon. It is important for aspiring marathoners to understand that it is one thing to run a 5-mile course, and quite another to complete a 26.2 mile race.
The decision to run a marathon should be given serious consideration. To run a marathon safely means making a significant time commitment to months of planning and training.
We suggest that runners consider three factors before they commit to their first marathon.
Schedule
Training for a marathon means dedicated time to training; but that’s not where your time commitment ends. You’ll also need time for proper recovery between training sessions, and should also factor in a higher-than-normal level of fatigue. If you are at a point where demands on your time are high, or you may not have the support you need, you might want to consider a half marathon instead. This shorter race still requires training, and will give you more first hand experience about whether you are ready for the demands of a longer race.
Pre-Existing Injuries
If you have any knee, hip, or back issues, marathon training is going to increase the stress on problem areas. This is a factor you should discuss with a physical therapist before you commit to training for a big race.
Nutrition
Marathon training increases your body’s nutrition needs. If you aren’t a healthy eater, are you ready to make significant changes in your diet to protect your body’s performance?
Running is a wonderful way to stay fit and healthy, and every runner talks about the emotional satisfaction that goes hand-in-hand with their sport. We applaud ambitious goals like checking that first marathon off the bucket list, and we want you to be ready and able to commit the time and discipline you’ll need to safely train to achieve your goal.
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
8:00am – 4:30pm
Dr. Kenneth Hegewald, DPM FACFAS has joined the OSM Team!
in AnnouncementsWe are happy to announce the newest edition to our team – Dr. Kenneth Hegewald, DPM FACFAS!
Dr. Hegewald is a board-certified, fellowship trained podiatric foot and ankle surgeon. He completed his undergraduate education at Carroll College in Helena, MT and podiatric medical school at Des Moines University in Iowa. He then went on to complete his foot and ankle surgical residency with Virginia Mason Franciscan Health in Tacoma, WA.
Following residency he furthered his training by completing the esteemed Silicon Valley Reconstructive Foot and Ankle Fellowship with Palo Alto Medical Foundation focused on trauma, reconstruction and total ankle replacement.
Dr. Hegewald comes to OSM with over five years of prior orthopedic foot and ankle experience treating year-round athletes in the Gorge where he worked out of Hood River, OR. He provides comprehensive foot and ankle care and offers a spectrum of advanced treatment options. He is board certified in foot, reconstructive rearfoot and ankle surgery by the American Board of Foot and Ankle Surgery. In his free time, Dr. Hegewald enjoys kiteboarding, and skiing outside of work as well as spending time with his beautiful wife, son and daughter.
We look forward to a happy future with Dr. Hegewald.
Causes of Elbow or Arm Pain
in Arm InjuriesArticle features on News Medical Life Sciences
There are various possible causes of elbow pain or arm pain. These include injury to the arm, compression of the nerves that serve the arm, arthritis, and various other health conditions.
Injury
A sprain can occur when a movement of the arm has caused damage to the connective tissues in the area. This can present as arm or elbow pain. This damage is usually acute and temporary, and the pain will improve with time as the tissues are repaired.
A fracture or dislocation of a bone in the arm or elbow may also be responsible for causing elbow pain. Most patients are able to pinpoint the cause of the pain or trace it to a certain incident that caused the damage.
Repetitive strain injury (RSI) can also cause elbow pain. It is due to the performance of repetitive tasks that involve movements of the elbows. As such, it commonly affects office workers who use computers frequently throughout the day, and other individuals whose job comprises repetitive manual work.
Tennis elbow or golfer’s elbow can cause elbow pain, and occurs due to the overuse of the muscles and tendons in the joint. It is so named because it is most common in individuals who plan tennis or golf, due to the arm movements that are involved in these sports.
Nerve compression
The joints and bones of an individual show wear and tear as part of the natural aging process. This can lead to the squashing or trapping of nerves, which in turn can cause pain in various areas of the body. In this case, the nerves around the elbow may be pinched, causing pain. Other sensations, such as numbness or tingling, may also be experienced.
