Winter Hand and Wrist Injuries

Winter sports, slippery sidewalks and snow blowers pose risks to many parts of the body, but hands and wrists in particular take a beating when temperatures plummet and snow accumulates, according to David Wei, MD, hand, wrist and elbow expert at ONS.

“The most common upper extremity injury in the winter months occurs when people extend their arms in front of them to break a fall when they slip on the ice or while engaging in a winter sport,” said Dr. Wei, who noted that several injuries can result from this reflexive action.

If the fall occurs while skiing, the skier can suffer a condition known as Skier’s Thumb if they land with the ski pole still in their hand.

When this happens, the ulnar collateral ligament of the thumb located at the base of the thumb  can get strained or tear. A simple strain can be managed with a thumb stabilization brace, over-the-counter anti-inflammatory medications and ice. Surgery may be necessary to reattach the ligament if a complete rupture has occurred and the thumb is unstable.

Compression, or buckle fractures, of the wrist can also result from an outstretched arm during a fall.  If this occurs near the growth plate in a child, a wrist cast or brace will allow the bone to heal in 3-4 weeks. In comparison, for adults fractures generally take about six weeks.  If a more complicated fracture occurs, where both bones of the forearm break and there is severe deformity of the forearm, the entire arm — including the elbow — may need to a cast.

Dr. Wei said the one way to minimize these injuries is to try to land on your forearms instead of using your hands to break a fall. Wrist guards may also provide additional protection for snowboarders and skiers. When possible, falling backwards, or uphill, may reduce the risk of higher impact injuries to the arms and hands. Finally, be mindful that skiers and snowboarders should refrain from attempting terrain that is above their ability and importantly. When fatigued, winter sportsmen should take frequent breaks or call it quits.

“Many of these injuries can be treated at an orthopedic urgent care facility,” said Dr. Wei. ONS offers after-hours, walk-in urgent orthopedic care at its Greenwich office from Monday through Friday, 5:00 – 8:00 pm, and on Saturday from 12:00 to 4:00 pm.

However, a trip to the emergency department is essential if the injury more severe, such as the ones that may occur with improper use of a snow blower. “The rotor at the bottom of the blower can get jammed from debris, such as a newspaper under the snow in a driveway,” said Dr. Wei. “People lose fingers by reaching in between the blades to remove the blockage. When the blades suddenly are free, they can continue to spin like a loaded spring injuring anything in its path.”

If such an event happens, the best course of action to save any amputated parts is to wrap them in gauze soaked with clean water and place the wrapped parts in a sealed plastic bag. The sealed bag should then be put into another bag that is filled with ice.  The patient should be transported immediately to an emergency department for evaluation and treatment by a specialty-trained hand and microvascular surgeon.



ONS Turns 20!


This month, Orthopaedic and Neurosurgery Specialists, PC (ONS) entered its 20th year as one the most respected and trusted orthopedic and spine practices in the region. Through the years, the practice has stayed true to its mission of putting the patient first and providing the highest standard of specialty care.

A Bold New Plan

Back in October of 1998, the concept for ONS was bold and new: to build a community practice of elite fellowship-trained subspecialists and neurosurgeons whose training , skill and expertise rivaled that of the doctors at large, city hospitals. Today, ONS’s physicians rank top among their counterparts by national, regional and local peer ranking agencies.

The original ONS was created with the merger of the practices of orthopedic surgeons Seth Miller, MD, John Crowe, MD (who retired in 2015), and neurosurgeon Mark Camel, MD, each of whom had top-tier specialty training in their respective fields. Their business model focused on providing specialized care of the entire musculoskeletal system. Their belief was, and continues to be, that patients have better outcomes when treated by a physician who specializes in their particular type of condition or injury. With this in mind, they assembled the practice with doctors who had specialty training in all the major body parts; shoulder and elbow, hand and wrist, knee, foot and ankle, joint replacement and the spine.

“Twenty years ago, it was a common belief that you had to drive to New York City to get the best specialized care,” said ONS president Dr. Miller. “We set out to challenge that assumption by recruiting exceptionally qualified physicians from the most elite specialty fellowship programs in the country to come work here in Greenwich, CT. We wanted to deliver world class care in a convenient and friendly environment so people could avoid the hassle of going to the city.”

This business model also supported a team-based approach to patient care. At ONS, physicians do not compete with one another for patients. Instead, ONS physicians work in collaboration with each other to ensure that a patient is seen by the most appropriate physician to treat that individual’s condition. That unique model consistently earns the practice patient satisfaction scores higher than 90%.

