Centered on Health 11-6-25 Changes in Orthopedics, focusing on foot and ankle care with Dr. John Lewis

Centered on Health 11-6-25 Changes in Orthopedics, focusing on foot and ankle care with Dr. John Lewis

Episode Transcript

Speaker 1 (00:01):
It's now time for Centered on Health with Baptists Help
on US Radio. Wait forty tell meny yjs. Now here's
doctor Jeff Tubler.

Speaker 2 (00:11):
Good evening, everyone, and welcome to another episode of Cedrin
on Health with Baptist's Help here on news Radio eight
forty whas. I'm your host, doctor Jeff Tumblin. We're joined
by our producer, mister Jim Fenn, and tonight we're talking
with doctor John Lewis, and orthopedis with the Louisville Orthopedic Clinic.
And about one million ankle injuries occur about every year,

(00:32):
so we're very fortunate that doctor Lewis, along with his
group at Louisville Orthopedic Clinic, have joined the Baptist family.
Doctor Lewis is an orthopedist specializing in the disorders of
the foot and ankle, with extensive training on complex ankle
reconstructive surgery and ankle replacement surgery. I've learned so much
just from reading about him. I can only imagine what

(00:52):
we're going to learn in the next hour. Doctor Lewis
was born in Louisville, Kentucky. He went to Sainte X
High School, did an undergraduate in medical school. At Duke,
where he also did fellowship at Howard Hughes Medical Institute
for Research on Joint Arthritis and doing residency at Duke
and subspecialty Fellowship Training and Foot and Ankle Surgery. Welcome
to Centered on Health.

Speaker 1 (01:14):
Well, thanks, Jeff, I'm excited to be here, looking forward,
looking forward to our conversation.

Speaker 2 (01:20):
Well, I'm excited to have you, and I'm just kind
of flex just a little bit here so that you
know that my very first job, when I was seventeen
years old, was at a foot an ankle surgeon's office.
So I am very excited to bring full circle here
and see where we have come since I was working
there a billion years ago. But I just want to
start off by kind of letting our audience know a

(01:41):
little bit about you. A lot of times people who
go into orthopedics, I think in particular, always knew that's
what they want to do. They either had an injury,
they were a sportsperson, or something drew them to it.
Was that the case with you, or how did you
choose this field?

Speaker 1 (01:55):
Yeah, I'll tell you that's pretty much exactly how it
happened to me. And you're right, it seems to in
the history of a lot of Borthspeedic surgeons. Actually, I
played soccer growing up and playing in high school. I
actually fractured my tibia or my lower leg while I
was playing soccer. And one of my teammates their dad.
Their father was a North Peedic surgeon, and he was

(02:16):
the one who treated me kind of got me back
from the injury, and after that experience with him, I
was actually pretty sure that's kind of what I thought
I wanted to do. Just being in his office and
seeing the patients and the X rays and the casting.
It was just a very it was obviously very bad
experience suffering the injury, but I came away from it
with a pretty good idea. I thought that's what I

(02:36):
wanted to do.

Speaker 2 (02:38):
And we know that's that sports at saying X is
a big deal. So that must have been a very
competitive season for you. So when I when I, you know,
look into the guests and I figure out, you know,
what I'm going to talk about you. I do talk
to people, and there's two things that I think people
should know about you that I heard over and over
again when I was asking about you. One is, you

(02:59):
have an excellent reputation in Louisville, which is wonderful. And
also apparently you like rap music in the o R.
Is that true or is that a myth?

Speaker 1 (03:08):
That is true? I do like I like, yeah, that
is true. I do like all kinds of music in
the operating room. But that is true.

Speaker 3 (03:16):
Wonderful all right.

Speaker 2 (03:18):
So you trained with doctor Robert Anderson, and I think
that was sort of a next level sort of training
that you got. What was it about that training that
you remember or bring with you to what you do
here in the Louisville community.

Speaker 3 (03:33):
Sure.

Speaker 1 (03:34):
Yeah, I did my a year of fellowship foot ancle
specific training in Charlotte at the North Oak Carolina Institute,
which is pretty well known nationally as a kind of
a paragon for ankle surgery ankle injuries, and Bob Anderson,
who unfortunately recently retired, but he was really the front
runner in footn angle sports medicine. So as foot and

(03:56):
ankle developed, we started to see more and more foot
ankle specific injuries that really required a foot and ankle
specialist to really treat them appropriately. And he was, you know,
he was the foot and ankle liaison for the entire NFL.
So when I was in training there, very frequently treated
professional athletes, not just from the NFL, but also from

(04:19):
pretty much every sport you know, MLB, the NBA. So
it was a very cool experience to see the kind
of injuries that these patients and athletes would have and
how to get them back to their sport. We were
able to, you know, take care of the Carolina Panthers
when I was there, and that was actually the season
they made it all the way to the Super Bowl.

Speaker 3 (04:38):
Wow.

Speaker 1 (04:39):
Fortunately, yeah, unfortunately, I think we all we all know
they didn't pull it out in the end, but it
was still a great season to be involved with that team.

Speaker 2 (04:47):
I mean, that's like a It sounds like a little
kid's dream to be able to be around all those
athletes and then to also have something to offer, which
is which is fantastic. So, so talk to us a
little bit about the foot and ankle. What is healthy?
What is the responsibility of the foot and ankle? Like,
what makes what's it supposed to do?

