Friday, November 11, 2011

Fracture of the Heel Bone (Calcaneus)

Fractures of the calcaneus can be debilitating injuries. Usually these fractures occur when tremendous forces impact the foot and damage the heel. Examples are falls from heights or motor vehicle accidents. Imagine standing on an orange and seeing it widen and squash flat. This is essentially what happens to the calcaneus. 

The joint between the calcaneus and the talus is called the subtalar joint. This joint is responsible for the inward and outward movements of the foot, otherwise called inversion and eversion. When the calcaneus is fractured the movement of inversion and eversion is commonly decreased or lost completely. The upward and downward movement of the ankle (dorsiflexion and plantarflexion) is not usually affected by fractures of the calcaneus.

There are numerous problems associated with fractures of the calcaneus. One is the widening and deformity of the bone itself. Another is irregularity of the subtalar joint that leads to arthritis. Fractures to the calcaneus may also cause injuries to the heel cushion (the heel pad) and to the nerves and tendons surrounding the heel. 

The ideal goal of treatment is to restore the dimensions of the heel as accurately as possible. This is always difficult because of the multiple fragments of bone that are commonly present. It is almost like trying to piece together a jigsaw puzzle.

For the majority of patients, surgery is the correct form of treatment. The goal of surgery is to restore the correct size and structure of the heel. This is done by performing what is called an open reduction and internal fixation of the fracture. The open reduction and internal fixation procedure is performed through an incision on the outside of the heel. The bone is put together and held in place with a metal plate and multiple screws. This procedure decreases the likelihood of arthritis developing and maximizes the potential for inward and outward movement of the foot.

There are times, however, when the bone is so severely smashed and fractured that, in addition to the open reduction and internal fixation, the heel joint (the subtalar joint) needs to be fused. This is done to decrease the chances of developing painful arthritis. Although the inversion and eversion movement of the foot is lost after a subtalar fusion, there is a more rapid return to activities and functions after this type of surgery. 

The ideal time to perform surgery is when there is minimal swelling of the skin. The Doctor will often use a foot pump device applied to the foot for a few days to decrease the swelling. This allows him to perform the surgery as soon as possible.

Following surgery, no walking on the foot is permitted for approximately 3 months. A bandage is applied to the leg after surgery. After the stitches are removed, movement exercises and therapy are started to try to maximize the function of the foot. It typically takes approximately six months to recover from this type of injury.


- Some of our clients have suffered Calcaneus fractures due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

Tuesday, November 8, 2011

Pain Management: Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy syndrome, is a chronic pain condition in which high levels of nerve impulses are sent to an affected site. Experts believe that CRPS occurs as a result of dysfunction in the central or peripheral nervous systems.CRPS is most common in people aged 20-35. The syndrome also can occur in children; it affects women more often than men.
There is no cure for CRPS.

What Causes Complex Regional Pain Syndrome?

CRPS most likely does not have a single cause but rather results from multiple causes that produce similar symptoms. Some theories suggest that pain receptors in the affected part of the body become responsive to catecholamines, a group of nervous system messengers. In cases of injury-related CRPS, the syndrome may be caused by a triggering of the immune response which may lead to the inflammatory symptoms of redness, warmth, and swelling in the affected area. For this reason, it is believed that CRPS may represent a disruption of the healing process.

What Are the Symptoms of Complex Regional Pain Syndrome?

The symptoms of CRPS vary in their severity and length. One symptom of CRPS is continuous, intense pain that gets worse rather than better over time. If CRPS occurs after an injury, it may seem out of proportion to the severity of the injury. Even in cases involving an injury only to a finger or toe, pain can spread to include the entire arm or leg. In some cases, pain can even travel to the opposite extremity. Other symptoms of CRPS include:

- "Burning" pain
- Swelling and stiffness in affected joints
- Motor disability, with decreased ability to move the affected body part
- Changes in nail and hair growth patterns. There may be rapid hair growth or no hair growth.
- Skin changes. CRPS involves changes in skin temperature -- skin on one extremity can feel warmer or cooler compared to the opposite extremity. Skin color changes also are apparent as the skin is often blotchy, pale, purple or red. The texture of skin also can change, becoming shiny and thin. People with syndrome may have skin that sometimes is excessively sweaty.
-CRPS may be heightened by emotional stress.

How Is Complex Regional Pain Syndrome Diagnosed?

There is no specific diagnostic test for CRPS, but some testing can rule out other conditions. Triple-phase bone scans can be used to identify changes in the bone and in blood circulation. Some health care providers may apply a stimulus (for example, heat, touch, cold) to determine whether there is pain in a specific area.
Making a firm diagnosis of CRPS may be difficult early in the course of the disorder when symptoms are few or mild.

CRPS is diagnosed primarily through observation of the following symptoms:

- The presence of an initial injury
- A higher-than-expected amount of pain from an injury
- A change in appearance of an affected area
- The presence of no other cause of pain or altered appearance

How Is Complex Regional Pain Syndrome Treated?

Since there is no cure for CRPS, the goal of treatment is to relieve painful symptoms associated with the disorder. Therapies used include psychotherapy, physical therapy, and drug treatment, such as topical analgesics, narcotics, corticosteroids, antidepressants and anti-seizure drugs. Other treatments include:

* Sympathetic nerve blocks: These blocks, which are done in a variety of ways, can provide significant pain relief for some people. One kind of block involves placing an anesthetic next to the spine to directly block the sympathetic nerves.
* Surgical sympathectomy: This controversial technique destroys the nerves involved in CRPS. Some experts believe it has a favorable outcome, while others feel it makes CRPS worse. The technique should be considered only for people whose pain is dramatically but temporarily relieved by selective sympathetic blocks.
* Intrathecal drug pumps: Pumps and implanted catheters are used to send pain-relieving medication into the spinal fluid.
* Spinal cord stimulation: This technique, in which electrodes are placed next to the spinal cord, offers relief for many people with the condition.
Reviewed by the doctors at The Cleveland Clinic Pain Management Department.

- CRPS is a very serious condition that has been experienced by some of our clients after a serious trauma. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD.