Foot and Ankle Center Blog

Posts for: June, 2014


Rafael Nadal returns the ball to Novak Djokovic during their final match of the French Open. (Thibault Camus/AP)

June 12, 2014 3:33 p.m.

This past weekend, the tennis world witnessed Rafael Nadal win his ninth championship on red clay at Roland Garros — a remarkable accomplishment. Nadal is recognized as the King of Clay and on his way to becoming the best ever. Interestingly, a November article in The Best You Magazine pointed out that Nadal is the combination of "brilliance and vulnerability." The brilliance is evident, but his vulnerability has been well-disguised. As it turns out, Nadal has a history of foot problems that has been nagging him since he was 19. Like athletes in all sports, Nadal is not bulletproof. His playing time is not infinite and at the French Open, you could see his sense of urgency.

Professional tennis is incredibly demanding on your body. Serves are launched at speeds as high as 120 to 140 MPH with “now you see it, now you don’t” spins that vanish off the court. The pros are masters at moving their opponents from corner to corner or from the baseline to the net. Matches can be grueling, sometimes lasting more than three hours in the blistering heat. Winners advance to play the next day with little rest. Some players even compete in doubles matches that are scheduled simultaneously with singles play. More than any other sport, tennis is probably the most demanding on a player’s feet and ankles.

Nadal has been managing a painful problem in his right foot since he was 19 years old. The weakness in his tarsal navicular bone above the arch was so bad his specialists thought he might never be able to play again. In order to prolong his career, Nadal worked with shoe companies to redesign an inner sole that would offset the pressures on his bone. Since then, Nadal has been able to play but his foot condition is a work in progress for the trainers and medical team. Healthy feet are critical for Nadal’s career to advance.

Many of my patients who participate in competitive sports have Posterior Tibial Tendonitis. This is especially common in soccer, tennis and basketball; however, it can also result following activities such as running, climbing stairs, walking, doing a new activity, overdoing an old activity, walking on uneven terrain or wearing improper footwear. Overuse and lack of treatment can result in crippling pain.

The posterior tibial tendon is probably the most important tendon in the leg. It extends from the medial tibia around the inside of the ankle into the foot. It starts just below the knee. Basically, it’s the main support for the arch and the foot.

Problems tend to occur underneath the inside of the ankle, often leading to an unstable gait. As the posterior tendon loses its ability to support the arch, the foot flattens and toes spread outwards. Other causes are related to long-term wear and tear of the tendons and ankle trauma from a sprain.

Posterior Tibial Tendonitis can be a tenacious injury but it can also be resolved with time and treatment. The goals of conservative management are to stop the symptoms and reduce the forces that are damaging the tendon, and to prevent arthritis from progressing. Here are some of the treatment options that are routinely done depending on the severity of the condition.

• Stop or decrease any activity that increase pain and worsens the tendon;

• Cold therapy. Apply ice regularly to the posterior tibial tendon for 15-20 minutes 3-4 times a day;

* Nonsteroidal anti-inflammatory medications to reduce swelling;

* Over-the counter shoes inserts or custom orthotics to provide arch support;

* Casts or boots to immobilize the ankle;

* Low-impact exercises that are non-load bearing like swimming, biking and elliptical machines;

* Physical therapy techniques including acupuncture (to relax muscle knots), ultrasound (deep heat), cold therapy (reduce swelling), electrical stimulators (soft tissue mobilization), corticosteroid injections (anti-inflammatory) and platelet rich plasma (restorative process to promote healing);

* Proper footwear to provide support and cushioning;

* Alternate footwear after workouts and change out gear after 300-500 miles;

* Conditioning and balance routines to strengthen tendons;

* Alter fitness activities and incorporate non-impact activities to promote cardiovascular endurance and strength;

* Working out in moderation and in a gradual manner;

* Cutting Edge MLS Laser therapy to reduce inflammation and pain and to kick-start the healing process.

