Do You Have Achilles Tendinitis?

Do you have pain at the back of your foot, just above the heel?  It could be Achilles Tendinitis.  Achilles Tendon

The Achilles tendon is the largest tendon in the human body. It is located at the back of the ankle joint and attaches the calf muscles to the heel bone. This tendon is used to walk, run, jump and push up on the toes. Achilles tendinitis is the inflammation of the tendon and is most often caused by overuse, or is a result of a strain injury.

SOME CAUSES

According to orthopedic foot and ankle surgeon, Dr. Mark Yakavonis, aging and sports activities that involve a lot of calf muscle usage, like basketball and tennis, have a higher incidence of injury to the Achilles tendon. Achilles tendinitis is also associated with a sudden increase of intensity or frequency of an exercise.

“People with Achilles tendinitis usually feel a dull ache or pain during activity and they may feel tenderness above the heel bone, particularly in the morning,” Dr. Yakavonis said. Stiffness that improves as the tendon warms up and mild swelling or a bump are other possible symptoms. However, sudden pain, swelling above the heel, difficulty walking or moving the foot up or down may indicate a rupture of the tendon. “Whenever there’s pain in that tendon area, it’s a good idea to have an orthopedic foot and ankle specialist take a look at it to determine if it is due to tendinitis or a more serious condition such as a partial tendon tear, heel bursitis or a rupture,” he said.

TREATMENT

When treated properly, Achilles tendinitis is usually resolved quickly. When left untreated, it may lead to a more serious condition or tear.

Some or all of the following may be used to treat the condition depending on its severity:

  • Rest

  • Nonsteroidal anti-inflammatory medication

  • Orthotics or shoe inserts that help support the muscle and relieve stress on the tendon

  • Bracing to restrict motion

  • Physical therapy that includes stretching, massage, ultrasound and strengthening exercises

  • A home exercise program

SURGICAL TREATMENT

Surgical treatments vary depending on the type of Achilles tendinitis a patient has and the severity of it. Some minimally invasive surgical treatments, addressing the calf muscle or heel bone, are new and exciting. If friction between the tendon and its covering sheath causes the sheath to become thick and fibrous and conservative treatments are not effective, surgery may be an option. A surgeon can remove the fibrous tissue and repair any tears. In some cases, where there is severe damage, the Achilles is reconstructed using an adjacent tendon. A temporary cast may be worn during recovery and a rehabilitation program is usually recommended.

PREVENTION

Dr. Yakavonis recommends the following tips to prevent Achilles tendinitis:

  • Choose a running shoe that provides cushion to the heel.

  • Walk and stretch to warm up gradually before exercising.

  • Stretch and strengthen the muscles in the calf.

  • Increase running distance and speed gradually.

  • Avoid unaccustomed strenuous sprinting and hill running.

  • Cool down gradually after exercise.

What’s Causing Your Heel Pain?

The foot has more than 30 different joints. If you consider the tons of stress your feet endure from walking and standing day in and day out, it’s no wonder that heel pain is the most common problem affecting the foot and ankle.

“Feet are anatomically designed to handle the pressure … to a point,” said orthopedic foot and ankle specialist, Mark Yakavonis, MD, “Repeated pounding on a hard surface while running, participating in another sport, or wearing ill-fitting shoes that inflame the foot’s tissues can cause pain on the bottom of your heel or behind it. Arthritis, wear and tear, or a build-up of uric acid in the small bones of the feet, known as gout, can also cause heel pain.

In most cases, heel pain can be relieved without surgery. Rest, stretching exercises, and possibly anti-inflammatory medication can usually do the trick. If left untreated, Dr. Yakavonis warned, a sore heel will only worsen and can develop into chronic and more problematic conditions.

For that reason, it’s important to consult with a an orthopedic foot and ankle specialist to determine the underlying cause of pain in your heel if it lasts more than a few days. A medical consultation is particularly imperative if the pain  intensifies when you put weight on the foot, if there are signs of infection or injury, such as swelling, discoloration or fever, or if your heel is warm to the touch.Foot picture

SOME COMMON CAUSES 

According to Dr. Yakavonis, pain under your heel can occur if you’ve bruised the heel pad by stepping on a hard object such as a rock, or from repetitive pounding on hard surfaces during sports. This pain usually goes away over time with rest.

