Footwear serves several useful functions, including protecting our feet, cushioning our body weight, providing comfort and, of course, adding a fashionable element to our wardrobe choices. However, selecting the proper footwear can also make a difference in your overall foot health. As you consider those fun new kicks, we encourage you to be mindful of how the correct type of shoe can help you avoid injuring or further exacerbating existing foot and ankle conditions. Specifically, ill-fitting shoes can be painful and cause issues like bunions, hammertoes, plantar fasciitis, Lisfranc injuries and more.

Of course, living on the gorgeous Gulf Coast, we can’t talk about footwear and not discuss flip-flops. When you live, work and play in the sunshine state, it’s nearly impossible to avoid wearing them. After all, it’s not particularly practical to march out on our sugar white sands in a pair of wing tip loafers. However, flip-flops are not appropriate for everyday use. They leave your feet vulnerable to bacterial and fungal infections, in addition to slipping around, causing painful blisters. Additionally, they contribute to heel pain, and the lack of support they provide can ultimately lead to bad posture.

We also treat many athletes of varying skill and experience levels who often find themselves wearing the wrong type of shoe. While the choices can be overwhelming, you can typically find shoes made for your specific athletic activity. From running, training and walking shoes to court and field sports shoes as well as specialty sports shoes, the options are endless. Visiting a specialty store where you can work with a trained staff member is often the best place to start.

For those who love to wear high heels, it’s equally imperative that you find the right fit to avoid injury or further damage to your feet and ankles. High heels are designed to point the foot down, which gives the leg a slender appearance. This position puts a lot of pressure on the ball of the foot, bending the toes up to meet the ground. The higher the heel, the higher the pressure on the ball of the foot, which, over time, wearing high heels may cause a stress fracture. However, by selecting options with lower heels and a wider toe box that matches your toe shape, you can alleviate pressure on the ball of the foot.

Regardless of the type of footwear you are considering, the following tips are helpful to keep in mind as you select how the shoes are constructed, correctly measuring your feet and finding the right fit.

Find a well-constructed shoe. Look for a cushioned heel with a firm sole that doesn’t easily twist or bend and has flexibility in the proper area, depending on the type of shoe. Adequate arch support in the shoe or inside the insert area is also essential.

Correctly measure and find the right size. Have your feet measured or measure yourself using provided online sizing guides. Your foot size and shape can change over time, and different brands may have minor differences in sizing that can have a significant impact. Additionally, measure both feet, as most people do not have feet precisely the same size, and take those measurements when your feet are the largest at the end of the day.

Consider the shape and fit of the shoe. The shape should resemble that of your foot and fit your foot comfortably. Don’t plan on shoes stretching over time. They should fit well when you buy them. The ball of your foot (the widest part just before your toes begin) should fit comfortably in the widest part of the shoe. If the shoe’s toe box is too small, your toes will rub against the top of the shoe causing calluses or sores.

Stand up and walk around in them. When you are standing, there is 3/8″ or 1/2″ (about the width of your finger) between your longest toe (usually the second toe) and the end of the shoe. Walk around to gauge the overall fit. They shouldn’t chafe or rub, and your heel should not slip or slide while walking.

If wearing the wrong type of shoe has caused an injury to your feet or ankles, or you have been experiencing symptoms of any of the painful conditions we’ve described, reach out to North Florida Bone & Joint Specialists. Our experienced physicians, Dr. Erik Nilssen and Dr. Sonya Ahmed are available to discuss your specific needs and develop a treatment plan that’s right for you. Call us at 850.435.4800 or complete our Online Appointment Form today.

Selecting the proper footwear can make a difference in your overall foot health.

Selecting the Right Shoes

May is National Arthritis Awareness Month, and of the more than 100 forms of this painful condition, many can affect the ankle. In fact, almost half of people in their 60s and 70s have arthritis of the foot and/or ankle, but not all of them have symptoms.

Arthritis refers to inflammation in one or more of the body’s joints, and while it can occur in many areas, it is very prevalent in small joints like the ones located in your feet and ankles. Unfortunately, arthritis cannot be cured, but it can be managed with a range of treatment options specifically designed to relieve symptoms and slow progression.

In the majority of cases, the joint will be swollen and painful. Usually, this pain develops gradually; however, it is possible for the pain to come on suddenly in some cases.

Tenderness or pain if pressure or weight is applied to the joint.