Cervical spondylosis is a condition that involves compression of the spinal nerves in the neck region. Some of these nerves are responsible for the sensory messages of pain carried to and from the arm. Damage to them can hence lead to arm pain. Sometimes the compressed nerve may be located in the arm.
A cervical rib is a musculoskeletal abnormality that involves the presence of an additional rib above the normal first rib. This extra bone can interfere with the free passage of nerves in the region, which may lead to elbow pain.
Arthritis
Osteoarthritis or rheumatoid arthritis that affects the elbow joint can lead to stiffness, pain and inflammation of the elbow and arm.
Osteoarthritis involves damage to the cartilage at the ends of the bones that help to prevent friction between the bones that take part in the joint, often due to overuse of or injury to the joint. This leads to rubbing of the bones against each other, which provokes the symptoms of arthritis.
Rheumatoid arthritis involves an autoimmune response of the body that leads to damage to the synovial membrane that lines the joints in the body, including the elbow. In this condition, both elbows are usually affected.
Other health conditions that cause elbow pain
Angina is a health condition that involves reduced blood flow to the heart muscles as a result of narrowing of the blood vessels. Individuals with angina may experience a dull, throbbing pain in the chest, neck, and left arm as a symptom of the condition, particularly during physical activity or when they undergo stress.
Gout is another health condition characterized by the formation of sharp crystals at various locations around the body, including inside the elbow joints. This is due to a high concentration of uric acid in the body. This can cause severe elbow pain during a gout attack.
Olecranon bursitis is the build up of fluid inside the fold of smooth synovial membrane that cushions the olecranon (the bony tip of the elbow joint). This can cause pain and inflammation.
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
8:00am – 4:30pm
Why are arthritis symptoms worse at night?
in ArthritisArticle featured on Medical News Today
Many people notice that their arthritis symptoms get worse at night. When this occurs, it can be hard for people to sleep, leaving them exhausted in the morning and potentially contributing to daytime pain or fatigue.
It is common for pain to get worse at night. A 2020 study found that online searches for information about pain management peaked between 11:00 p.m. and 4:00 a.m.
Doctors do not fully understand why arthritis pain often worsens at night, but possible causes involve changes in the levels of hormones and cytokines, which are cell-signaling proteins, in the body. Daytime arthritis medication, which some people take during the morning, may also wear off by the evening.
In this article, we examine why arthritis pain gets worse at night and how it disrupts sleep. We also provide tips on ways to improve sleep.
Why arthritis symptoms get worse at night
Researchers have several theories to explain why many people with arthritis experience worse pain at night.
One theory is that the body’s circadian rhythm may play a role. In people with rheumatoid arthritis (RA), the body releases less of the anti-inflammatory chemical cortisol at night, increasing inflammation-related pain.
Other processes may also intensify RA pain, including the nighttime release of pro-inflammatory cytokines, an increased number of cells traveling to inflamed tissue, and changes in the body’s immune response.
Additionally, the body releases higher levels of melatonin and prolactin at night, both of which can cause an increase in inflammatory cytokines.
A person’s arthritis inflammation and pain may worsen if:
How arthritis disrupts sleep
Many studies show a link between arthritis and sleep deprivation. People with arthritis may have trouble falling asleep and staying asleep. They may also report lower quality sleep due to the pain that the condition causes.
A 2021 study involving 133 people with arthritis and 76 matched controls found that 54.1% of people with arthritis reported poor sleep quality. The issues included:
A 2018 study reached a similar conclusion. The researchers compared 178 people with arthritis — 120 with RA and 58 with osteoarthritis (OA) — with 51 people with no arthritis. The rate of insomnia was comparable between the OA and control groups, at 32% and 33%, respectively. However, insomnia was significantly more prevalent among the RA group, affecting 71% of these participants.
Both studies also found a link between arthritis and mental health. People with arthritis were more likely to report marital problems and experience depression, suggesting that insomnia may be a reaction not only to arthritis but also to stress.
The link between arthritis pain and sleep goes in both directions. For example, arthritis can make it difficult to sleep, but sleep deprivation can also worsen arthritis pain. A 2018 study found that pain intensified as sleep worsened. In addition, a 2017 study found that people with knee OA who had poor quality sleep were more likely to ruminate on their pain.