If the pain beneath your heel is mild at first but then flares up when you take your first steps in the morning, you may have plantar fasciitis, This condition  is caused from inflammation of the tissue band (fascia) that connects the heel bone to the base of the toes. Plantar fasciitis is the most common condition causing heel pain. If plantar fasciitis is left untreated, a painful heel spur (calcium deposit) can develop where the fascia attaches to the heel bone.

PAchilles Tendonain from behind the heel could indicate inflammation of the bursae and the Achilles tendon at the point where the tendon goes into the heel bone. Achilles tendinitis and associated pain from retrocalaneal bursitis can build slowly over time, causing the skin to thicken, become red and/or swell. In some cases, a bump that feels warm to the touch can develop at the back of the heel. If pain increases with the start of an activity after a period of rest or if it is too painful to wear shoes, your physician may order an X-ray to determine if a bone spur has developed.

Injuries to the nerves in the foot can also produce heel pain. Neuropathy, or nerve damage, and Tarsal Tunnel Syndrome, in which the large nerve in the back of the foot becomes pinched and inflamed, are the two most common nerve-related conditions.

If you experience pain that makes it difficult to walk or enjoy your everyday activities, schedule an appointment at ONS with one of our foot and ankle orthopedic specialists, Michael Clain, MD or Mark Yakavonis, MD, by calling 203-863-1145 or request an appointment here.

07/10/2019

Synthetic Cartilage Implants

NEW PRODUCT APPROVED FOR SURGERY HOLDS PROMISE FOR ARTHRITIS SUFFERERS. 

ONS orthopedic foot and ankle surgeon, Dr. Mark Yakavonis, was a guest today on Healthy Frontiersa White Plains community television program hosted by Dr. Louis Bisogni.  Dr. Yakavonis discussed a significant new development in the treatment of big toe arthritis that has the future potential to alleviate arthritis pain in larger joints in the body. Dr. Yakavonis and Michael Clain, MD, also of ONS, are among the few orthopedic foot and ankle surgeons in the country who offer this option to their patients.

The new synthetic cartilage implant was approved as a treatment for painful arthritis in the joint of the big toe in July, 2016, but  Dr. Yakavonis explained that it has been a highly effective treatment in Canada, Europe and Brazil since 2002.  The implant, called Cartiva, is made of saline and a bio-compatible polymer that is similar in consistency to a contact lens and is the size and shape of a No. 2 pencil eraser.  The surgical procedure takes about 30 minutes to complete. The implant is inserted through a tiny incision between the bones metatarsophalangeal or MTP joint, where the natural cartilage has worn away.

Dr. Yakavonis named a few benefits for patients over conventional treatments. For instance, unlike the metal materials used in traditional MTP joint replacement, this implant is different. The implant is tolerated by the body’s immune system. This will reduce the risk of inflammation or rejection.  And it’s unlike fusion surgery, which fuses the two bones in the big toe together to eliminate the painful bone-on-bone rubbing. This product is flexible and allows for the return of full range of motion in the joint.

Recovery from the implant surgery is relatively easy, when compared to other foot surgical procedures.  Following the ambulatory procedure, patients are sent home with their foot in a soft wrap.  While patients should rest with the foot on a pillow as much as possible while the toe heals, they are able to put some weight on the foot for balance when walking.  There is no need for crutches or a scooter to get around.

According to Dr. Yakavonis, this type of implant his being researched for use in larger joints such as the knee. Down the road, he said, the potential for arthritis relief for joints all over the body is limitless. It is good news for the nearly 54 million people in the United States who are suffering from some form of arthritis.

Dr. Yakavonis said neither he nor ONS has any commercial interest in this product. “It’s just an amazing option to relieve my patients from pain and I am thrilled to be able to offer it to them.”

Further, Healthy Frontiers airs on White Plains Channel 76 and Verizon Channel 45. It will air on Thursdays at 6:30 pm and Friday’s at 10:30 am.  This segment should begin broadcasting next week.

ONS Sports medicine specialists Dr. Marc Kowalsky and Dr. Katherine Vadasdi have each been guests on the program in the past, along with hand and wrist surgeon Dr. Wei, hip and knee replacement specialist Dr. Jonathan Berliner.  Watch those interviews.

Dr. Louis Bisogni is the head chiropractor for the New York Yankees and has private practices in White Plains and Somers, NY.