Higher pain levels and increased swelling after resting or sitting for extended periods of time.

Sticking or grinding sensations when moving the joint.

Difficulty performing daily activities that involve climbing stairs and/or walking.

Dull aching in the affected joint(s) even while lying down or sitting in a chair.

Individuals with ankle arthritis also experience Achilles tendonitis more frequently than those who do not. Therefore, to fully understand the symptoms of ankle arthritis, the symptoms associated with Achilles tendonitis must also be addressed. These include:

Inflammation and pain in the backside of the heel, primarily when running or walking.

Swelling and/or discomfort in the back of the heel.

The skin on the heel feels hot to the touch.

A limited range of motion upon flexing the foot.

For those diagnosed with ankle arthritis, non-surgical and surgical treatment options are both available, as determined by your physician.

Non-surgical treatment options for arthritis often include medications by mouth (anti-inflammatories), injections (steroids or other), physical therapy, weight loss, changes in shoes, or orthotics such as pads in your shoes or custom-made braces. Injections are also a common course of treatment. They include strong anti-inflammatory medications such as cortisone and artificial joint lubricants (also known as viscosupplementation or hyaluronic acid) or platelet-rich plasma therapy.

When non-surgical treatments fail, surgical intervention can include cleaning the arthritic joint by removing bone spurs that restrict motion. More often, especially with advanced arthritis, your foot and ankle orthopedic surgeon may recommend replacing the joint with an artificial joint or fusing the joint to eliminate painful motion.

As with any treatment option for ankle arthritis or other foot or ankle-related condition, Dr. Erik Nilssen and Dr. Sonya Ahmed provide the most innovative options possible. If you are experiencing symptoms of ankle arthritis and would like to schedule an appointment with North Florida Bone & Joint Specialists, call us at 850-435-4800 or schedule an appointment online.

The symptoms of ankle arthritis include joint pain and swelling as well as others, with most patients also experiencing Achilles tendinitis.

Treating Ankle Arthritis

Do you have recurring ankle pain, especially when walking or extending your ankle or heel? You might be among the roughly 10% of people with an extra or “accessory” foot bone called the os trigonum.

The os trigonum is a tiny bone that forms behind the talus, or ankle bone. Although the os trigonum is present at birth (congenital), it usually doesn’t cause any symptoms until adolescence, when a tiny portion of the talus doesn’t fuse normally with the remainder of the ankle bone, isolating a small portion of bone which forms the separate os trigonum. In a few people, the os trigonum may become partially fused, forming a prominence at the back of the ankle. The bone can range in size and shape, appearing as a small, flat bone or a larger, rounded prominence. Sometimes, the os trigonum causes no symptoms and remains undiagnosed; but in adolescents who are active including student athletes and dancers, the accessory bone can irritate the soft tissues that surround it or cause a painful impingement (pinching) of other tissues. Often, the tiny bone becomes compressed or “crunched” by the ankle and heel bones on either side of the os trigonum, resulting in an “pinching” effect sometimes referred to as a “nutcracker injury.”

What symptoms and issues are associated with the os trigonum?

Os trigonum symptoms are far more common in dancers, swimmers, high jumpers and other athletes who repeatedly point their toes and place repetitive pressure on the toes that transfers force to the ankle area. When symptoms are present, they can include:

pain and aching deep in the back portion of the ankle, especially when walking or pointing the toes

tenderness in the back of the ankle when the area is pressed or rubbed

swelling in the back of the ankle or near the Achilles tendon

decreased range of motion and movement when pointing the toes

Because the symptoms of os trigonum can mimic other common foot and ankle injuries like Achilles tendon injuries, sprains and even fractures, a careful physical exam followed by x-rays or other imaging tests are commonly used to confirm diagnosis prior to treatment. Once the os trigonum has been identified as the cause of symptoms, treatment can include nonsurgical management with rest and immobilization of the ankle, including the use of a special boot or splint to provide support to the joint while inflammation subsides and the injured soft tissues heal. Using an ice pack may also help decrease inflammation and pain. Oral medications and injections of corticosteroid medications into the affected area can also be very effective in relieving symptoms and helping inflammation subside. When these approaches fail to provide long-term or meaningful relief of symptoms, surgery may be needed to remove the os trigonum so impingement, pressure and painful symptoms do not occur. Following surgery, physical therapy can help restore range of motion and flexibility to the joint.

Traditional surgical intervention involves an open, often extensive approach resulting in more scar formation and longer recovery.  At North Florida Bone & Joint Specialists we have developed an arthroscopic approach through two small incisions allowing patients a much quicker return to sport or activities of daily living.

If you’re having ankle pain or if you’ve already been diagnosed with os trigonum, the next step in treatment is to schedule an exam and evaluation with the North Florida Bone & Joint Specialists. As a top, multidisciplinary medical treatment and research facility in Pensacola, Fl., the Florida Bone & Joint Specialists specializes in the diagnosis and treatment of ankle and foot injuries, offering both nonsurgical and surgical approaches as needed based on each patient’s individual symptoms, medical needs, lifestyles and treatment goals. As the first dedicated orthopedic sports medicine-based foot and ankle clinic in the United States, the center offers state-of-the-art care and innovative treatments aimed at providing every patient with individualized care for optimal results. Click below to schedule your evaluation and take the first step toward better foot and ankle health.

Recurring ankle pain, especially when walking or extending the ankle or heel might be a sign of an extra or “accessory” foot bone called the os trigonum.

What You Need to Know About Os Trigonum

Os Trigonum: What You Need to Know

Arthritis literally translates to “inflammation of the joint” and describes the degenerative process through which a joint space loses its “cushioning,” whether are the result of injury, illness or the natural process of aging. It is the leading cause of musculoskeletal pain and can be found in almost every part of the body, from the shoulder all the way down to the smallest joint of the toe. Our joints are intricate structures shaped from cartilage, bone, muscle and connective tissue, all of which can gradually weaken over time or be damaged by acute injury. While there are more than one hundred known types of arthritis, the three most common forms are osteoarthritis, which is by far the most prevalent; rheumatoid arthritis, which is caused by the body’s own immune system generating a chronic inflammatory response in the joints; and post-traumatic arthritis, which is caused by the lingering structural damage of acute injuries.

The most common symptom of arthritis is pain, stiffness and swelling in the affected joint, as well as weakness in the joint and the surrounding muscles. The joint may also feel warm to the touch and appear slightly red or splotchy, especially if you are suffering from a severe form of arthritis. Symptoms can come and go or remain constant and can vary in severity from mild to unbearable.

Cartilage plays a crucial role in the joints of the body, as it “cushions” the joint spaces and prevents bone-on-bone contact; arthritis describes any disease process or injury which leads to the loss of this critical soft tissue structure. Through the process of arthritis, cartilage weakens and disappears, ultimately leading to bone-on-bone contact, which is incredibly painful. There are a variety of factors that can lead to someone developing arthritis, but the most common causes are the gradual wear-and-tear of the aging process, traumatic injury, and abnormal immune responses. Some common risk factors that can increase one’s risk of developing the condition are a genetic predisposition, obesity, previous injury to a joint, and weak or underdeveloped muscles supporting a joint. Arthritis is also more common in women than men, which is thought to be tied to hormonal differences between the sexes.

Many of the most common risk factors for arthritis, including age, genetics, and gender, are outside of our control. However, there are still some preventative measures that can be taken to help lower your risk of developing this painful condition. Maintaining a healthy weight, eating a well-rounded diet rich in healthy fats, setting and adhering to a physician-approved exercise regimen, and protecting your joints during day-to-day activities can all go a long way towards preventing your joints from degrading to an arthritic state. It is also highly advisable to avoid smoking and heavy alcohol consumption, as these vices are proven risk factors for developing certain types of arthritis.

If you have already developed arthritis, do not despair; there are a number of treatment options available to you. In extreme cases, an arthritic joint can be replaced with an implant in a complex surgery known as total joint arthroplasty. However, science has afforded us a number of non-surgical interventions that can be tried long before surgery becomes necessary. These include physical therapy, steroid injections, orthobiologic treatments like PRP injections and stem cells, and hyaluronic acid injections.

What is a Hyaluronic Acid (HA) Injection?

Hyaluronic acid is a naturally occurring component of the fluid that fills the joint space (called synovial fluid), which, alongside cartilage, cushions the joints of the body. As your arthritis progresses, the hyaluronic acid in your synovial fluid thins and can ultimately disappear, leading to worsening joint pain and stiffness. A hyaluronic acid injection, which is sometimes referred to as viscosupplementation, seeks to replenish the joint’s supply of this critical compound. There are a number of hyaluronic acid injections available today, including Euflexxa, Hyalgan, Orthovisc, and Synvisc. Your physician will decide which injection to use based on a number of factors, including age, the severity of your arthritis, your insurance carrier’s medical policies, and your family and medical history.

