Bunions or ‘Hallux Valgus’

Your big toes hurt, you got bunions, and those strappy high heels kill you..

Seems like you got ‘Hallux Valgus‘ and your toes look like the pic below

Well its mostly a combination of genetics and footwear (and a few other causes).

Its almost exclusively a problem of the shoe-wearing races (exceedingly rare in barefoot tribes).

So wear shoes with a broad toe-box or something like the ‘kohlapuri’ sandal (see pic)

..keeps the big toe where its supposed to be eh?

High heels and pointy toes may look great but they won’t do the bunions any good. Wear comfortable shoes to the party, change shoes for the duration of the party and remove the fashionable shoes as soon as possible!

Surgery is indicated only for pain, worsening deformity and difficulty in wearing shoes etc.

Surgery is NEVER to be undertaken for cosmetic purposes.

And before I forget.. Dump those splints; (pic) they don’t work, are expensive and of course, uncomfortable!

Who you gonna call? (HINT: your friendly neighbourhood orthopod..)

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I want my Vitamin D!

Orthopods (like yours truly) frequently advise vitamin D supplements with calcium for healthy bones. However I bet you didn’t know this is turning to be one useful vitamin!

But before you go rushing to buy the super economy size bottle; you can overdose on this vitamin with serious health effects. So talk to your friendly neighbourhood orthopod!

Who you gonna call..?

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How 2010 was important for your health..

Midnight of 31st December will ring in 2011 amid much revelry. The bygone year however left much to ponder in medicine. Briefly:

  1. Propoxyphene, a painkiller, was linked with potentially fatal heart rhythm abnormalities and withdrawn. Drugs like Algaphan, Diagesic, Distalgesic, Depragesic, Femidol, Darvon etc contain propoxyphene and need to be avoided/changed.
  2. HbA1c is a better test to screen for diabetes according to new guidelines and would lead to earlier diagnosis and fewer missed diagnoses.
  3. Calcium supplements taken without Vitamin D may increase the risk of heart attack by up to 30%. So take Vit D with your calcium tablet!
  4. Tramadol (Tramal, Adolan, Campex, Merlon, Tramagesic etc.), a commonly used morphine-like painkiller, is not only habit forming but linked to a higher risk of suicide!
  5. Chocolate may be good for you! Consumption of chocolate may decrease the incidence of stroke and stroke related death.
  6. Codeine (Codagesic, Napadoc, Paracod, Paracodeine etc), a common morphine-like painkiller used for 6 months is linked to a higher risk of cardiovascular (heart) events. Use for as little as 30 days is linked to a higher risk of death from all causes. Especially to be avoided in the elderly.

With best wishes for a happy and risk-free new year from your friendly neighbourhood orthopod!

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Joint Injections in Osteoarthritis

Did you know?

Steroid injection into the knee provides relief for 1 week on average.

3,5 or up to 7 ‘Hyalgan’ or ‘Synvisc’ injections given into the knee at weekly intervals act like oil in a rusty joint and ease symptoms on average slightly longer than steroid injections.

You may not feel the benefit of injection before a week or two. So be patient.

Relief obtained is variable and a minority will admit to no benefit.

Joint injections can be dangerous in the presence of poorly controlled diabetes, tuberculosis or any serious infection anywhere in the body, therefore you will often be asked for a blood/urine test to rule out such diseases before joint injections are given.

Hyalgan/Synvisc is made from chicken ‘combs’ so you may not be able to tolerate them if allergic to chicken or eggs.

Only qualified personnel can safely administer injections into joints.

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Managing your Osteoarthritis: Its easy!

Disclaimer first: Don’t treat yourself. See your doctor (that would be me) to rule out anything more serious. All interventions assume there are no cardiac or other serious conditions.

Remember: Osteoarthritis damage is NOT reversible by any medicine here or abroad!

Understand: More than 90% management is non-medical and IN YOUR HANDS. Losing weight and exercise will delay disease progress and improve symptoms. Avoid stressing the involved joints – Yes, you can’t play squash or football. Start golf! Switching doctors will only get you different painkillers (and ulcers).

Now take a look at the image:

Interventions in green will prove most effective and carry no risk. Yellow are effective and carry mild to moderate risk in the long term. Red are also either less effective OR carry higher risk.

Bottomline: Lose that weight. Go out for a walk (daily). Wear good shoes for that walk. Take paracetamol/tylenol for the pain and use a painkiller ointment/cream on the joint.

Now switch off this machine and go out for that walk already..!

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Buying a new sports shoe?

Good sports/walking/jogging shoes are an investment towards your joints so invest wisely.On the high end this is a multi-billion dollar industry with shoe names that would be more appropriate for fighter jets or lunar probes. The big brands complicate choosing a shoe like it’s rocket science.

On the other hand is the cheapo Chinese knockoff that is murder on your heels and arches.

What to do? Read on:

Firstly, don’t be a cheapskate and set aside about 3-5 k (rupees) for your shoe.

  • Flex the sole of the shoe. It should have a crease/flex zone where the ball of your foot will rest. It should not flex midway at the arch level.
  • Press into the sole with your thumb and try flexing the sole SIDE TO SIDE by pressing on both sides of the shoe. If the sole is too soft your foot will feel each pebble on the road. Stay away from such shoes.
  • Press the heel cup/from side to side and from behind inwards. It should be firm with some give but not rigid.
  • After lacing up your shoe should have about a thumbnail’s worth of space to spare after the toes and should NOT be a snug fit. The heel however should not piston in and out.
  • Try before you buy until the salespeople cry!
  • Walk all over the shoe store in your shoes. Sports shoes should be comfortable from the word go. If they don’t feel right at this time, they never will! Which is also why you should NEVER ask someone to get you a sports shoe from abroad.

The most expensive shoe is not necessarily the best. Check for the features above and then try out all shoes with these features until you find the one most comfortable for you.
Among Pakistani sports shoes the ‘Cheetah’ is barely tolerable. All others have crap soles and should be avoided (I’m open to correction here). Cheapo Chinese/Thai etc shoes are worthless. Don’t throw your money on them.

Finally. Sports shoe soles have a life. You need to change them in 6 months to a year depending upon exercise levels and your weight. Happy running!

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Ladees and Jantermen..

Now after ‘facebook’ and ‘twitter’, muzammil’s ortho will be blogging here off and on. Stay tuned..

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