 

 

 

 

 

Common Causes of Heel Pain

FOOT SPECIALIST DR. MARK YAKAVONIS, MD, MMS, AN ORTHOPEDIC SURGEON AT ONS, GETS TO THE BOTTOM OF THE QUESTION, WHY DOES MY HEEL HURT?

The foot has more than 30 different joints. If you consider the tons of stress your feet endure from walking and standing day in and day out, it’s no wonder that heel pain is the common problem affecting the foot and ankle.

Feet are physiologically designed to handle the pressure … to a point. Repeated pounding on a hard surface while running, participating in another sport, or wearing ill-fitting shoes that inflame the foot’s tissues can cause pain on the bottom of your heel or behind it. Arthritis, wear and tear, or a build-up of uric acid in the small bones of the feet known as gout, can also cause heel pain.

In most cases, heel pain can be relieved without surgery. Rest, stretching exercises, and possibly anti-inflammatory medication can usually do the trick. If left untreated, however, a sore heel will only worsen and can develop into chronic and more problematic conditions.

For that reason, it’s important to consult with a an orthopedic foot and ankle specialist to determine the underlying cause of pain in your heeL. If it lasts more than a few days, a medical consultation is particularly imperative if the pain  intensifies when you put weight on the foot, if there are signs of infection or injury, such as swelling, discoloration or fever, or if your heel is warm to the touch.Foot picture

SOME COMMON CAUSES

Pain centered under your heel could occur if you’ve bruised the heel pad by stepping on a hard object such as a rock, or from repetitive pounding on hard surfaces during sports. This pain usually goes away over time with rest.

If the pain beneath your heel is mild at first but then flares up when you take your first steps in the morning, you may have plantar fasciitis, which is inflammation of the tissue band (fascia) that connects the heel bone to the base of the toes. Plantar fasciitis is the most common condition causing heel pain. If plantar fasciitis is left untreated, a painful heel spur (calcium deposit) can develop where the fascia attaches to the heel bone.

PAchilles Tendonain from behind the heel could indicate inflammation of the bursae and the Achilles tendon at the point where the tendon goes into the heel bone. Achilles tendonitis and associated pain from retrocalaneal bursitis can build slowly over time, causing the skin to thicken, become red and/or swell. In some cases, a bump that feels warm to the touch can develop at the back of the heel. If pain increases with the start of an activity after a period of rest or if it is too painful to wear shoes, your physician may order an X-ray to determine if a bone spur has developed.

Injuries to the nerves in the foot can also produce heel pain. Neuropathy, or nerve damage, and Tarsal Tunnel Syndrome, in which the large nerve in the back of the foot becomes pinched and inflamed, are the two most common nerve-related conditions.

If you experience pain that makes it difficult to walk or enjoy your everyday activities, schedule an appointment at ONS with one of our foot and ankle orthopedic specialists, Mark Yakavonis, MD or Michael Clain, MD by calling 203-863-1145 or request an appointment here.

07/10/2019

Summer is a Good Time to Treat Bunions

SUMMER IS A GOOD TIME TO TREAT BUNIONS, ACCORDING TO FOOT AND ANKLE SPECIALIST, DR. MARK YAKAVONIS.

As sandals return to the wardrobe this summer, the disfiguring prominences known as bunions can present cosmetic and physical problems for those sufSemi circle of colorful flip flops on old weathered blue painted beach decking. Space for copy.fering from the foot condition. Bunions can be extremely painful, making it difficult to find shoes that don’t put pressure on the area or cause more discomfort.

While there’s no explanation why some people develop bunions and others do not, bunions can arise at any time from adolescence through retirement. The condition does affect women more than men though, and studies have shown that wearing high heeled shoes tends to exacerbate the problem.

“Treatment for bunions varies depending on the severity,” said Dr. Mark Yakavonis, an orthopedic surgeon who specializes in foot and ankle surgery and orthopedic trauma at ONS. “Ice, anti-inflammatories and orthotics can help alleviate pain. However, if a bunion is not addressed early, the pain can become disabling and require surgery to realign the bones, ligaments and tendons to bring the big toe back to its correct position.”

In the past, bunion surgery required a lengthy recovery and a cumbersome foot cast. Now, new techniques, materials, and an emphasis on maintaining mobility through the healing process has made bunion surgery much less of an ordeal. Casts are rarely applied, patients normally use crutches for one to three weeks and complete recovery takes two to four months.

“Having bunion surgery in the summer has many advantages over the winter months,” said Dr. Yakavonis. “Navigating ice and snow while recovering can be hazardous, and the recovery shoe, which is essentially an open-toe sandal, is much easier to deal with in the warmer months. After that, almost any open sandal would be more comfortable than putting your healing foot in a shoe.”

Despite the medical advances and reduced recovery time, a bunionectomy is not a procedure to undergo on a whim. Also, cosmetics alone are not a good reason to have the surgery. People with bunions that impact the quality of their daily lives should consult with a specialist to learn which treatment option is most appropriate.

07/10/2019

Are shoes the culprit of foot pain?

ONS orthopedic surgeon Dr. Michael Clain, who specializes in foot and ankle surgery met with News 12 On Health Reporter Gillian Neff to discuss whether the cause of foot pain is related to shoes.

news12_Clain

Dr.Clain says foot issues like bunions and hammer toes are exacerbated by shoes. Bunions may appear to be bumps growing on the foot, but they’re actually bones shifted out of place by frequent wear and tear and it is best to find shoes that can accomodate your feet comfortably. Watch the NEWS12 “What’s Ailing You: Aching Foot Pain” with Gillian Neff.

For more on bunion surgery and the results read: Suffer from Bunion Pain? Dr. Clain Offers Solutions.

ONS Stamford: Off to a Great Start

ONS_Stamford
5 High Ridge Park, 3rd floor, Stamford, CT 06905

On the evening of June 22, 2015, Orthopedic & Neurosurgery Specialists (ONS) held a grand opening celebration of a second ONS location at 5 High Ridge Park in Stamford, CT. The event was a first look at the new facility for the public, complete with informative stations about injury prevention, exercise tips and sports medicine stations with medical models and video presentations. Throughout the evening, around 200 guests toured the office, and learned about injuries and treatments of the foot and ankle, hand and wrist, shoulder and elbow, hip and knee, spine and Platelet Rich Plasma treatment. ONS physicians were available to answer questions. ONS Physical Therapy showcased injury prevention exercises for tennis, golf and running. Local businesses participated in the evening as guests enjoyed food and beverage and displays and a drawing of exciting prizes. The ONS physicians, clinicians and staff members were pleased with the opportunity to meet and greet the Stamford community! To learn more about our new Stamford office please visit https://onsmd.com/ons-stamford/.

MRI versus the Stress Test: Which one do you need?

Mark Yakavonis, MD, MMS, is an orthopedic surgeon who specializes in foot and ankle surgery. Dr. Yakavonis has expertise in treating a variety of foot pain and deformity related conditions including Achilles tendonitis, ankle instability, cartilage injuries, bunions and hammer toes and keeps up to date with the latest breakthroughs in the field. Most recently, the unnecessary reliance on the MRI compared to conducting a simple stress test has caught his attention. The following is what he wants you to know:

Nowadays, orthopedic surgeons will frequently order Magnetic Resonance Imaging (MRI) studies for patients suffering from acute or chronic musculoskeletal injuries. Radiographs, also known as plain films, show a two dimensional projection or shadow of bone. It is useful for diagnosing obvious displaced fractures, but subtle findings are often missed.

The MRI is advanced technology that provides information in three dimensions about bone, tendon, muscle, ligament, fat, swelling, fluid, etc., but are unlike plain films, which just show bone. Basically, it shows us just about everything we need to know short of nerves and other subtle dynamic findings. It uses no radiation and is incredibly safe.

But in the setting of an ankle fracture – where either the fibula or tibia is broken near the ankle and our job as surgeons is to determine which ankles will be fine with a cast and which need a surgical correction – AN MRI IS OF NO ADDED BENEFIT. What I want to determine in this setting is whether the fracture is “stable.”

An unstable fracture will shift with time, even with a good cast, and certainly once a patient begins walking. Shifting is a very bad thing, especially in the ankle. It leads to abnormal pressures on the joint, cartilage wearing, degenerative changes, and stiffness, also known as post traumatic arthritis. In an active and healthy patient, that is unacceptable. A significantly better outcome is achieved with a one hour surgery to fix the fracture and restore anatomic alignment and stability.

The main problem with an MRI is that it is a static test. The images are taken with the patient lying flat on a table. There is no weight or force across the ankle joint. While an MRI can image the ligaments in the setting of an ankle fracture, these ligaments are always injured, but whether they are injured to the point of instability is indeterminable.

A simple test that costs very little and takes about 5 minutes is a stress radiograph. Using either gravity or the hands of a surgeon, a mild stress is placed across the ankle joint. If the joint widens or shifts I know that it will do the same in the future. The most up to date orthopedic literature supports stress x-rays are the best way to decide between surgical and non-surgical treatment, not MRIs.

The other problem with an MRI is cost and time. It is a 30-45 minute test and carries with it a significant cost. The burden of the cost is shared by the patient, the insurance company, and society as a whole. With the skyrocketing costs of healthcare in our country we should reject the notion of ordering tests when they should have no effect on our decision.

A 2014 article supports this from the Journal of Bone and Joint Surgery, the official scientific journal of the American Academy of Orthopaedic Surgeons.

07/10/2019

Ready for Spring Sports?

Golfer

Foot and ankle, hand and wrist injury prevention tips by orthopedics specialists

When: February 25, 2015 at 6:30 p.m.
Where: Noble Auditorium, Greenwich Hospital
Speakers: Mark Yakavonis, MD, MMS, Mark Vitale, MD, and Paddle and Tennis Professional Patrick Hirscht

If golf or racket sports are in your plans for the spring you will want to hear tips from fellowship trained orthopedic foot and ankle specialist Mark Yakavonis, MD, MMS and fellowship trained hand/wrist/elbow specialist Mark Vitale, MD, MPH who will discuss common injuries seen in golf and racket sports. Special guest and local tennis pro Patrick Hirscht will also speak. Learn about common injuries, and how to choose footwear, braces and exercises to prevent injury and play your best; whether it’s the foot, hand, wrist or elbow, they’re all at risk for injury when you’re active. Dr. Yakavonis and Dr. Vitale will discuss nonsurgical and surgical treatments, along with ailments particular to racket sports. You will have the opportunity to ask questions at the conclusion of the talk. The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.

07/10/2019

The Fragile Feet: A Gymnast Story (Part II)

Gymnast
Gymnast on balance beam.

Remember last week’s post? Surprisingly enough, gymnasts share a lot in common with ballerinas, especially in terms of injuries of the feet.

Both gymnasts and dancers place a tremendous amount of stress on their feet for a significant amount of time per week – often greater than 10 hours a day. Because of this combination of stress and time, stress fractures are common. Stress fractures can occur almost anywhere in the foot or ankle, but the most common locations are the metatarsals, navicular, tibia, calcaneus, and fibula. A key to avoiding stress fractures is proper nutrition, avoiding disturbances in the menstrual cycle, and proper technique and amount of training. A gymnast who trains 4 hours a week that increases the workload to 10 hours a week in preparation for a performance without any ramp up is a setup for stress fractures. A better way to ramp up training would be to increase the workload by approximately 25% per week, or going from 4 hours a week to 5 hours a week and so forth. The treatment of stress fractures varies depending on the location and character of the fractures. It also depends on the patients demands and expectations. In most situations a period of immobilization and rest is all that is necessary.

Young gymnasts often complain of various painful lumps and bumps on the feet. Some of these are calluses, which are the bodies response to repetitive force on areas of weight bearing. Another extra bone in the foot – the accessory navicular, also thought to exist in about 10% of all people – can be a troublemaker for gymnasts in particular. It is a tender prominence on the inside of the ankle. Flatfooted patients will sprain or strain the ligaments that attach to the accessory navicular. Continued activity worsens the symptoms and the first line treatment is a period of immobilization to allow it to heal. When that fails, the extra bone is excised, and the damaged tendons and ligaments on the inside of the ankle are repaired or reconstructed.

Many of the problems in both ballet and gymnastics results from the nature of the sports – long hours and repetition in little to no footwear. These patients are predisposed to develop certain problems based on the alignment or posture of the feet. Feet come in two general shapes – flat and high arched. In reality it is a spectrum. So many problems can be treated simply by accommodating or adjusting a patient’s flat or high arch with a specific type of shoe or insert (orthotic). Unfortunately, the competitive gymnast and dancer cannot wear athletic shoes or orthotics. Some may be able to train in orthotics or custom shoes and that is important to keep in mind.

Want to learn even more? Dr. Yakavonis will be giving a seminar on “Solutions for Foot and Ankle Pain: Beyond a Foot Massage.”  The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.

