Low-back pain

Low-back pain is a common problem, most commonly due to spraining injuries, disk herniations, and facet joint arthritis. There are many other less-common causes of back pain, including tumor, infection, stress fractures, compression fractures, and spondylitis

Disk herniations

Disk herniations oftentimes produce sciatic pain radiating down the thighs and legs. The majority of disk herniations respond to conservative treatment. An MRI study is reserved for those patients who do not improve within a reasonable interval of time. Microscopic diskectomy is the standard treatment for disk herniations that do not respond to conservative management.

Spondylolisthesis

Spondylolisthesis is a condition where there is instability of the lumbar vertebrae, allowing one vertebra to displace forward upon another. The condition can be caused by a stress fracture of the pars interarticularis or can be related to degenerative facet arthritis with instability. Spondylolisthesis, secondary to stress fractures, is oftentimes asymptomatic. Spondylolisthesis from facet joint disease usually occurs in older individuals, beyond the age of 50.

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Spinal stenosis

Spinal Stenosis is a condition where there is narrowing of the spinal canal, where the nerves are compressed, oftentimes causing hip and thigh pain. This is usually aggravated by walking, relieved by sitting and also relieved by bending forward. Vascular insufficiency can also cause lower-extremity claudication symptoms, but usually involves the legs rather than the thighs. Surgery is often necessary for spondylolisthesis that does not respond to conservative treatment and usually requires a decompression of the stenotic canal accompanied by a fusion of the unstable vertebrae, oftentimes with the use of instrumentation for stabilization and better healing of the fusion.

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Scoliosis

Scoliosis is a lateral curvature of the spine. Eight-five percent of the cause of scoliosis in adolescents is unknown and is termed "idiopathic." Scoliosis is often progressive during adolescence and spinal growth. Bracing is a standard treatment for scoliosis that is progressing greater than 25 degrees and in an adolescent who still has at least one more year of active spinal skeletal growth before maturity. Bracing after growth has been completed is not effective. Surgery for scoliosis is often performed for those curves that are progressive over 45 degrees to 50 degrees. Scoliosis usually does not cause pain in young individuals but can be painful in later adulthood when accompanied by degenerative arthritis of the scoliosis.

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Spinal fractures

Spinal fractures commonly occur from falls from ladders or rooftops. Fractures which have instability and are productive of deformity usually require surgical stabilization and fusion. Common compression fractures that are not associated with instability usually heal satisfactorily with a limited interval of bracing.

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Tendenitis

Inflammation of the tendons- The foot has many tendons, all of which can become painful as a result of overuse or poor foot wear. We see athletes frequently who jump too much early in the season and irritate the Achilles tendon. They can occasionally tear the Achilles tendon, but this is usually in the older athlete, after age 35. The tendons to the toes are often irritated by shoes which are too small or tight causing a rubbing. This is especially common on the top of women's feet from tight pumps. The large tendon on the inner-side of the foot (posterior tibialis tendon) becomes inflamed due to over-use, rubbing or too flat a foot and suffering foot strain. The diagnosis is made for all these problems by looking for a tender area with swelling. Some times there is a gritty feeling as the tendon moves. Treatment is usually rest, anti-inflammatory medications, changing the shoes and occasionally using arch supports (orthotics).

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Sprained Ankle

Acute over stretching of the ankle ligaments. This is usually due to a twisting injury. The ligaments on the outer side of the ankle are stretched too far and become inflamed or may actually tear. Sometimes the injury can be so severe that the ankle becomes unstable, or tends to give away on uneven ground. The diagnosis is usually obvious due to the pain and swelling on the outer side of the ankle. It may be too painful to walk. Treatment includes rest, elevation, ice and compression with an elastic bandage. We encourage early return to weight bearing and resumption of sports as quickly as possible. We often issue braces to protect the ligaments as they heal. If the ankle remains unstable or painful we occasionally have to operate to repair torn ligaments.

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Bunions

Deformity of the 1st toe- This problem is more common in women. In this condition the first toe angles outward and the foot may be too wide for the shoes. This causes pressure on the inside of the foot where it rubs on the shoe. The rubbing causes pain and a bursitis over the inside of the foot. The toe deformity seem to be related to the type of shoes women wear and is also inherited. Some families have more of a problem, often mothers and daughters. Treatment includes changing the shoe wear, ( ugly, wide shoes), stretching the shoes, various pads and surgery if the condition is too painful. At the time of surgery, we straighten the 1st. toe and often try to narrow the foot by breaking (an osteotomy) the metatarsal. Good pain free results are usually obtained.

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Corns

Thickened skin on a toe- Corns result from the smaller toes rubbing against the shoes or other toes. This may be a result of a hammer toe (the middle of the toe curls upward) rubbing against the shoe or due to a bone spur rubbing against a toe next to it. Treatment usually includes various types of pads, shaving the corn, stretching the shoes and occasionally surgery to straighten the toes and remove spurs.

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Mortons Neuroma

A painful condition occurring in the web space between the 3rd and 4th toes. The plantar nerve becomes caught under the metatarsal bones and after repeatedly being stepped on, a small nerve tumor forms. We see it frequently in people who work on hard floors, especially in thin soled shoes. The condition causes pain, burning and occasionally numbness in the 3rd and 4th toes. Treatment includes pads, cortisone injections and often surgical removal.

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