Sometimes surgery is necessary to remove tissue that has degenerated in the tendon. The type of surgery varies depending on the severity of the deformity and dysfunctions. The surgeon must take into consideration such things as the position of the heel, deviation of the joints and forefoot, soft tissue condition, quality of the tibial tendon, and level of arch collapse. There are many surgical techniques used to treat soft tissue repairs (minor PT tears, PT tear with weakness of tendon, spring ligament and deltoid repair, and Achilles lengthening or gastrocnemius recession). Other surgical techniques are used to correct a supple foot (deformity, valgus heel, naviculocuneiform fusion, forefoot varus with bunion or hypermobility) and a rigid foot (ankle fusion, hindfoot fusion, midfoot fusion and forefoot lapidus).

There are a number of new modalities and trends that are emerging as well as the combination of new modalities to accelerate healing. Some of these include use of platelet rich plasma and stem cell aspirate therapy; use of tissue augmentation materials; use of allograft tendon and bio-tendonitis fixation technology; and bone-healing biologics.

Dr. John Sigle is a board-certified foot and ankle surgeon with years of experience treating Posterior Tibial Tendonitis. Athletes who experience this problem are welcome to see him at the Foot & Ankle Center of Illinois for a diagnosis and treatment.



United States' Jozy Altidore, right, shouts out as he pulls up injured as Ghana's John Boye looks on Monday at the Arena das Dunas in Natal, Brazil. (AP Photo/Dolores Ochoa) 

June 17, 2014 3:14 p.m.

The opening FIFA World Cup soccer game between the United States and Ghana was on the world stage this week in Natal, Brazil. Having lost to Ghana in 2006 and 2010, this contest was billed as a grudge match for the U.S. Everyone wondered if the U.S. had the grit and skill to avoid a three-peat.

The stands were covered in red, white and blue. Thousands of fans painted their faces and bodies and wore stars-and-stripes clothing. A huge support group for the U.S. team known as the American Outlaws was everywhere. Their passion and love for the team was obvious.

Chants like, “USA! USA! USA!” and “HEY, BELIEVE THAT WE WILL WIN! HEY, BELIEVE THAT WE WILL WIN!” were electrifying and convincing. The chants had meaning and sounded like mantras filled with psychological and spiritual power. And they seemed to be a motivator — within 30 seconds of the game, the U.S. crowd erupted as U.S. captain Clint Dempsey scored the team’s first goal. Twenty minutes later, U.S. striker Jozy Altidore was injured with a pulled hamstring and carried off the field. At half time, U.S. defender Matt Besler also left the game due to tightness of the hamstring. He was replaced by John Brooks, who went on to score the winning goal in the 86th minute.

As the U.S. continues in pool play against Portugal and Germany, Besler is expected to return, but it’s unlikely that Altidore will play. The intense play will probably result in other injuries as the tournament progresses.

Injuries are not only affecting the U.S. team. Players on other national teams are also out of commission. Injuries can play a significant factor in a team’s chance for success, and the medical staff and trainers will play a key role in facilitating their recovery and return to the field.

Soccer injuries are usually the result of trauma or overuse, but they can also result from poor conditioning and improper rest intervals and warm-ups. Trauma injuries happen as a result of a sudden impact with another player or forces caused by twisting, pivoting, decelerating, jumping and irregular landings. Other injuries are caused by overuse. These occur when stress is placed on the joints, muscles and soft tissues that have not had ample time to heal. Overuse injuries usually start out small and develop into a more serious problem that becomes painful and debilitating.

The most common lower extremity injuries in soccer are ankle sprains (when the ligaments around the ankle joint are torn or stretched), Achilles tendonitis (overuse injury in the back of the ankle), Achilles rupture (when the tendon behind the heel cord is torn requiring surgical intervention) and plantar fasciitis (inflammation of the thick fibrous band that runs along the sole from the heel bone to the toes).

Other lower extremity injuries include blisters, pulled or strained calf muscles, shin splints, sprains and strains and stress fractures.

Injuries to the upper extremities include hamstring pulls, tears or strains (similar to what occurred with Altidore and Besler), stress fractures to the leg, patellofemoral pain syndrome (knee), muscle cramps, Illiotibial band syndrome (pain on the outside portion of the knee and lower area), anterior cruciate ligament and posterior cruciate ligament injury (knee), medial collateral ligament and lateral collateral ligament damage (knee), torn cartilage damage (knee), groin pulls and head concussions.