The Fragile Feet: A Ballerina Story (Part I)

Ballerina
Ballerina in en pointe position

Dr. Yakavonis, MD, MMS, of ONS and Greenwich Hospital is an orthopedic surgeon specializing in foot and ankle surgery and treatments for adult foot conditions as well as youth sports injuries in field athletes, gymnasts and ballet dancers. He shares a two-part blog about conditions to be aware of for ballet dancers and gymnasts.

Ballet dancers feet are much like a musician’s handsthey earn a living with them. In addition to putting an amazing amount of stress on their feet, they also are often well below an ideal body weight – either because of the stress of an enormous amount of training or because of unrealistic expectations placed on them by the ballet community. This leads to several different and often unique foot and ankle conditions.

One fairly unique foot and ankle condition in ballet is caused by the en pointe position. In this position an enormous amount of strain is put on the dancer’s great toe, as it is essentially holding up the entire body weight through a small joint. The main flexor tendon of the toe, called the flexor hallicus longus – normally quite small, takes over the job of the largest tendon in the body, the Achilles. The flexor hallicus longus hypertrophies well in compensation for its new job, but unfortunately this tendon is forced through a tight tunnel in the back of the ankle. When it gets too large it will get pinched in the posterior ankle joint. Patients develop painful irritation of the bones and soft tissues in the posterior ankle. An extra bone in the posterior ankle called the os trigonum, which present in about 10% of all people, can be become very painful and irritated in many ballerinas. This constellation of problems is called posterior impingement of the ankle, and it is noticed by the patient as a vague deep pain in the posterior part of the ankle, in front of the Achilles, that is felt with plantarflexion, the position of pointing the foot and toes downward.

Ballet dancers suffer from numerous other problems of the foot & ankle, many of which are not unique. One of the less glamorous problems they deal with are corns, calluses, and blisters. These are necessary adaptations to allow a high level dancer to compete.

Similar to posterior impingement, which arises from dancers spending an inordinate amount of time and stress in an extreme position at the ankle, ballet dancers will develop anterior impingement at the ankle. This comes from repetitive forceful dorsiflexion – pulling the foot and toes upward, toward the shin. Landing from jumps and deep knee bends exacerbate this problem. Pain is felt in the anterior ankle.

Treatment for the above condition is customized to the patient. Often a minor activity modification, or period of rest, can dramatically improve the symptoms. Unfortunately, rest is not easy to come by in the competitive living of a gymnast. Many dancers will treat the symptoms with a combination of anti-inflammatory medications and occasional steroid injections in the region of maximal tenderness. Surgery is a last resort option for any ballerina – when symptoms persist for many months and are limiting, despite all other efforts. Surgery is typically very successful in these patients and can be done with arthroscopic or minimally invasive techniques.

The most common orthopaedic injury of all is also very common amongst ballet dancers: the lateral (traditional) ankle sprain. The mainstay of treatment for ankle sprains is rest, ice, compression, and elevation – mnemonic RICE. A short period of rest and immobilization (1-2 weeks) is followed by aggressive physical therapy, with strengthening of the muscles that stabilize the ankle. Recent research has pointed to improved short and long-term outcomes when early motion and weight bearing is initiated. There is promising early research on the role of stem cell injections – harvested from the patient’s own blood or bone marrow – in the setting of an acute ankle sprain. This is a technique we will offer for the highest level athletes and dancers in certain situations, understanding that the research data on this intervention is still in development.

… to be continued in the next segment, The Fragile Feet: A Gymnast Story (Part II)

Want to learn even more? Dr. Yakavonis will be giving a seminar on “Solutions for Foot and Ankle Pain: Beyond a Foot Massage.”  The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.

07/10/2019

What do you do when you are diagnosed with an old (chronic) Achilles tendon rupture?

Mark Yakavonis, MD, MMS, is an orthopedic surgeon who specializes in foot and ankle surgery. Dr. Yakavonis has expertise in treating a variety of foot pain and deformity related conditions including Achilles tendonitis, ankle instability, cartilage injuries, bunions and hammer toes.  His practice will also focus on youth athlete sports injuries and the types of injuries seen in field athletes, gymnasts and ballet dancers.