Investing in the FutureONS Greenwich Office

From its humble origins on the first floor of Building 6 at Greenwich Office Park in Greenwich, patient satisfaction and word of mouth propelled the practice’s expansion. ONS now occupies the entire building and has satellite locations in Stamford, CT and Harrison NY, where 26 orthopedic and spine physicians provide comprehensive musculoskeletal care from head to toe.  All ONS locations feature physical therapy centers and digital X-ray. The Greenwich and Stamford locations also offer state-of-the-art MRI services. In addition, ONS leases space in Building 9 of Greenwich Office Park to house the finance and accounting departments and the Call Center.

With a focus on delivering the best possible patient outcomes, ONS has invested in leading edge technologies like digital X-ray systems and ultrasound to stay at the forefront of patient care. They were leaders in adopting electronic medical records (EMRs) to replace paper charts, and ONS is still among the few independent practices to offer onsite MRI services.

In 2004, ONS was among the first private practices to offer physiatry. Also known as physical medicine and rehabilitation, physiatry is a field of medicine that specializes in the diagnosis and non-surgical treatment of the musculoskeletal system and the diseases and conditions that affect a person’s ability to function in a normal capacity.PRP - Plasma Rich Platelets

ONS fellowship-trained physiatrists use non-surgical, opioid-free treatments including epidural injections and image-guided steroidal injections as alternatives to surgery.  With the advent of regenerative medicine therapies using stem cells, platelet rich plasma and other natural substances, physiatrists also perform the newest biologic treatments that promote self-healing.

Achievements and Milestones

During the past two decades, ONS physicians have broken clinical ground in a number of areas.  They were among the first to do computer-assisted joint replacements, image-guided therapeutic injections, and Cyberknife® procedures.

In 2006, Dr. Miller became the first surgeon in Connecticut to perform a reverse shoulder replacement. The previous year, Dr. Francis Ennis was the first in the region to perform a computer-assisted knee replacement. More recently, Drs. Clain and Peden were among the first to use a new synthetic cartilage to treat MTP joint arthritis. In August of this year, spine specialist, Dr. Scott Simon, was the first neurosurgeon in Fairfield and Westchester counties to perform spine surgery using a highly advanced robotic navigation system. ONS surgeons have also been ahead of the curve in developing opioid-free pain management protocols and opioid-sparing surgery.

Ongoing Research and Discovery

ONS physicians don’t just rely on the research of others. Through the establishment of the non-profit ONS Foundation for Clinical Research and Education (ONSF) ten years ago, ONS physicians have studied and developed better techniques to improve patient outcomes. ONSF research has been published in the most respected national and international medical journals and ONS physicians are often called upon to speak at medical conferences. ONSF president, Dr. Paul Sethi helped establish guidelines for surgical techniques and helped set surgical standards for needle use during certain surgical procedures. Dr. Sethi and other ONS physicians have taken a lead role in developing new national guidelines for the use of opioids to manage post-surgical pain.  Now most ONS surgical patients can avoid addictive pain medication due to the use of new pain management protocol delivered during surgery. The Foundation’s community outreach projects include injury prevention seminars, a mini-med school summer program for high school students who have an interest in a career in medicine, class trips from local schools and technical demonstrations to outside clinicians.

A Focus on Sports Medicine

As sports and athleticism gained popularity with people of all ages and abilities, ONS established a Sports Medicine specialty center that has attracted physicians into the practice who have had Hockey injuryaffiliations with professional sports teams such as the New York Mets, Los Angeles Dodgers and Texas Rangers as well as local college and high school teams. ONS sports medicine specialists apply the same treatment strategies used for high performance professionals to care for semi-pro, student and recreational athletes.  ONS sports medicine specialists also launched ONS Ortho Access, a resource for school trainers and coaches to have immediate access to a physician by phone to assist in determining the best way to manage a student who has been injured during a game or practice.

Ambulatory Surgery

In 2016, ONS Partners opened the Stamford Ambulatory Surgery Center(ASC), at First Stamford Place in Stamford, CT. The ASC is a brand new facility specifically designed for musculoskeletal surgeries and interventional pain management. The Center includes four surgical suites designed for orthopedic and neurosurgical procedures with the latest arthroscopic and computer-assisted technology. Particular attention was paid to patient comfort when designing the waiting room, and pre-operative and post-operative areas. The Stamford ASC is Accredited by the Association of Ambulatory Health Care (AAAHC), and licensed by the Connecticut Department of Public Health (DPH).

Expanded Hours for Patient Care

In June 2018, ONS launched ONS Urgent Ortho Care. The after-hours, convenient walk-in service provides a fast, cost-effective alternative to an emergency room visit for sudden injuries or other musculoskeletal problems. Urgent orthopedic care is available on Mondays through Fridays from 5:00 – 8:00 pm and from 12:00 – 4:00 pm on Saturdays.  There are plans to expand the service later in the year.

The practice employs over 200 in staff including operations, call center, billing office and clinical operations. Some of whom have been with ONS since its founding. ONS is in network with all major insurances and many smaller insurance providers.

In this day and age of costly concierge medicine and large hospital physician networks, ONS has always held true to its founding mission:  to provide world-class, specialized care to patients in Fairfield and Westchester County, with the convenience and personal touch of a small, independent community practice.  That unique ONS brand of care and compassion will never change with age.


Why ONS Patients Need Fewer Opioids

As soon as it became apparent that common surgical procedures could become inadvertent pathways to opioid dependence, surgeon Paul Sethi, M.D., and a team of colleagues at Orthopaedic & Neurosurgery Specialists (ONS) began looking into ways to reduce that risk for patients.

With Dr. Sethi as lead researcher, the group of orthopedic surgeons conducted years-long research into opiate-sparing, post-surgical options through the non-profit, ONS Foundation for Education and Clinical Research (ONSF).  Dr. Sethi is president of ONSF.

As a result of their study, the majority of ONS patients now are better able to tolerate pain following certain surgical procedures than in the past. ONS surgeons are writing far fewer opioid prescriptions, and, in many cases, no prescriptions for opiates at all.

“We know patients are concerned about post-surgical pain and there is also real apprehension about opioid use,” Dr. Sethi said. “We have been able to address their concerns by incorporating the newest and most comprehensive pain management techniques and non-opiate alternatives.”

Finding solutions for pain management

Dr. Sethi and his associates tested a pain-reducing intra-operative protocol that keeps the surgical area numb for the first few days following a procedure.  They found that patients who received the new treatment reported lower pain scores, took fewer, if any, opioids to control pain and rarely asked for refills.

While this new mode of pain management is currently used in a number of ONS surgeries, Dr. Sethi’s initial study focused primarily on decreasing opioid consumption following arthroscopic rotator cuff repair, a procedure with a particularly painful period of recovery.  He recently presented the research findings at the prestigious 2018 American Shoulder and Elbow Surgeons (ASES) meeting in Chicago, IL.

During the period of the study, he reported, patients who were administered a long lasting analgesic, liposomal buipivacaine, in addition to an interscalene block with bupivacaine (ISB), reported statistically and clinically lower pain scores than the control group who received the ISB alone. Patients who were given both compounds consumed 64 percent fewer opioids than the control group and 58 percent of the patients receiving the protocol had stopped taking opioids by post-surgical day 4, compared to on 15 percent of patients in the control group.

Moreover, none of the patients with the protocol requested a prescription refill during the five-day post-op period; 28 percent of the control group requested refills during the five-day span.  This is particularly significant in limiting the risk of addiction.  According to the Centers for Disease Control and Prevention (CDC), opiate use beyond five days, and prescription refills, directly increases the risk of developing an opiate dependence.

“We have found that we can keep our patients safe from the dangers of opioid addiction by using this new multimodal, opioid-minimizing pain management strategy,” Dr. Sethi noted.

Pain relief that’s safer for patients and others

While there isn’t any other data to indicate how many opioid pills patients should be given after rotator cuff surgery, the ONS research team determined that 25 oxycodone 5mg pills, at most, should be sufficient to manage the pain during surgical recovery. This is in sharp contrast to the current average amounts prescribed, which a recent report, Exposing a Silent Gateway to Persistent Opioid Use, found to be 93 pills.

Fewer opioids is not only good for the patient, it reduces the risk that unused pills, which are often improperly stored or disposed of, can fall into the hands of opioid abusers.

“Now that we are able to perform many opiate-free surgeries, our patients are much happier,” Dr. Sethi said.

Regenerative Medicine Seminar

Stem cell therapy. Super PRP. The future of medicine is now! Expert Dr. Tim Greene will discuss the latest biologic treatments that augment the body’s own natural healing powers to repair, and Stem Cell Therapyin some cases, regrow damaged cartilage and tissue. Q & A will follow.  FREE.  Please register by calling 888-305-9253 or online

WHEN:  Wednesday, October 10

TIME:    6:00 – 8:30 PM

Greenwich Hospital
Noble Auditorium
5 Perryridge Road
Greenwich, CT 06830

Can Tiger Wood’s Surgery Help You?

Spinal fusion may not improve your golf game, but it can make it less painful.

Eighteen months ago, Tiger Woods underwent spinal fusion surgery to relieve the debilitating back pain that had forced him to drop out of the sport where he is considered one of the greatest golfers of all time.

Six months after the procedure, Woods started swinging a club.  Last Sunday, Woods took first place at the  the 2018 Tour Championship in France.  It was his first major tournament win in 5 years.

Before his lower spine fusion, Woods said his pain had gotten so intense that playing golf was the furthest thing from his mind.

“I was beyond playing. I couldn’t sit. I couldn’t walk. I couldn’t lay down without feeling the pain in my back and my leg. That was a pretty low point for a very long time,” he told senior writer Bob Harig of

Spinal fusion surgery has been around for more than 50 years; however, recent developments in minimally invasive techniques, computer navigation and robotics have made spinal fusion less invasive, safer, and more precise. Newer technology also reduces the need for repeated x-rays during surgery, which decreases radiation exposure for the patient and the attending surgical staff.  Recovery is quicker and outcomes are much better than in years past.