Depending on which brand of hyaluronic acid your physician elects to move forward with, you could receive anywhere from one to five total injections spread out over weeks or months. Regardless of the schedule, all of the injections typically unfold in the same manner. Your physician will prep the injection site with a cleaning solution to prevent infection, numbs the area with a cold pack or local anesthetic, and inserts a needle into the joint space, injecting the hyaluronic acid once they have localized the needle with ultrasound guidance. Hyaluronic acid injections are very safe, and the most common side effects are minor pain and swelling at the injection site, as well as the short-term buildup of joint fluid. These will typically pass in a matter of days, but in rare cases, this inflammation can last for a longer period of time.

If you are suffering from joint arthritis and think viscosupplementation may be right for you, reach out to us today. The only way to know for sure whether or not this minimally-invasive treatment option can help is to consult with a physician.

Hyaluronic acid is a naturally occurring component of the fluid that fills the joint space that, alongside cartilage, cushions the joints of the body.

Hyaluronic Acid for Arthritis

Arthritis and Hyaluronic Acid

IS TOTAL ANKLE ARTHROPLASTY (TAA) A GOOD OPTION FOR ANYONE WITH ANKLE ARTHRITIS?

While TAA can be a very good solution for many patients with advanced ankle arthritis, it’s not always the best solution. In general, TAA may not be a good choice for patients with:
• prior ankle joint fusion surgery
• active local or systemic infections
• certain types of nerve problems called neuropathy or other neurological problems
• insufficient bone or muscle tissue that interferes with proper positioning and stabilization of the implant
• problems with the ligaments that support the ankle
• some circulation issues, including vascular necrosis in the region
• issues affecting the skin or soft tissues surrounding the joint, which could interfere with normal healing
• certain anatomical deformities in the ankle area or in the knee that preclude proper positioning of the joint replacement
• inability to follow through with postoperative instructions, including physical therapy


If you’re overweight, you may be asked to lose weight prior to surgery to reduce the stress on the implant once it’s in place. Patients who smoke will need to stop two weeks before surgery to improve circulation, which is necessary for proper healing.

Total ankle arthroplasty is performed under general anesthesia. The specific surgical technique will depend on the implant that’s being used. Our practice uses the Salto® Total Ankle Prosthesis & the Zimmer Biomet Trabecular Metal Total Ankle; these are state-of-the-art ankle implants designed to more accurately replicate normal ankle anatomy for optimized function and mobility and natural joint movement. The procedure begins with an incision on the front and top of the ankle joint to provide total access to the joint. Once the joint is exposed, a special alignment guide is placed on the tibia (the lower leg bone that makes up part of the ankle joint) to ensure the implant is properly placed. The Zimmer© Biomet Trabecular Metal™ Total Ankle amount of the tibia bone is removed, followed by removal of a portion of the talus bone (one of the bones of the foot that comprises part of the ankle joint). Bone tissue is removed from three areas of the talus to provide greater stability for the implant.

Next, the implants are temporarily positioned over the bones, and the surgeon carefully assesses the joint function and movement, adjusting the placement of the implant components as needed. Once the surgeon has determined the ideal placement of the implant, the implant components are permanently placed on the bones, and the incisions are closed with small sutures (stitches). A splint or cast will be placed on the foot to keep the ankle stable and protected. Most patients remain in the hospital for a day or two before being discharged.

Check out this video: The Zimmer© Biomet Trabecular Metal™ Total Ankle.

AFTER ANKLE JOINT REPLACEMENT: RECOVERY AND LIFESTYLE CHANGES

Once your surgery is complete, it’s very important to closely follow your surgeon’s guidelines during recovery to ensure the area around the implant heals properly. A cast will be applied to the ankle, and you’ll need to use crutches, a walker, or a wheelchair to avoid any weight bearing on the joint for four to six weeks after surgery. A moderate amount of pain is normal during the first two weeks following surgery, and pain medication will be prescribed to relieve discomfort during the initial healing period. Mild discomfort can persist for several months following surgery as the bone continues to fuse with the implant components. Keeping the ankle elevated during the initial stages of healing can reduce swelling and discomfort. A follow-up visit will be scheduled for one to three weeks after your surgery, at which time the stitches will be removed. When indicated, physical therapy will begin soon after surgery with activities tailored to your specific needs. In most cases, you’ll gradually return to normal daily activities during the first six weeks or so, following your procedure.

