Ask the Doc...If The Problem Persists - See A Specialist

5/30/2014, 1:36 p.m.
It is always important for physicians that treat someone who has had an injury or surgery on a bone or joint to consider the importance of the functional aspects of that individual.

“If someone has had an injury or surgery on a bone or joint that has healed, but they are still having problems, can anything else be done to help them?”

Your question is a good one and heartfelt. That said, it obviously depends upon what the incident was as well as what type of treatment was rendered.

Generally speaking, it’s important to understand that in many instances there is a great deal more that can be done for problems such as this that are often not thought of. The reason for this is often due to our current age of specialization, which like most things has both positive and negative aspects.

A specialist is someone who really knows more and more about less and less. So the more well versed they are in their own area of expertise, the less they are often aware of what may be available to help you outside of their own specialty. I see this each and every day and am quite frankly absolutely amazed.

As a specialist myself, I knew early on that I would face this same problem, so although I had the best training in the country in my own specialty, every Friday for many years, I visited and observed the top physicians I could find at Emory and elsewhere in specialties other than my own. I spent the day with them, continuing to see things I otherwise would never have had the opportunity to learn. It has helped me greatly in understanding the much broader aspects of medicine and in being able to offer my patients far more.

It is always important for physicians that treat someone who has had an injury or surgery on a bone or joint to consider the importance of the functional aspects of that individual. Structural problems like a longer leg or flattened foot that might not have been a problem for years, often becomes significant once an injury occurs. That’s because injuries put additional stress on our structurally imperfect musculoskeletal systems. They also alter body mechanics.

For example, ACL knee injuries are often associated with excessive pronation (a rolling in or flattening of the foot). Even surgical procedures that have been done in an expert manner do nothing to treat this underlying factor, and so lingering pain and the likelihood of recurrence remains. Those that have had an ankle fusion or severe fractures will have a shortening on that side. Many may already have had a shortening on that very same side.

Now the added shortening of an injury or surgery could cause major problems in the weight-bearing joints of the knees, hips and back. Simply putting a lift on the other side that is not very accurately done will lead to many other musculoskeletal issues with other joints. These same individuals usually benefit from certain shoe modifications on the injured side that also are often not prescribed.

The same is true of those that have had a joint replacement due to an injury or arthritis. These patients often think that their problem is solved. But much like putting a new tire on a car, if the frame is bent, the new tire will also wear out early and irregularly.

The bottom line is that I honestly feel everyone should be evaluated structurally and this is true even if they have not had surgery or an injury. We are all moving, structural entities that are imperfect and asymmetrical at best. We all have one leg that is longer, one foot that is flatter, etc. and any degree of abnormality will increase our risks of injury, hamper optimal performance in any sport, and can later cause arthritic changes. Permanently correcting these problems can truly be beneficial in many, many ways.

A former reconstructive foot and ankle surgeon, past Clinical Instructor of Medicine at Emory, and Fellow of the American College of Rheumatology, Dr. Pack practices in Greensboro and Atlanta. He treats athletes at all levels and works with patients who have arthritis and want to remain active. In the 2004 Olympics he had a silver and gold medalist, and helped the UGA Golf Team (2005 NCCA National Champions). For further information please contact him directly at 706-454-0040 or dr.loupack@mindspring.com or see www.drloupack.com. His new book, The Arthritis Revolution, Latest Research on Staying Active Without Pain Medication or Surgery, is available on LuLu.com or Amazon.com.