Archive for the 'Ankle and Knee' Category

Consultant Q&A with Mr Fares Haddad- leading knee and hip surgeon

Mr Fares Haddad- leading knee and hip surgeon

Considering having hip or knee surgery?  Make sure you read my interview with top London knee and hip surgeon Mr Fares Haddad.  During Consultant Q&A I ask Fares questions that are on my patients’ minds about his field of hip and knee surgery. If you want to know about latest advances, “lubricating” injections for the knee and more, then please read on.

At BOOST PHYSIO we’ve enjoyed rehabilitating many of Fares’ patients over the years following hip and knee operations and I’ve also had the benefit of watching Fares perform various knee operations-hence we highly recommend him to our patients. If you want to read Fares’ impressive biography and CV follow this link to his website, but in brief Fares Haddad is a Hip and Knee Reconstructive Surgeon at University College Hospitals, The Princess Grace Hospital and the Wellington Hospital.  He is Divisional Clinical Director of Surgical Specialties at UCH, and Director of the Institute of Sport, Exercise and Health at University College London.  Clearly an expert in his field!

Q: Fares, you are well known for being one of a few surgeons to perform key hole surgery for hip problems. Which patients do you find benefit the most from this procedure?
A: 
Hip arthroscopy is a procedure that has expanded dramatically over the last ten years. The indications have become much clearer. The most successful interventions are in cases where there are isolated labral tears or when patients present in the early phases of femorocetabular impingement (FAI) before the joint is irrevocably damaged. FAI is a condition where the bones of the hip joint develop in such a way that the patient can function relatively normally, and often very athletically, but where abnormal contact between the femur and pelvis damages the hip. These are typically in sporting individuals who either suffer an acute injury, the labral tear, or get the insidious onset of symptoms through activity such as running, cycling or football. Plain x-ray imaging and MRI scan gives us most of the information we need although CT scanning is occasionally necessary to look at the bony anatomy. By dealing with the primary bony impingement as well as the problems within joint we decrease symptoms and hopefully also prevent recurrence and further progression of the problem in future. 

Q:  What does the future hold for technological developments in treatments for arthritic hip and knee joints?
A: 
The management of early arthritis of the hip and knee is progressing at an impressive rate. Technical developments will focus in the first instance on prevention thus by replacing the damaged menisci and the damaged joint surface and injured ligaments. The new work on partial resurfacing of joints with novel materials such as Oxinium is very exciting. New work also on customising joint replacement will change the face of the management of arthritis giving us joint replacements that are much more functional and geared to high end activity such as sports. 
 
Q:  Which sports do you believe are suitable for patients following total hip replacement surgery?
A: 
Following a hip replacement operation, we encourage our patients to get back to normal day to day activity within 6 weeks. All non impact sports such as long distance walking, gym exercises, swimming, doubles tennis and golf are encouraged. It is perfectly feasible for patients to play singles tennis or indeed in certain circumstances squash and many of our patients do get back to running but it is important for the patients to realise that there is a tension between the amount of impact activity that they do and the wear that they will cause to their new joint. 

Q:  How effective do you find “lubricating” injections are for arthritic knees?

A:  Our experience of the Hyaluronic acid lubricating injections for knee and hip arthritis has been mixed. There are some patients who have an extremely good response that lasts up to six months. There are others who do not respond at all. It is very difficult to predict. My personal experience is that those patients have dry knees without effusions tend to respond better to Hyaluronic acid therapy whereas those with effusions can respond to aspiration and injection but do so for a shorter period of time.  These are nevertheless interesting therapies which we must continue to pursue both in our athletic population when we often use them after surgery and also in the arthritic population.

I hope that you have found this Consultant Q&A interesting, if you wish to discuss any issues regarding your hip or knee condition with myself or one of my physios, please do not hesitate to contact us, you can call the clinic in Hendon, NW London on 020 82017788 or email us at info@boostphysio.com 

The BOOST Blogger- Steven Berkman

Regards… The Boost Blogger, Steven Berkman

Cryocuff cold compression therapy

The Cryocuff is a fantastic bit of physiotherapy equipment we’ve invested in at BOOST PHYSIO. Cryocuff is a cold-compression therapy system that is ideal for treating knee, ankle and foot swelling and pain.

We tend to use it most often post-operatively. For example following total knee replacement, ACL reconstruction surgery, key hole surgery to the knee and post-meniscectomy. For ankle injuries we use Cryocuff to bring down swelling after torn ligaments, fractures and surgery (eg following bunion surgery, achilles tendon repair surgery etc).

What exactly is the Cryocuff system? There are various garments used for the different body parts- ie ankle, knee etc. These are applied by your physiotherapist to the affected area and the the garment is filled with iced water! As the garment fills with the iced water it begins to compress the affected area.

You should be familiar with the acronym RICE which is used in physiotherapy treatment and injury management: Rest, Ice, Compression, Elevation. Cryocuff treatment forms a crucial part of the ice and compression of the RICE regime.

Boost Physio in Hendon will apply and use this treatment when appropriate.

Ugg foot patient

I found out today that one of the people we are rehabilitating following her ankle and foot surgery diagnosed her problem from reading my article on UGG foot in our newsletter.

If you don’t know what UGG foot is, I’ll fill you in quickly. Ugg type boots may look very comfy and cosy and good for you, but they don’t support your feet. If you have dropped arches, pronate (that’s when your foot rolls inwards while walking) or very flat footed- wearing ugg type boots for long periods can be very painful and harmful for your feet and ankles. As our patient discovered…

She lives in her Uggs and in flat flip flop sandals. As her foot and ankle pain developed she thought she ought to wear her Uggs more, because she thought they were so good for you. Wrong- they were a big part of her problem.

She finally saw my article after months of trouble- diagnosed herself- but it was too late. She has had to have an operation to repair the tibialis posterior tendon in her foot and ankle because it had been over stretched and torn. A problem that would have been prevented if she’d been wearing better shoes instead of her Uggs and flip flops all the time.

Following excellent surgery and physiotherapy at BOOST PHYSIO she is on her road to recovery.

David Beckham’s Achilles injury- 6months at least

Everyone is asking me “how long will David Beckham be out for”- a long time I keep telling them!  It sounds like he has a ruptured achilles tendon, this is very easy to diagnose with 1 very simple test (the need for MRI’s and advanced scans etc is a nice bonus, but mainly useful if you suspect a partial tear only).

The achilles tendon is the very strong and tough sinew that attaches that big calf muscle (gastrocnemius and soleus) to the calcaneus (heel bone).  Ruptures (where the tendon snaps completely) of the achilles tendon are a common injury in over 35 year olds, making David Beckham a prime candidate for a rupture.  It is a common injury it football, but also in tennis, squash and basketball due to the explosive push-off (and also in fathers and sons races at school sports day as a good friend of mine will testify).

So what is the treatment- well it aint gonna grow back by itself- so surgery it is.  I’ve personally diagnosed and sent for surgery 4 cases of ruptured achilles tendon that have been missed by GPs.  The surgery stitches the tendon together and then usually involves immobilising the leg from the below the knee down to the toes for 6 weeks.  Then is the slow process of physiotherapy to recover the movement and strength.  Like I said 6 months out of sport at least. 

One of my patients had surgery in Israel for a ruptured achilles tendon which was very successful- this involved a per-cutaneus stitching of the tendon.  Per-cutaneus is where there is only a very small hole made in the skin, rather than a big incission to perform the traditional operation.  This led to much quicker rehab and recovery time- reduced by approximately 1/3.  I suspect that in David Beckham’s case a traditional procedure will be performed (probably today) because it is critical that the tendon is repaired very strongly and this may not be the case with the per-cutaneus procedure.

So in short David Beckham will not be able to attend the world cup in my opinion.

Steven Berkman- the Boost Blogger

The BOOST Blogger- Steven Berkman

So if UGGs are bad, how are Crocs?

You may have read about my view that UGG type boots can be bad for your feet and knees, well someone asked me today- what about Crocs? 

How good are Crocs for you

How good are Crocs for you?

 While they score low on style, Crocs actually score very high on being anatomically moulded with correct support being provided for the foot and hence ankle.  Not only this, but the very material that Crocs are made of are excellent for shock absorption and minimizing stresses and strains to the feet and ankles. 

The whole issue about shoes is that they should help to support the structure and mechanics of the foot and of course be comfortable and reduce shock being transmitted through the foot.  Crocs do this well, UGGs do this poorly.  

Looking at the inside of a Croc it is easy to see that it has has a contoured surface with arch support and a good heel cup that nestles your heel bone.  This heel cup and arch support help to maintain the mechanical alignment of the foot, ankle and knee.  In particular they minimise pronation, which is the movement that occurs in the foot when the foot rolls from the outside of the heel to the front of the big toe,  pronation can stress the ankle and knee joints and muscles. 

UGGs are they bad for you?

Could UGG type boots be bad for you?

UGG type boots however support the foot very poorly, they do not provide enough support to the heel bone (calcaneus) and the sole of the shoe does not have sufficient arch support.  For someone who is flat footed these shoes (along with shoes like ballet pumps) can be a big problem as they stress the sole of the foot, can lead to ankle and even knee pain. In children whose feet are still developing and growing particular care must be taken.