Tips to get better sleep with arthritis
As insomnia can make pain worse, it is important that people with arthritis take steps to improve their sleep, as well as treating their pain.
Practice better sleep hygiene
Tossing and turning at night when unable to sleep may cause a person to notice and fixate on their pain. Good sleep hygiene may help a person fall asleep faster and remain asleep longer. People can try the following:
While they are working on improving their sleep hygiene, a person may find it helpful to get back up if they cannot fall asleep. Doing this helps the association between bed and sleep remain strong.
Develop an arthritis pain management strategy
A person can work with a doctor to develop a plan for managing arthritis pain.
Where possible, it is important to avoid going to bed in pain. A doctor can recommend an appropriate pain relief medication to prevent pain before bedtime. They might suggest:
Identifying and managing arthritis triggers can also be helpful. A person can try keeping a pain and sleep log to determine and address any patterns that seem to worsen sleep or pain.
Consider psychotherapy
Being in pain night after night can affect a person’s emotional well-being and cause them to experience more pain. A 2017 study of people with knee OA found that people with sleep issues tend to catastrophize and focus on their pain, intensifying both pain and insomnia.
Therapy can help a person better cope with their pain and deal with daytime stressors that undermine sleep. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based intervention that assists a person with learning new skills for sleeping better.
Summary
Nighttime arthritis pain is common. However, having arthritis does not mean that a person has to live with chronic sleep deprivation. The right combination of medications, sleep hygiene practices, and lifestyle adjustments may help a person sleep better and for longer.
People with arthritis should be aware that while pain can make sleep worse, low quality sleep can also intensify pain and increase stress. This can create a vicious cycle that arthritis medication alone may not be sufficient to break.
The best path to complete relief is to treat both insomnia and arthritis. A person can work with their doctor to create a treatment plan that addresses the two conditions.
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
8:00am – 4:30pm
Swollen Knee Causes and Treatments
in Knee Injuries, Knee PainArticle featured on the Mayo Clinic
Overview
A swollen knee occurs when excess fluid accumulates in or around your knee joint. Your doctor might refer to this condition as an effusion (ih-FYU-zhen) in your knee joint. Some people call this condition “water on the knee.”
A swollen knee may be the result of trauma, overuse injuries, or an underlying disease or condition. To determine the cause of the swelling, your doctor might need to obtain a sample of the fluid to test for infection, disease or injury.
Removing some of the fluid also helps reduce the pain and stiffness associated with the swelling. Once your doctor determines the underlying cause of your swollen knee, appropriate treatment can begin.
Symptoms
Signs and symptoms typically include:
When to see a doctor
See your doctor if:
Causes

Many types of problems, ranging from traumatic injuries to diseases and other conditions, can cause a swollen knee.
Injuries
Damage to any part of your knee can cause excess joint fluid to accumulate. Injuries that can cause fluid buildup in and around the knee joint include:
Diseases and conditions
Underlying diseases and conditions that can produce fluid buildup in and around the knee joint include:
Risk factors
Complications
Complications of a swollen knee can include:
Prevention
A swollen knee is typically the result of an injury or chronic health condition. To manage your overall health and prevent injuries:
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
8:00am – 4:30pm
Common Heel Pain
in Foot PainThis article is featured on Humpal Physical Therapy & Sports Medicine Centers
Plantar fasciitis is a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes called a heel spur. Plantar fasciitis is the correct term to use when there is active inflammation. Plantar fasciosis is more accurate when there is no inflammation but chronic degeneration instead. Acute plantar fasciitis is defined as inflammation of the origin of the plantar fascia and fascial structures around the area. Plantar fasciitis or fasciosis is usually just on one side. In about 30 per cent of all cases, both feet are affected.
ANATOMY
Where is the plantar fascia, and what does it do?
The plantar fascia (also known as the plantar aponeurosis) is a thick band of connective tissue. It runs from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps support the arch of the foot by acting something like the string on an archer’s bow. It is the source of the painful condition plantar fasciitis.