Although surgery will help restore normal joint function, you’ll need to restrict physical activity to prevent strain on the implant and the bones and tissue surrounding it. After your ankle has healed, you’ll still be able to enjoy most low-impact activities like walking and hiking, swimming and golf, but you’ll need to avoid high-impact activities that place a lot of strain on the ankles. This includes any activities that involve running, jumping, pivoting, or torquing (rapid joint rotation as in tennis or football) or heavy lifting. You may also have to avoid other activities that involve additional strain on the ankle joint, including some types of manual labor. Before beginning any activity that involves the ankles or feet, it’s always best to discuss your specific activity limitations with your doctor to prevent potentially damaging the implant or the tissues surrounding it. It’s also important to maintain a healthy weight to decrease the strain on the implant and the joint structures and to stop smoking, so circulation and tissue health are optimized.

HOW WILL I KNOW IF THE ANKLE IMPLANT PROCEDURE WAS A SUCCESS?

The Total Ankle implant is associated with a very high rate of success, and most patients will have no significant issues following their recovery. Roughly, there are 7,000 Total Ankle surgeries per year. Clinical studies show the implant is associated with a 93% success rate at a mean follow-up of 6.4 years. However, you should call your surgeon immediately if you notice:
severe pain that persists after two weeks post-op
redness around the incision site
fluid leaking from the incision
sudden onset of pain or swelling in the joint
changes in joint function

WILL MY ANKLE IMPLANT SET OFF A METAL DETECTOR OR INTERFERE WITH MEDICAL IMAGING?

Ankle implants use metal components, and these components can interfere with magnetic resonance imaging (MRI), X-ray imaging, and metal detectors, including security scanners used in airports and other locations. Following surgery, you’ll receive a special patient ID card that indicates you have an ankle implant. You should present this card to any doctor ordering medical imaging and when metal detecting devices are used, including walk-through scanners.

One of the most important steps you can take in ensuring the success of your TAA procedure and reducing your potential risks is making sure you select the best surgeon for the job. Optimally, that means selecting a doctor with significant experience in total joint replacement procedures, including total ankle arthroplasty. Although joint replacement surgery is not uncommon, ankle replacement surgery has evolved significantly during the past decade. Choosing an orthopedic surgeon who specializes in foot and ankle surgery and who has an established record of successful ankle implant surgeries plays a critical role in reducing the risk of complications during both surgery and recovery. The right surgeon will also provide you with the peace of mind you need so that you can feel confident in your care and your short-term and long-term results. During your consultation and evaluation visit, be sure to ask your surgeon about his or her experience in foot and ankle surgeries, specifically with regard to total ankle replacement procedures. Also ask about follow-up care as well as the surgeon’s experience with patients who have medical, health, and lifestyle profiles similar to yours. And finally, ask the surgeon to review the procedure with you, as well as what you can expect during the follow-up period.

While TAA can be a very good solution for many patients with advanced ankle arthritis, it’s not always the best solution.

Total Ankle Replacement FAQs

A Lisfranc injury can occur in the form of a sprain, fracture, or dislocation.

A Lisfranc injury can occasionally be mistaken for an ankle sprain, therefore a proper diagnosis is important. Your Pensacola foot and ankle surgeon will ask you a series of questions about your injury and will give you an examination of your foot in order to determine how severe your injury is and come up with a diagnosis.

He may take x-rays or some other type of imaging study to get a full evaluation of the severity of your injury. Additional examinations might be needed while you are under anesthesia to evaluate a weakening of your joint and surrounding bones or fracture.

One of the most common causes of Lisfranc injury is a car accident. You can get this injury for other reasons such as:

The direct or indirect force to your foot is what leads to this injury. If you drop a heavy object on your foot this is known as a direct force. Twisting your foot is an example of indirect force.

On the bottom of your midfoot, you have the Lisfranc and other ligaments that are stronger than the ones found on the top of your midfoot. When you get a sprain or your ligament stretches and they become weakened, it can result in your mid-foot joint becoming unstable.

This is when a bone is broken in your Lisfranc joint and can be either a break through the bones of your midfoot or you pull off a small piece of bone (avulsion fracture).