Achilles tendon ruptures will often not be discovered for months after the injury. In the months between injury and showing up at the doctor’s office, the torn tendon develops scar tissue which decreased the quality and elasticity of the tissue. Because of this, directly repairing the torn tendon, as is done in an acute injury, becomes is less than ideal. In this situation, we will supplement the tendon repair with a tendon transfer. Essentially, we borrow a tendon that bends the big toe (there is another tendon that compensates when it is borrowed), reroute it, and reattach it to the heel bone. This does two very important things:

1. It supplements the strength of the torn Achilles, allowing a quicker and better recovery.

2. It provides improved blood supply to the Achilles repair, providing healing factors to the area of diseased tendon.

In summary, ruptures of the Achilles Foot_AnklePictendon are increasingly common in our aging yet increasingly active population. In cases where an Achilles rupture is missed or the rupture cannot be repaired directly under normal tension, adding the flexor hallicus longus tendon transfer allows for significantly improved results with a shorter recovery.

If you suffer from foot and ankle pain and would like to attend a free seminar, Dr. Yakavonis of ONS is an orthopedic surgeon specializing in foot and ankle surgery, and Greenwich Hospital will present Solutions for Foot & Ankle Pain: Beyond Foot Massage . He will present treatments and surgical techniques for bunions and other foot deformities. Learn more and register online here.

07/10/2019

Suffer from Bunion Pain? Dr. Clain Offers Solutions

Michael Clain, MD
Michael Clain, MD

Bunions are a common deformity encountered in the foot where the big toe is out of alignment. This creates pain in that toe and often in the lesser toes as well. The deformity makes it difficult to find shoes that fit comfortably.  Ill-fitting shoes can contribute to the situation but the underlying deformity is genetic. This is why most patients can recall a parent or grandparent that had the problem.

In consultation, I often tell patients that the options are to accommodate the foot with wider shoes, gentle arch supports and sometimes padding or I encourage them to consider surgery.  The decision to proceed with surgery should be based on the overall level of discomfort and deformity.  This will differ from patient to patient.  It is rare that the patient that must have bunion surgery.  Most people will choose surgery due to the accumulation of annoyances, discomfort, pain and deformity in other toes.

Actual X-ray of patient of Dr. Clain before bunion surgery
X-ray of patient of Dr. Clain before bunion surgery
Same Patient. Post-Bunionechotmy
Same Patient. Post-Bunionechotmy

It is very important, from my point of view, to communicate realistic expectations for the procedure and the ultimate result. I try hard to be very specific about the time involved in recovery and give every patient a written “expected surgical recovery.” It is obviously difficult to remember everything when you as the patient are given a great deal of information so it’s helpful to have a summary to refer to.

Not all bunions are the same. Routinely, I perform about six different surgical procedures.  The goal is to do the most appropriate operation for your particular foot and circumstance.  With careful communication and a well thought-out plan it is highly likely that we should be able to get a great result for almost any foot.”

For more information about Dr. Clain, click here.

If you suffer from bunions and would like to attend a free seminar on foot pain Dr. Yakavonis of ONS and Greenwich Hospital will present Solutions for Foot & Ankle Pain: Beyond Foot Massage is an orthopedic surgeon specializing in foot and ankle surgery. He will present treatments and surgical techniques for bunions and other foot deformities. Learn more and register online here.

07/10/2019

Do You Experience Foot or Ankle Pain?

Mark, Yakavonis, MD, MMS, will be speaking at the Noble in Greenwich Hospital December 9th at

6:30pm to address Solutions for Foot & Ankle Pain: Beyond Foot Massage. Here is a summary of what he will present:

A painful foot or ankle condition can limit a patient’s function and quality of life with every step. Conditions from the toes to the Achilles tendon will be discussed with emphasis on surgical and nonsurgical options, including old standards and the most cutting edge new technologies. Topics covered will include foot and toe deformities such as bunions, hammertoes, flat feet, and high arches, with special attention to when and how these conditions should be treated or when they should be left alone. Plantar fasciitis and Achilles tendinitis will be discussed in detail with emphasis on the natural progression of the disease, what we know works and what is experimental. Arthritic conditions of the foot, ranging from the big toe to the ankle will be included.

A team approach is an important aspect of foot and ankle care. ONS physical therapist Alicia Hirscht, DPT, SCS, CSCS will discuss and answer questions about the role of physical therapy to improve foot and ankle pain and dysfunction.

ONS Senior Clinical Specialist Alicia Hirsch
ONS Senior Clinical Specialist Alicia Hirsch, DPT, SCS, CSCS

Dr. Yakavonis will introduce an orthotic maker he typically works with and will discuss when and how orthotics are used, from inexpensive over-the-counter inserts to custom molded prostheses. Other options to be discussed will include stem cell technology and image-guided injections.

Dr. Yakavonis will open up a question and answer session following the seminar. This event is free registration requested, call (203) 863-4277 or (888) 305-9253, or register online at:  https://www.greenhosp.org/CREG/ClassDetails.aspx?sid=1&ClassID=7253

Foot Ankle Pain Brochure

07/10/2019

Foot and Ankle Surgeon and Physiatrist join ONS

Specialists in foot and ankle surgery and physiatry added to growing practice.

We are pleased to announce that orthopedic surgeon Mark Yakavonic, MD, MMS, and interventional physiatrist Christopher Sahler, MD have joined the ONS team.

Dr. Yakavonis learned his medical degree at New York Medical College, in Valhalla, NY. He did his residency in orthopaedic surgery at Boston University Medical Center, in Boston, MA and completed fellowship training in foot and ankle surgery at Harvard-Massachusetts General Hospital in Boston, MA.

Dr. Yakavonis has expertise in treating a variety of foot pain and deformity related conditions including achilles tendonitis, ankle instability, cartilage injuries, bunions and hammer toes.  His practice also focuses on youth-athlete sports injuries and the types of injuries seen in field athletes, gymnasts and ballet dancers.

Christopher Sahler, MD
Christopher Sahler, MD Physiatrist

Dr. Sahler completed his residency in physical medicine and rehabilitation at the Mount Sinai Hospital in Manhattan where he was elected Chief Resident. He continued his training at the Mount Sinai to complete a fellowship in sports medicine and interventional spine treatments. During that time, he also served as team physician for the Globe Institute Junior College sports teams, and was a physician and team captain for the New York City Marathon. He is board certified in sports medicine.

Dr. Sahler uses biomechanical assessments and diagnostic ultrasound to determine the precise source of a problem. He applies non-operative modalities to treat musculoskeletal injuries and restore proper function including ultrasound and X-ray guided steroidal injections, viscosupplementation and PRP (Platelet Rich Plasma) to treat pain and restore proper mobility. Both doctors are in network with Aetna, Oxford/United Healthcare, and Yale New Haven Anthem. “We are pleased to bring two new sub-specialty trained physicians into our practice to meet the growing demand for musculoskeletal care in Fairfield and Westchester counties,” said Dr. Seth Miller. “Dr. Yakavonis and Dr. Sahler are both highly trained and will be great assets to our practice.”

Upcoming Events at Greenwich Hospital

  • On Tuesday, December 2, from 6 to 7 p.m., Dr. Sahler will speak about exercise as a treatment for chronic pain.
  • On Tuesday, December 9, from 6:30 to 7:30 p.m., Dr. Yakavonis will talk about solutions for foot and ankle pain; beyond foot massage.

Both talks will be held in the Noble Conference Center and are open to the public. ONS is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma. 

ONS Orthopedic Surgeon and Sports Medicine Specialist, Timothy Greene, MD Gives Insight on Paul George Injury

Time Greene, MDTeam USA’s scrimmage this past Friday night was definitely one to remember; and not in a good way. ONS Orthopedic Surgeon and fellowship trained Sports Medicine Specialist, Timothy Greene, MD, gives us some insight on NBA Super Star, Paul George’s gruesome injury that caused jaws to drop and made an entire arena become strikingly silent.

“NBA star Paul George sustained a gruesome leg injury during Friday night’s Team USA basketball game in Las Vegas. While trying to contest a layup, George’s leg hit the basketball stanchion causing an open tibia/fibular fracture. The injury consists of a complete break of the shin bone and small bone in the lowerleg that penetrates through the skin. When the bone penetrates the skin, there is an increased risk of infection and thus an urgent surgery was preformed the night of the incident to clean and repair the ends of the bone and skin and place a rod in the shin bone.

The road to recovery will most likely be a long one for the NBA superstar. When the bone penetrates the skin, it increases the time for healing. Studies examining these types of injury show that it can take up to 6 months to get complete healing of the bone. Although we often see our professional athlete’s recover and return to a high level of play in a surprisingly rapid timeframe, it is not unreasonable to expect that Paul George may take an entire year to return to elite level basketball.”

To learn more about the incident, read this article by The Huffington Post.

Orthopaedic and Neurosurgery Specialists PC (ONS) is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma. For more information, please visit www.onsmd.com.