Remember to tune in to the remainder of the World Cup games. I am sure the American Outlaws will feel your support through the airwaves. You will be astounded at the high level of skills that these world-class players possess.

If you play soccer and suffer from lower extremity problems, consult with your physician or podiatrist.

Dr. John Sigle is a board-certified foot and ankle surgeon who has years of experience treating lower-level extremity injuries. Call (217) 787-2700 for a consultation at the Foot & Ankle Center of Illinois. Advanced care and treatment options are available to keep athletes in the game.


Former Illini Deron Williams' ankle issues common among...


No one will ever forget the magical 2004-05 Illinois men’s basketball
team that made it to the national championship game — especially me,

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No one will ever forget the magical 2004-05 Illinois men’s basketball team that made it to the national championship game — especially me, since I am an Illini grad and former member of the I-Block and the Orange Crush cheering sections. What a team! What a run they had! 

Recognized as the best Fighting Illini team ever, Illini fans still follow the careers of the starting five — Dee Brown, James Augustine, Luther Head, Roger Powell and Deron Williams. Williams has had the most notable career of the crew. After being selected third in the 2005 NBA draft, he was named to the All-Rookie Team, became a three-time All-Star and a two-time gold medalist on Team USA. 

Once tabbed as the top point guard in the NBA, Williams’ dominance has declined in recent years because of painful ankle injuries that limited his full range of motion. Despite receiving platelet-rich plasma therapy and cortisone injections to ease pain and inflammation, Williams got only short-term relief. He was not able to compete in his true explosive and effective form. As a foot and ankle surgeon, I know how devastating ankle problems can be, especially on a world-class athlete who depends on his feet. 

This past season, he missed 18 games mostly due to an ankle sprain. His points, assists and minutes per game were also the lowest since his rookie year. Williams openly expressed his frustration and loss of confidence because of limited mobility on the court. Having completed his second year of the five-year, $98 million contact, Deron decided to have surgery on both ankles. 

According to a Brooklyn Nets news release last week, Deron had surgery on both ankles. Arthroscopic surgery was performed on his left ankle to remove bone spurs in the front and back of his ankle, and to clean the ankle joint. He also had a bone chip removed below his right ankle joint. 

Deron’s condition is medically referred to as Anterior Ankle Joint Impingement Syndrome. This is a common problem with athletes that is usually caused from jamming the front portion of the ankle joint (forced dorsiflexion). This is seen in basketball players descending from a rebound or landing after a drive to the basket, volleyball players landing after blocking a shot or lunging for a dig, soccer players kicking or executing a body feint and dancers doing a plie or barrel role. 

Microtraumas and improper healing often cause bone spurs on the distal tibia and dorsal talus (basically the ankle joint) and cause impingement with motion of the ankle. It usually impinges the front portion of the ankle joint capsule and can cause intense pain, almost bringing you to your knees in agony. 

This condition is easily taken care of with Ankle Arthroscopy. Through two small incisions, we can clean out the bone spurs with the ankle scope and clean out the synovitis (inflammation of the joint lining) and provide significant relief with minimal recovery time. Often, the patient can walk on the same day of surgery.

If lateral ankle instability is an issue as well, from chronic sprains with torn ligaments, a small incision can be made laterally after the ankle arthroscopy to sew the ligaments together to provide stability to the ankle joint. There are times that the chronic ankle instability can be bad enough that tendon grafting has to be done to reconstruct the ligaments, but this is rare, and seen only in extreme cases. 

Deron Williams is expected to have a full recovery and dramatic relief of ankle pain after surgery. For the next month and half, he will be on crutches and begin rehab until light workouts begin in August. The Illini Nation and Brooklyn Nets will all celebrate when he gets back to training camp in the early fall.

Dr. Sigle is a board-certified foot and ankle surgeon with years of experience in performing arthroscopic surgery. He also received comprehensive foot and ankle arthroscopy surgical certification from the American College of Foot and Ankle Surgeons. Athletes who experience ankle sprains or pain are welcome to see him at the Foot & Ankle Center of Illinois for a diagnosis and treatment.