A dislocation is when your Lisfranc joint bones are forced from their regular positions.

If you are experiencing symptoms of this injury, it’s important you set up an appointment with your Pensacola orthopedic specialist immediately. If you can’t, elevate and keep off your injured foot. You should also apply an ice pack to the injured area every 20 minutes, which will help keep your pain and swelling down.

Other types of nonsurgical treatments for a Lisfranc injury might include:

Immobilization. A cast and crutches might be used to keep your foot immobile and avoid any added weight on it.

Oral Medications. To reduce inflammation and pain, the doctor might recommend ibuprofen and other nonsteroidal anti-inflammatory medications.

Elevation and Ice. You can reduce swelling by keeping your foot elevated and applying ice to the affected area.

Physical Therapy. Once your pain and swelling have subsided, your doctor might prescribe physical therapy.

In some cases, particularly when there is significant displacement of the midfoot joints with instability, you might require surgery for your Lisfranc injury, which may include internal fixation or fusion, followed by rehabilitation. Your orthopedic surgeon will work with you to decide which type of surgery will best suit your individual case. Emergency surgery might be needed for more extreme injuries.

To learn more about Lisfranc Injuries, visit our conditions page here.

A Lisfranc injury can occasionally be mistaken for an ankle sprain, therefore a proper diagnosis is important.

FAQs for Lisfranc Injury

When most people hear the word ultrasound, images of a happy, expectant couple huddled around a black and white screen hoping to catch a glimpse of their baby for the first time come to mind. While this is accurate–and adorable to think about!–ultrasound actually has clinical applications far beyond obstetrics, and ultrasound machines are just as often found in the offices of sports medicine physicians. This advanced imaging modality can be used for the diagnosis, treatment and management fo a wide-variety of musculoskeletal conditions, and is quickly becoming the standard of care across the country. Furthermore, ultrasound offers a number of key advantages over traditional advanced imaging techniques like x-ray, computed tomography (CT), and magnetic resonance imaging (MRI).

Ultrasound scanning, which is often called sonography, uses a transducer or probe and ultrasound gel to emit high-frequency sound waves into the body. The transducer collects the refracted sound waves as they “bounce” back off of structures within the body, and then a computer within the machine processes those waves into an image that is projected on the screen. This process takes microseconds, so ultrasound imaging is real-time and on-demand. Because ultrasound images are captured, processed and displayed in real-time, they allow a clinician to visualize the structures and movement of the musculoskeletal system, and can even display the flow of blood through the vessels within muscles, tendons, and ligaments.

Applications of Ultrasound Imaging in Orthopaedics

Ultrasound machines, which can range in size from a cellphone to a small cabinet, use sound waves to visualize the soft tissues of the body, including muscles, tendons, ligaments, and joint spaces. They provide safe, painless, and real-time imaging to a clinician, without any harmful ionizing radiation or the need for uncomfortable positioning. Ultrasound imaging has both diagnostic and therapeutic uses in orthopaedics, making it a very versatile tool.

The primary use of ultrasound imaging in sports medicine is as a diagnostic tool. The ability to visualize the anatomical structures of a joint or extremity in real-time and under the physics of movement allow sports medicine physicians to more accurately diagnose soft tissue injuries. Ultrasound also excels at locating and identifying foreign bodies, as frequently happens in traumatic accidents. The procedure can be used to diagnose tendon, muscle, and ligament tears; sprains; effusions in the joint and bursae; nerve entrapments; and tumors, cysts or abscesses.

In addition to the diagnostic applications, ultrasound imaging is often used as an adjunct to minimally-invasive procedures. Whether a physician is performing an injection, orthobiologic/regenerative medicine procedure, or another minimally- or micro-invasive procedure, their need to visualize the anatomy of the treatment area is paramount. Ultrasound imaging allows a physician to do just that in a safe, painless, and cost-effective manner, and as such has been incorporated into the standard of care for a number of these procedures.

Ultrasound has a number of advantages over other advanced imaging modalities. As mentioned above, the fact that ultrasound imaging is on-demand and real-time lets a physician view the underlying anatomy both at rest and in motion, which allows for a more accurate diagnosis. Ultrasound imaging is also highly portable–some units fit in the palm of your hand–which allows it to be deployed virtually anywhere. It is also safe–so safe, in fact, that they routinely perform the procedure on pregnant women!–painless, and much faster than magnetic resonance imaging (MRI) or computed tomography (CT) scans. Finally, ultrasound imaging is a very cost-effective solution as it demands a fraction of the cost of other advanced imaging modalities. One study estimated that substituting ultrasound for MRI, when appropriate in treating musculoskeletal conditions, would save Medicare almost $7 billion in fifteen years!

If you are suffering from a musculoskeletal injury or condition, there is a good chance ultrasound imaging should be a part of your diagnosis and treatment plan. Seeking out a physician with advanced proficiency in ultrasound imaging could lead to safer, more affordable, and more accurate treatment. Dr. Hackel is among the leading ultrasound operators in the world, and he is called on frequently to teach courses across the country to share his knowledge.

Ultrasound scanning, which is often called sonography, uses a transducer or probe and ultrasound gel to emit high-frequency sound waves into the body.

Ultrasound: Not Just for Babies!

Research and the Evolution of Sports Medicine

Disease and injury of the musculoskeletal system represent one of the fastest growing sources of pain, disability, and death today. As the world’s population continues to age and become more and more susceptible to orthopaedic conditions, many of which are driven largely by the aging process, the importance of this field of study will only increase. As a result, there has been an increasing focus placed on researching the biology and physiology of the musculoskeletal system, the underlying causes of the various diseases that plague it, and the mechanisms of injury that acutely harm it. This type of research requires a vast, multidisciplinary approach, drawing on the fields of cellular and molecular biology, chemistry, biomechanics, mechanical engineering, and clinical research.

One of the most exciting and promising avenues of research in orthopaedics today is regenerative medicine. Regenerative medicine is the burgeoning field of clinical research and treatment that focuses on harnessing the body’s innate ability to heal itself in the management of musculoskeletal injuries. The two most common regenerative medicine procedures are platelet-rich plasma (PRP) therapy and stem cell injections. While many of the treatments that fall under the umbrella of regenerative medicine are still in the early stages of development, study, and regulatory approval, many clinicians believe that these procedures hold great promise for the treatment of orthopedic disorders. Furthermore, regenerative medicine has applications beyond the muscles and bones of the body, so it has the potential to revolutionize countless current areas of medical treatment.

As stated above, stem cell injections, which use the body’s own stem cells to promote healing and recovery, are one of the most well-known and sought-after regenerative medicine procedures today. Adult stem cells are found throughout the body and can be harvested from a patient’s bone marrow or adipose (fat) tissues. These cells have many regenerative and anti-inflammatory properties, so clinicians believe that they may have the ability to treat some common conditions that cause damage to the soft tissues within the body (e.g., torn cartilage, arthritis, etc.). When extracted, processed and injected back into the body, these base cells have the potential to promote healing and repair by developing into muscle, vascular, cartilage or even bone cells.

One of the studies currently being conducted to test the efficacy and safety of stem cell injections is the Multicenter Trial of Stem Cell Therapy for Osteoarthritis (MILES) study. The study is a multicenter research trial being conducted to compare the efficacy of corticosteroid control injections against three regenerative medicine procedures for the treatment of unilateral osteoarthritis of the knee: 1) mesenchymal stem cell preparations from autologous bone marrow concentrate, also known as BMAC; 2) adipose-derived stem cells; and 3) third-party human mesenchymal stem cells manufactured from umbilical cord tissue. The study is being funded by The Marcus Foundation and will be conducted at four clinical sites across the United States, including Andrews Research and Education Foundation (AREF) in Gulf Breeze, FL. Dr. Josh Hackel is the Principal Investigator for the AREF study site and one of the clinical leaders who shaped the design and methods of this potentially game-changing study.

To be eligible for this study, you must be between 40 and 70 years of age and have a recent diagnosis of osteoarthritis in one knee. If you or a loved one are suffering from knee osteoarthritis, please reach out to Dr. Hackel and his team today. You may qualify for this ground-breaking research trial!

As the world’s population continues to age the importance of sports medicine as a field of study will only increase.

Blog Posts for Ankle Pain

Selecting the Right Shoes

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Treating Ankle Arthritis

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Os Trigonum: What You Need to Know

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Arthritis and Hyaluronic Acid

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Total Ankle Replacement FAQs

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FAQs for Lisfranc Injury

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Ultrasound: Not Just for Babies!

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Research and the Evolution of Sports Medicine

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