“Today’s technology has so many benefits for patients suffering from spinal problems,” said neurosurgeon, Scott Simon, MD, of Orthopaedic & Neurosurgery Specialists (ONS). Dr. Simon was the first in Fairfield and Westchester Counties to perform robotic assisted spinal fusion surgery using the newest state-of-the-art Globus Excelsius GPS robotic system.

Spinal fusion surgery welds together two or more vertebrae in the spine to reduce motion in the section that causes pain from arthritis, injury, disease, or degeneration. Each procedure is slightly different depending on the patient’s individual condition, but typically the surgeon will decompress the nerves and replace a damaged disc (discectomy) with a bone graft and a synthetic cage in order to reestablish a normal level of space between the affected vertebrae and the nerve channels. In Tiger Wood’s case, the 5th lumbar vertebra had slid slightly over the sacrum, a condition known as spondylolisthesis, and was corrected by fixating and fusing the 5th lumbar vertebra to the sacrum.  In time, the vertebrae heals into one solid piece.

Most cervical (neck) fusion cases can be performed on an outpatient basis with patients recovering at home and moving about on the same day.  Thoracic and lumbar spinal fusions for the mid and lower back usually require a hospital stay of two to four days, depending on the location and complexity of the condition.  In addition to spinal fusion, a neurosurgeon may also recommend a procedure known as a laminectomy, during which damaged bone or tissue is removed.

According to Dr. Simon, spinal fusion surgery is only recommended after conservative treatments, such as NSAIDs, physical therapy and injections have failed to provide lasting pain relief.  Spinal fusion may be used to treat a number of back and neck problems, including:

Depending on the nature and location of the spine disorder, neurosurgeons will use one of three approaches to perform the procedure.  The anterior approach requires a small incision to be made through the front or side of the abdomen to reach the lumbar region or through the front of the neck to reach the cervical spine.  With the posterior lumbar approach, a small incision is made in the middle of the lower back; posterior cervical fusion is performed through the back of the neck.


Patients tend to feel better in less time than it takes for the bone fusion to become solidly formed. “Post-lumbar surgical patients should avoid bending or lifting until they are cleared by their surgeon,” Dr. Simon said.  Most patients are off all pain medication by week 3 and often return to work by week 6.  Full recovery from cervical fusion can take from three to six months.  Thoracic and lumbar fusion can take longer, from six months to a year to heal completely.

If you experience prolonged back or neck pain that radiates down a limb, consult with a board certified neurosurgeon to learn if spinal fusion is an option for you.

ONS neurosurgery specialists are spinal fusion experts who use the latest state-of-the-art technology for the greatest precision and shorter recovery periods.


Schedule an appointment to find out if spinal fusion surgery is an option to treat your back pain.

Dr. Marc Kowalsky Headed to International Tournament

ONS Sports Medicine expert, Dr. Marc Kowalsky, will serve as team physician for the USA Rugby National Team Selects at the upcoming 2018 World Rugby Americas Pacific Challenge in Dr. Kowalsky at Rugby CutMontevideo, Uruguay from October 6 – 14.  Dr. Kowalsky has served as team physician for the USA Rugby National Teams since 2013.  “This is a challenging competition that will help the USA team prepare for the 2019 Rugby World Cup in Japan,” he said.

According to the USA Rugby website, the Americas Pacific Challenge was introduced in 2016 to boost the high-performance pathway and to support the Americas Rugby Championship and Pacific Nations Cup as well as November international test window preparation.

The six “A” team tournament includes two teams each from the Pacific Islands, North America and South America.

This year’s tournament sees reigning champions Argentina XV compete alongside Canada A, Samoa A, Tonga A, Uruguay A and USA Selects.

The World Rugby Americas Pacific Challenge will be a first-past-the-post tournament format, played across three competition rounds on October 6, 10 and 14. Teams in Pool A will play all teams in Pool B once, and teams in Pool B will face all teams in Pool A once. The tournament winner will be decided by the total number of competition points accumulated in the three matches played.

Pool A consists of Argentina XV, hosts Uruguay A and Tonga A, while 2017 runners-up USA Selects are in Group B with Samoa A and Canada A.

Agustín Pichot, World Rugby Vice Chairman and Rugby Americas President was quoted saying “With Rugby World Cup 2019 on the horizon, the Americas Pacific Challenge continues to play a key role in supporting player development.”

Dr. Kowalsky’s interest rugby began when he played the sport while at Dartmouth College.  Locally, he is team physician for Iona Rugby Football Club, White Plains Rugby Football Club, and the Greenwich High School Rugby team.