The plantar fascia is made up of collagen fibers oriented in a lengthwise direction from toes to heel (or heel to toes). There are three separate parts: the medial component (closest to the big toe), the central component, and the lateral component (on the little toe side). The central portion is the largest and most prominent.
Both the plantar fascia and the Achilles’ tendon attach to the calcaneus. The connections are separate in the adult foot. Although they function separately, there is an indirect relationship. If the toes are pulled back toward the face, the plantar fascia tightens up. This position is very painful for someone with plantar fasciitis. Force generated in the Achilles’ tendon increases the strain on the plantar fascia. This is called the windlass mechanism. Later, we’ll discuss how this mechanism is used to treat plantar fasciitis with stretching and night splints.
CAUSES
How does plantar fasciitis develop?
Plantar fasciitis can come from a number of underlying causes. Finding the precise reason for the heel pain is sometimes difficult.
As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This is just how the string on a bow is stretched by the force of the bow trying to straighten. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body.
As this process of injury and repair repeats itself over and over again, bone spur (a pointed outgrowth of the bone) sometimes forms as the body’s response to try to firmly attach the fascia to the heel bone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem.
As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate padding on the heel. With less of a protective pad on the heel, there is a reduced amount of shock absorption. These are additional factors that might lead to plantar fasciitis.
Fat Pad
Some physicians feel that the small nerves that travel under the plantar fascia on their way to the forefoot become irritated and may contribute to the pain. But some studies have been able to show that pain from compression of the nerve is different from plantar fasciitis pain. In many cases, the actual source of the painful heel may not be defined clearly.
SYMPTOMS
What does plantar fasciitis feel like?
The symptoms of plantar fasciitis include pain along the inside edge of the heel near the arch of the foot. The pain is worse when weight is placed on the foot. This is usually most pronounced in the morning when the foot is first placed on the floor.
Prolonged standing can also increase the painful symptoms. It may feel better after activity but most patients report increased pain by the end of the day. Pressing on this part of the heel causes tenderness. Pulling the toes back toward the face can be very painful.
DIAGNOSIS
How do health care providers diagnose the condition?
When you first visit medical care, the doctor will typically examine your foot and speak with you about the history of your problem. Diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions.
Some patients may be referred to an additional doctor for further diagnosis. Once your diagnostic examination is complete, treatment options will be offered that will help speed your recovery, so that you can more quickly return to your active lifestyle.
TREATMENTS
Non-surgical Rehabilitation
Nonsurgical management of plantar fasciitis is successful in 90 per cent of all cases. When you begin physical therapy, Physical Therapists will design exercises to improve flexibility in the calf muscles, Achilles’ tendon, and the plantar fascia.
Treatments will be applied to the painful area to help control pain and swelling. Examples include ultrasound, ice packs, and soft-tissue massage. Physical Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine, prescribed by your doctor, into the sore area.
There may be customized arch support, or orthotic, designed to support the arch of your foot and to help cushion your heel. Supporting the arch with a well fitted orthotic may help reduce pressure on the plantar fascia. Alternatively, we may recommend placing a special type of insert into the shoe, called a heel cup. This device can also reduce the pressure on the sore area. Wearing a silicone heel pad adds cushion to a heel that has lost some of the fat pad through degeneration.
Your Physical Therapist will also provide ideas for therapies that you can perform at home, such as doing your stretches for the calf muscles and the plantar fascia. We may also have you fit with a night splint to wear while you sleep. The night splint keeps your foot from bending downward and places a mild stretch on the calf muscles and the plantar fascia. Some people seem to get better faster when using a night splint and report having less heel pain when placing the sore foot on the ground in the morning.
We find that many times it takes a combination of different approaches to get the best results for patients with plantar fasciitis. There isn’t a one-size-fits-all plan. Some patients do best with a combination of heel padding, medications, and stretching. If this doesn’t provide relief from symptoms within four to six weeks, then we may advise additional Physical Therapy and orthotics.
Finding the right combination for you may take some time. Don’t be discouraged if it takes a few weeks to a few months to find the right fit for you. Most of the time, the condition is self-limiting. This means it doesn’t last forever but does get better with a little time and attention. But in some cases, it can take up to a full year or more for the problem to be resolved.
Post-surgical Rehabilitation
Although recovery rates vary among patients, it generally takes several weeks before the tissues are well healed after surgery. The incision is protected with a bandage or dressing for about one week after surgery. You will probably use crutches briefly, and your Physical Therapist can help you learn to properly use your crutches to avoid placing weight of your foot while it heals.
The stitches are generally removed in 10 to 14 days. However, if your surgeon used sutures that dissolve, you won’t need to have the stitches taken out. You should be released to full activity in about six weeks.
Surgical release of the plantar fascia decreases stiffness in the arch. However, it can also lead to collapse of the longitudinal (lengthwise) arch of the foot. Releasing the fascia alters the biomechanics of the foot and may decrease stability of the foot arch. The result may be increased stress on the other plantar ligaments and bones. Fractures and instability have been reported in up to 40 per cent of patients who have a plantar fasciotomy.
Throughout your post-surgical recovery, your Physical Therapist will note your progress and be watchful for the development of fractures and instability.
PHYSICIAN REVIEW
Your doctor may order an X-ray to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation.
Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter’s syndrome, or ankylosing spondylitis. These are diseases that affect the entire body but may show up at first as pain in the heel.
A cortisone injection into the area of the fascia may be used but has not been proven effective. Studies show better results when ultrasound is used to improve the accuracy of needle placement. Cortisone should be used sparingly since it may cause rupture of the plantar fascia and fat pad degeneration and atrophy, making the problem worse.
Botulinum toxin A, otherwise known as BOTOX, has been used to treat plantar fasciitis. The chemical is injected into the area and causes paralysis of the muscles. BOTOX has direct analgesic (pain relieving) and anti inflammatory effects. In studies so far, there haven’t been any side effects of this treatment.
Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It’s possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.
Clinical trials are underway investigating the use of radio frequency to treat plantar fasciitis. It is a simple, noninvasive form of treatment. It allows for rapid recovery and pain relief within seven to 10 days. The radio waves promote angiogenesis (formation of new blood vessels) in the area. Once again, increasing blood flow to the damaged tissue encourages a healing response.
SURGERY
Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas:
Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision.
Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present that is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.
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
8:00am – 4:30pm
What a Dislocated Elbow Means
in Elbow InjuriesArticle featured on the Cleveland Clinic.
The elbow is composed of three bones. A dislocation happens when any of these bones become separated or knocked out of place. If you think you have dislocated your elbow, you should get immediate medical help.
What is a dislocated elbow?
A dislocated elbow occurs when any of the three bones in the elbow joint become separated or knocked out of their normal positions.
Dislocation can be very painful, causing the elbow to become unstable and sometimes unable to move. Dislocation damages the ligaments of the elbow and can also damage the surrounding muscles, nerves and tendons (tissues that connect the bones at a joint).
You should seek immediate medical treatment if you think you have an elbow dislocation. Treatment reduces the risk of irreversible damage.
How common is a dislocated elbow?
The incidence of the injury has been estimated at 2.9 events per 100,000 people over the age of 16. In children, dislocations can happen when someone yanks on the child’s arm.
SYMPTOMS AND CAUSES
What causes a dislocated elbow?
There can be various causes of a dislocated elbow.
What are the signs and symptoms of a dislocated elbow?
A dislocated elbow can be partial or complete. A complete elbow dislocation involves a total separation and is called a luxation. When the elbow joint is partially dislocated, it is called a subluxation.
Doctors also classify elbow dislocations according to the extent of the damage and where it occurs. The 3 types include:
The signs and symptoms of a dislocated elbow vary depending on the severity of the injury and the bones involved. They include:
DIAGNOSIS AND TESTS
How is dislocated elbow diagnosed?
A doctor diagnoses a dislocated elbow by looking at the arm and moving the joint.