ONS is Proud to Sponsor Kid’s Race & Local Charities

Come see us this  Saturday at the  ONS Westchester Kid’s Race at the Westchester Triathlon starting and ending at Rye Town Park.  We will be there on Sunday for the Olympic Triathlon, too, cheering on seasoned triathlete and  ONS Physician Assistant, Jason Salomon, MMS,  PA-C.

The ONS Westchester Kids Race is a fun and safe event. The swim takes place in the protected and shallow waters of Playland Beach, the bike route is through Playland Park on closed roads, and the run is along the boardwalk. The kids finish their race with a sprint down the finish chute, just like the pros!  The ONS Westchester Kids Race is great for the first timer and for the seasoned younger triathlete.  The event is sold out with 400 young runners.

ONS is proud to sponsor this 501 (c) 3 organization that promotes a love of sport for people of all ages and supports worthwhile local non-profits. Click here to see the list of charities.

Here’s the schedule:


Date:    Saturday, September 22

Start Time:   8:00 AM


Date:    Saturday, September 22

Start Time:   10: 15 AM


Date:    Sunday, September 23

Start Time:   7:00 AM

Hope to see you there!

ONS Adds Joint Replacement Case Manager

Tori Kroll, RN, is known to many ONS physicians and staffers from her former position as the coordinator for joint and spine programs at Greenwich Hospital.  Tori worked in various departments at the hospital for 38 years, and it was there that she developed her love of orthopedics and helping orthopedic patients.

“This is a dream job for me,” she said of joining ONS.

In this newly created role, Tori provide joint replacement patients with a full continuum of personalized care from the time a surgery is scheduled through the initial months of recovery.  The position provides many advantages to patients, including a direct line for any questions or concerns.  In addition, Tori may visit patients’ homes to evaluate post-op safety and arrange for supportive equipment, if needed. She may also coordinate post surgical at-home care or a stay at a skilled-care facilities of preferred providers.

“It’s all about achieving the best outcomes,” said Tori. “By establishing a close relationship with patients, we can fully prepare them for every level of the procedure and after.”

ONS Physician … Compassionate to the Bone

Dr. Alex Levchenko is featured in the September 2018 issue of the Westchester WAG magazine article called Compassionate to the Bone.   In the piece, writer Phil Hall covers a lot of territory, Alex Levchenko, MDfrom Dr. Levchenko’s specialty in physiatry, the difference between an MD, medical doctor, and DO,, doctor of osteopathic medicine – Dr. Levchenko is the latter,and the dangers in youth sports specialization to the ONS practice-wide commitment to compassionate care.

“Our practice prides itself on being compassionate,” Dr. Levchenko says. “We run on time, so patients don’t come and wait for hours. We think compassionate care is the key. We look at you as a human being and not just a part of the body.”

Hill also describes the genesis in Dr. Levchenko’s interest in medicine, writing:

Levchenko’s interest in all things medical took root during his childhood in Soviet Russia. “My parents were teachers,” he recalls. “My mom was teaching high school biology and my dad was teaching music. We had a huge library at home. From the time I was a kid I was always interested in that. By the age of 12, I covered the whole high school curriculum. We were given an assignment at school to write about who we want to be. I decided medicine would be the best route for me. The older I got, I knew that is what I wanted to be.”

In 1994, the 19-year-old Levchenko had the opportunity to pursue medical studies in the U.S. He was grateful to pursue studies away from the political upheaval that followed the collapse of the Soviet system and Boris Yeltsin’s raucous presidency.

“It was an interesting time — a turbulent time in Russia,” he says. “I was lucky to be presented with an opportunity to come here.”

Levchenko attended college at New York University and medical school at New York College of Osteopathic Medicine in Old Westbury. His residency took place in the Physical Medicine and Rehabilitation Department at New York University Langone Medical Center and his fellowship in the Orthopaedic Sports and Spine Rehabilitation Department of Mount Sinai Hospital.

Read the entire article.

Expert Foot and Ankle Surgeon Joins ONS

ONS is proud to announce the addition of orthopedic foot and ankle surgeon, Mark Yakavonis, MD, to the accomplished team of  ONS orthopedic specialists, neurosurgeons, physiatrists and Mark Yakavonis, MDphysical therapists. Dr. Yakavonis will see patients at ONS’s Greenwich office and at its Westchester location at 500 Mamaroneck Avenue in Harrison, NY.

Dr. Yakavonis is a fellowship-trained specialist whose expertise includes foot and ankle sports injuries, fractures, cartilage injuries, neuromuscular disease and arthritis.  He performs minimally invasive and arthroscopic surgical techniques and ankle joint replacement.

Dr. Yakavonis earned his medical degree from the New York Medical College in Valhalla, NY. He completed his residency in orthopedic surgery at Boston University Medical Center, followed by a fellowship in foot and ankle surgery at Harvard-Massachusetts General Hospital, in Boston MA.