In many cases, doctors use an imaging test called an X-ray to see if the bone is injured. Occasionally, doctors use tests called MRI or CT scans to look for damage to the surrounding muscles and tendons.
MANAGEMENT AND TREATMENT
How is a dislocated elbow condition managed or treated?
Some dislocated elbows return to their usual position on their own. More severe cases need a doctor to return the bones to their proper position.
Treatment for a dislocated elbow varies according to the severity of the injury. Steps you can take to reduce pain while you wait to see a doctor include:
Treatments for an elbow dislocation include:
PREVENTION
Can dislocated elbow be prevented?
Caution can help reduce your risk of a dislocated elbow. Be careful on slippery surfaces and stairs to avoid falls. Avoid overtraining in sports to avoid overuse injuries.
What are the risk factors for dislocated elbow?
People at higher risk for a dislocated elbow include those who:
OUTLOOK/PROGNOSIS
What is the prognosis (outlook) for people with dislocated elbow?
Recovery times vary according to the severity of the elbow dislocation. Many dislocated elbows do not cause any further problems once they heal. They usually feel better as soon as a doctor puts the joint back in place.
LIVING WITH
When should I call the doctor?
Contact your doctor if you have the symptoms of a dislocated elbow. Do not try to push a dislocated elbow back into place yourself. This effort could damage the surrounding tissue and tendons and lead to complications. If you have a dislocated elbow, let your doctor know if you think you are not healing correctly or continue to have problems.
What questions should I ask my doctor?
If you have a dislocated elbow, you may want to ask your doctor:
When can I go back to my regular activities?
Healing time for a dislocated elbow varies depending on the severity of the injury. Most people with a dislocated elbow can return to their usual activities once a doctor has returned the joint to its normal position.
A sling can help protect the elbow joint so you can return to your usual activities while the joint heals. Your doctor will let you know when you can resume more physical activities such as sports or lifting heavy objects.
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
8:00am – 4:30pm
Managing Neck and Lower Back Pain
in Back Pain, Neck PainArticle featured on Cone Health
According to Dahari Brooks, MD, neck and lower back pain is often caused by muscle strain, degenerative disc disease or arthritis.
“If the pain comes on suddenly and out of the blue, you may have pulled a muscle and can begin with at home treatments,” shares Dr. Brooks.
If you suspect a pulled muscle, Dr. Brooks suggests resting for a day. You can treat pain with over-the-counter anti-inflammatory medications. In the first 24 hours or so, cold therapy can help minimize pain and swelling. Place an ice pack on the painful area for 10 minutes followed by 20-minute breaks. Later, you can consider cold and/or heat therapy for relief. Ease back into exercising with walking and stretching.
“On the other hand, if your chronic pain has worsened over time or you experience a sudden onset of arm or leg weakness, pain or numbness, it is time to make an appointment,” adds Dr. Brooks. “A comprehensive physical examination will help determine the cause of your problem.”
During office visit, you will be examined for issues such as a pinched nerve. You may need to take an x-ray to rule out structural issues. Often, physical therapy or steroid injections can offer improvement. If not, soft tissue imaging can reveal bone spurs or discs that have herniated, degenerated or broken down over time.
“If you are experiencing horrific or radiating pain, weakness or numbness in the neck or limbs or lack of balance, make an appointment to be seen right away,” concludes Dr. Brooks. “These types of symptoms can signal a more serious issue and require more immediate attention.”
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
8:00am – 4:30pm
Is It Time for a Pain Management Reboot?
in pain reliefArticle featured on WebMD
Now that we are entering a new phase in the COVID-19 pandemic where access to vaccines is high, infection rates are declining, and there is greater access to health-related services, this might be a time to reevaluate your pain management plan and consider what changes can make a positive impact.
Let’s start by taking a look at some of the ways the pandemic may have increased your pain problem:
Now that access to resources has likely improved in many of your communities, here are some thoughts to help you navigate your next steps:
Now might be the perfect time to consider what you can safely add or modify to your pain management plan. Before starting something new or restarting something that maybe you haven’t done in over a year, it is always a good idea to first talk with your doctor.
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
8:00am – 4:30pm