While a resident, Dr. Yakavonis received the Resident Research Award for his research into a novel operative technique for reducing ankle syndesmosis (high ankle sprain). He was later awarded a national research grant to continue his research from the Arthroscopy Association of North America.  A published author and frequent lecturer, Dr. Yakavonis was named an Emerging Leader by the American Orthopaedic Association.

“ONS has been dedicated to helping patients maintain active lifestyles for 20 years. By adding Dr. Yakavonis to our prestigious team of orthopedic foot and ankle surgeons, ONS will be able to accommodate the increasing patient demand for an elite level of expertise in lower extremity conditions,” said Seth Miller, MD, president of ONS.

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 physiologically designed to handle the pressure … to a point,” said orthopedic foot and ankle specialist, Sean Peden, 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. Peden 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. Peden, 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, Sean Peden, MD or Michael Clain, MD by calling 203-863-1145 or request an appointment here.

Dr. Vadasdi: Mom of the Week

In case you missed it, Dr. Katherine Vadasdi was profiled as the “Mom of the Week” by the local Greenwich website,  We all know Dr. Vadasdi for her amazing talents as a doctor, but, as the article notes, she is also a committed mom to Jack, 8, and Sophie, 6.  As any working mother can attest, managing a demanding career and a family is no easy task. Dr. Vadasdi credits her husband, other family members and friends for being an incredible support system.  Dr. Vadasdi also discusses her family’s love of the outdoors and her own personal athletic accomplishments.  Read more

Lifelong Athlete Stays That Way, Thanks to ONS

Jeffrey B. Mendell has been active his entire life and he plans to remain that way for as long as he can.

At 64, the athletic Bedford resident and real estate developer still plows down mountain moguls in Colorado several times a year, bikes more than 50 miles per week along the backcountry roads of Greenwich and Bedford, and plays 50+ rounds of golf each season.

“I just love being active outdoors,” he said.

Over the years, however, Jeff’s intense athletic pursuits have taken a toll on his body.  In each instance, he turned to the specialists at Orthopaedic & Neurosurgery Specialists (ONS) to repair his injuries. “I’ve had two rotator cuff surgeries, meniscus surgeries on both knees and on the first ski day of 2016 I caught an edge and broke my wrist,” he explains.  “I know I’m going to have to slow down at some point…. but I’m just not ready to yet.”

Jeff said he thoroughly researched the best orthopedic surgeons in the NY area when he suffered his first injury several years ago. He consulted with orthopedic surgeons in New York City and, on a friend’s recommendation, he checked out Dr. Paul Sethi’s qualifications on the ONS website,  Jeff was immediately impressed.  “I watched videos of Dr. Sethi speaking at medical conferences about complex knee and shoulder surgeries and was attracted to both his intelligence and surgical experience. We met at ONS and after a thorough discussion, I was convinced that he was an especially talented surgeon and the right doctor for me.”

Dr. Sethi performed a very sophisticated procedure to repair Jeff’s severely damaged right rotator cuff and torn bicep tendon injured in a high speed fall while skiing. The procedure included the use of a synthetic patch to reattach the rotator cuff to the bone and the outcome was flawless.  From that point on, Jeff has turned to ONS physicians and physical therapists to help him recover from his sports injuries.

“I’ve had outstanding outcomes from the surgeries I’ve had with the ONS team,” he said. “I send my family to ONS when they get hurt and I tell all my friends to go there when they suffer an orthopedic injury.  Personally, I wouldn’t consider going anywhere else.”

ONS Urgent Ortho Care now in Greenwich

If you’ve ever experienced a long wait in an emergency department when you’ve suffered a sudden sprain or broken bone, you will appreciate the new orthopedic urgent care service that ONS launched on Monday, June 18.

ONS Urgent Ortho Care offers after-hours emergency orthopedic care at the ONS Greenwich office at 6 Greenwich Office Park, between the hours of 5:00 pm and 8:00 pm, Monday through Friday and Saturday from 12 – 4:00 pm.  No appointment is necessary.

“Orthopedic injuries can happen to anyone at any time,” said Seth Miller, MD, president of ONS. “ONS Urgent Ortho Care gives patients a fast, convenient and less costly alternative to a visit to an emergency room.  Patients can walk in and be seen right away by a professional orthopedic team who are trained to deliver state-of-the-art-care for musculoskeletal injuries.”   Studies show that sprains and fractures rank among the top ten reasons for a visit to an emergency department.

“ONS Urgent Ortho Care is a continuation of our mission to provide our surrounding communities with the highest standard of specialized orthopedic and spine care,” Dr. Miller said.  ONS is in network with all major insurances.

ONS currently offers same day appointments during business hours for patients who experience a sudden, acute musculoskeletal injury between 8:00 am and 5:00 pm, Monday through Friday.  Patients can request same day appointments by calling 203-869-1145.

With 25 sub-specialty trained physicians in orthopedics, neurosurgery, sports medicine and physical medicine and rehabilitation, ONS has been the one of the most comprehensive and advanced practice of its kind in the region for more than 20 years. ONS has offices in Greenwich and Stamford, CT and Harrison, NY which offer a state-of the-art medical facility, onsite physical therapy centers, digital x-ray and MRI.  Note: ONS Urgent Ortho Care is currently available at the Greenwich office only.

An All-Star Comeback

When Greenwich High School senior, Alex Mozian, accepts his diploma in June, he will be celebrating the culmination of a remarkable year as Greenwich High School’s hockey star.  After leading the Cardinals to the finals of the state championship, the 18-year senior was awarded team MVP as well as the Division 1 MVP and 1st Team All State by the CT State Hockey Coaches Association, among many other honors.  What’s even more impressive about the young athlete’s accomplishments during his final year on the ice as a Cardinal is the fact that he was sidelined during his junior year for the entire season after sustaining consecutive injuries, any one of which could have ended his career.

“Before the injuries, Alex was getting noticed by college scouts.  He was also selected for the USA hockey regional showcase camp, where college recruiters check out the talent,” explained Joe Mozian, Alex’s father. “Junior year should have been his year.”

Instead, Alex faced the daunting task of recovering and rebuilding his strength to get back on the ice as quickly as he could, working with a team of ONS specialists and physical therapists to help get him there.

Alex’s troubles began in December, 2016, when the skate of an opposing player lacerated Alex’s lower right leg.  Alex collapsed on the ice and was taken to the nearest hospital emergency department where the injury was stitched up. Once at home, the pain and swelling increased hourly. It became apparent to parents and player that something more serious had occurred.  Alex was able to see ONS foot and ankle orthopedic surgeon, Sean Peden, MD, the next morning.

Based on the nature of the cut and Alex’s inability to lift up his leg, Dr. Peden determined that a critical tendon had ruptured – the anterior tibial tendon. This tendon is responsible for lifting the foot during activities. A prompt MRI was obtained which confirmed the diagnosis.

“The tendon was completely severed and had retracted, meaning the cut edges had separated from each other significantly,” said Dr. Peden. Knowing how important return to play was to Alex, Dr. Peden performed a procedure that would allow him to maintain strength as much as possible to support a quicker recovery. He was in a cast for just 2 weeks.

Alex showed the same determination off the ice as he so regularly did on the ice.  When he wasn’t working on post-surgical rehabilitation with his ONS physical therapist, Courtney Kirellis, to regain strength and mobility in his lower leg, Alex focused on building his upper body and core strength.

Remarkably, Alex was back on the ice by mid-March, and scored a hat trick and an assist at his first game in April, which was a national championship game.  The family’s excitement was short lived, however. During his third game back, Alex suffered a knee-on-knee collision with an opponent that resulted in a lateral meniscus tear to his left knee.  Once again, the Mozian family turned to ONS.

“After the fantastic experience we had with Alex’s first surgery, Alex insisted that he wanted to go back to ONS,” said Joe. “We had every confidence he would get the best care there.”

“Everyone at ONS made me feel like I was their most important patient.  I felt like they were working with me so I could achieve my goals,” Alex explained.

Sports medicine physician and knee specialist, Dr. Katherine Vadasdi, surgically repaired the injury.  The procedure went without a hitch, but Alex was in for the long haul with physical therapy rehabilitation. Not only did he miss the rest of the Nationals tournament, he had to sit out the US hockey showcase, and all the spring and summer showcase tournaments for colleges.

Understandably, the second injury took an emotional toll on the young athlete, as he watched his peers get accepted to college teams. But with Courtney’s help, Alex regained his strength and determination to stay active and ready to play. On his own, Alex lifted weights in his basement and practiced shooting 100 pucks a day while standing on one leg – the leg Dr. Peden had repaired.

“Alex was an ideal patient,” said Dr. Vadasdi, “He did everything in his power to stay strong and positive throughout a tough healing process.

Alex was cleared to skate in August, and when the school year began that fall, he was ready to reach out to recruiters.  Then, the unthinkable happened.  A freak collision with an opponent brought Alex crashing to the ice with the hockey stick still in his hand.  The injury?  A broken scaphoid bone in his right wrist, a particularly difficult bone to repair.  While most upper extremity fractures take about 6 weeks to heal, scaphoid fractures typically take at least 12 weeks and sometimes as long as 6 months to heal.

This time Alex trusted the skilled hands of ONS’s Dr. Mark Vitale, an award-winning hand and wrist surgeon. Dr. Vitale understood how desperately Alex wanted to get back on the ice, and surgically inserted a tiny compression screw to stimulate healing.

“The surgery was personalized to Alex to allow for early range of motion and durable protection to the bone in the earlier healing periods, which is much more important to a high level athlete looking for rapid return to play,” explained Dr. Vitale.

Alex returned to the ice in October stronger and better than ever, scoring a season high 60 goals and assists to lead the Greenwich Cardinals to the state finals for the first time since 2014. And while Alex is sad to leave behind his Cardinals teammates when he graduates in June, his career will continue. Alex’s story and his post-surgical successes of the past season caught the attention of a number of coaches from elite prep schools. As a result he will pursue a post-graduate year at The Hotchkiss School, starting in the fall and his dream of playing NCAA hockey still alive.

ONS on Spring Training

An article by  Tanya Kalyuzhny, DPT, MDT, director of physical therapy at ONS in Greenwich, was published recently in the Greenwich Sentinel.   Greenwich Physical Therapy

In Spring Training is Not Just for Pros, Tanya stresses the importance of building strength and flexibility before staring up seasonal activities to avoid many of the painful injuries that can crop up.  In the March 16 issue, she writes:

If you’re like me, you’re chomping at the bit for spring to arrive so you can tie up your sport shoes and head out in the sun with your racquet or golf club in hand.

Not so fast!

If you haven’t been using the muscles necessary for your sport in the past few months, you’ll need to start slowly and make sure you have the strength and conditioning needed to play before the season is underway.

A simple pre-season program using light weights or an exercise band can help protect against back strain, arm pain and worse. Start with daily stretching exercises, held for a minute, and move on to two sets of weight bearing or resistance exercises of 15 repetitions three to four times a week.

Avoid Golf and Tennis Injuries

Common golf and tennis injuries are usually the result of muscle strain and fatigue, muscular imbalance, overuse, or any combination of the three. As with any physical activity, core muscle strengthening is essential to train your pelvis, lower back, hips and abs to work together to give you power, better balance and stability. Without core strength, the muscles in your back, neck and extremities will be strained taking you through your motions.

Beyond the core, your shoulders need to be ready for the demands of the repeated overhead, rotating motions required in tennis and golf. Conditioning that area is not only important to prevent tendinitis and rotator cuff problems, weakness in the joint’s surrounding muscles can also lead to pain elsewhere in your arm when smaller muscles are forced to overcompensate.

To avoid painful shoulder injuries, it’s important to strengthen the peri-scapular (shoulder blade) muscles as well as the four muscles that make up the rotator cuff. The rotator cuff helps stabilize the upper arm within the shoulder socket and manage the speed of your swing and follow through.

You can strengthen and increase flexibility in this region of your body by using light weights or an exercise band.

In general, exercises that involve the internal and external rotation of the shoulder are good for the rotator cuff. You can work on external rotation by alternating arms to rotate the band away from your body, starting with your arms waist level and forearms parallel to the floor.

For internal rotation exercise, tie your band to a door knob and hold it in one hand across your shoulder. Start with your arm bent at 90 degrees as though you are waving hello, and slowly stretch the band downward until your forearm is parallel to the ground. Slowly return to your starting position and switch arms.

It’s also important to keep your pectoral muscles and those in the back of your shoulder supple. A corner stretch is great for the pecs. Lean into a corner of a room with each of your forearms resting on the adjacent walls and hold the stretch.

Cross body stretches, achieved by moving your extended arm across your chest, will help prevent and reduce any tightness that may occur in the back of the shoulder.

These exercises will also help reduce the risk of elbow conditions such as tendinitis and golf and tennis elbow. Elbow injuries can occur because the wrist muscles, which originate in the wrist but attach at the elbow, become overused or lack proper strength to match the demand of each sport.

Exercises to help thwart this from happening involve wrist flexion and extension while holding a light weight. First, sit while you hold a weight, palm facing down. Raise the weight by pulling the hand upward, bending at the wrist. Next, rotate your arm so the palm of your hand is facing the ceiling and bend your wrist to move the weight upward.

Common sports-related lower extremity injuries, including calf strains and ankle sprains, can be avoided if the musculature is strong enough to support the acceleration and deceleration involved in walking, running and jumping. Ankles are particularly vulnerable to quick changes in direction. Single leg balance exercises are the best way to protect against ankle and calf issues. Try standing on one leg on a balance board, standing on one leg with your eyes closed, or standing on one leg on a pillow. Single leg heel lifts from the edge of a step, and slowly lowering the heels below the step are also good calf exercises.

When you do head out to the court or the greens, start slowly and be sure to warm up. Don’t play an 18-hole round of golf without a few days swinging at the driving range. Immediately before play, start with 5-10 min warm up with a light jog or walking briskly in place. When you’re done for the day, cool down and gently stretch your muscles.

My last piece of advice is to have a professional evaluate your technique and equipment. An improper grip, ill-fitting racket or club, and/or faulty body mechanics can lead to an injury no matter how fit you are.