Speaker 3 (05:05):
What's its function? Right?

Speaker 1 (05:08):
Yeah, so you know it's the lower extremity, so a
little bit different primary primary function than an upper extremity.
You know, it's more for propulsion, getting you to be
able to not only get around just day to day,
you know, walking around, but also to have a stable
base for which you can propel if you want to

(05:28):
do anything higher functions such as sports, athletics, training. But basically,
you know, it is the support system for which your
entire skeletal apparatus functions.

Speaker 2 (05:43):
And when we talk about the foot and ankle, I
think I think most of us know, like it's very
there's a lot of bones in the foot and ankle there,
but it's not just bones. And as we talk about
injuries and foot and ankle issues tonight, what are the
other structures that are important in the foot and ankle
that we would need to know about to kind of

(06:04):
understand some of these injuries.

Speaker 1 (06:06):
Sure, and as you said, you know, once you get
in below the ankle to the hind foot, the midfoot,
and the forefoot is basically how you typically break down
the regions of the foot, the bone, the bone anatomy
is very important. You can have problems or injuries with
all of those, but at most most joints, uh most joints,
there's a combination of ligaments and tendons that work is

(06:28):
both static, static and dynamic motors to keep the ankle
and foot stable as well as provide function.

Speaker 2 (06:37):
So these injuries can they can be of the bone,
or the ligament, or the tenon or the muscle all
down there.

Speaker 1 (06:45):
Or some combination of of all of them.

Speaker 2 (06:49):
So let's start with some of the injuries and because
I'm trying to, you know, break this down into sort
of different categories as we sort of wrap our head
around it. But let's start with injuries that I think
most of our listeners would be kind of used to
hearing this term. So I think we're all familiar with
the term a sprain, But what exactly what part of

(07:11):
the foot anatomy are we talking about? And what is
a sprain?

Speaker 1 (07:16):
Yeah, it's a great question, and the long or the
short answer is it can be a lot. An ankle
sprain can refer to a fairly wide variety of injuries.
If we're you know, a lot of sprains are associated
with some uh some bony problems as well, but your
classic ankle sprain typically involves ligaments. Sometimes you'll hear, you know,

(07:37):
on sporting networks or the news, somebody had a low
ankle sprain or a high ankle sprain, and that just
refers to different complexes of ligaments that live in different
areas around the ankle, and a classic low ankle sprain
if you have somebody that just you know, stepped off
the curve wrong or stepped awkwardly on a tennis ball,

(07:57):
uh and their ankle twists and I think every most
people have probably had that happen once in their life.
That typically refers to an injury of the ligaments that
live at the very tip of your fibrillar bone, which
is that bony knob you feel on the outside of your ankle,
and those ligaments connect the ankle to the foot, and
those ligaments are what are essential to prevent a pathologic
or a pathologic motion arc in the ankle. So those

(08:20):
are the ligaments that are responsible to keep your ankle
in a tethered range of motion so you don't develop
what we call instability, meaning a feeling that your ankle
is too loose or it's going to give out on you.

Speaker 2 (08:32):
So does the we fear about high ankle sprain a
lot with you know, sports injuries that make news for
you know, our professional athletes and stuff. But it is
a high ankle sprain.

Speaker 3 (08:43):
Is it worse? Is it harder to heal?

Speaker 2 (08:44):
That are people out longer with an injury like that.

Speaker 1 (08:48):
In general, a high ankle sprain which refers to an
injury to the ligament complex that lives above the ankle
join itself. So it's where the two bones in the
lower leg, the tibby and the fibula, they actually have
a connection and a joint between them, and it's an
injury to those ligaments. It's typically a higher energy injury.

(09:09):
They can be offered. They can be injured at the
time of a routine low ankle sprain, that can be
injured with an associated fracture, but typically it takes a
little more forced to disrupt those ligaments, and the treatment
can be variable based on the pattern, how many of
the ligaments have been injured, and how the patient does clinically.

Speaker 2 (09:32):
Well, we are just getting started. I have a lot
more questions about that injury. But we're going to take
our first break here, and I want to remind everybody
that you are listening to Centered on Health with Baptist
Health here on news radio eight forty WHS. I'm your host,
doctor Jeff Tulblan. Tonight we're talking about John. We're talking
about foot and ankle injuries with doctor John Lewis from
the Louisville orthopeda Clinic.

Speaker 3 (09:53):
We'll be right back.

Speaker 2 (10:02):
Welcome back to Centered on Health with Baptist Health here
on News Radio eight forty whas I'm your host, doctor
Jeff Tublin, and tonight we're talking about changes of orthopedics,
focusing on the foot and ankle with doctor John Lewis
from the Louisville Orthopedic Clinic. And we've been talking right
before the break. If you're just joining us about sprains,
a very common injury, Welcome back, doctor Lewis. So as

(10:27):
we talk about these injuries, you know, from working backwards
from a diagnosis of a sprain, we don't know when
we roll our foot over the curb or this if
we've sprained it or broken it, and all we know
is it hurts, it's swollen, maybe a little starting to
look at a little discolored. What are the things we
should be looking for? Can an individual self diagnosis sprain

(10:50):
by knowing certain things? Or how do we know if
it's broken or just sprained.

Speaker 1 (10:54):
Yeah, that's a great question, and it's something that you know,
as practitioners we deal with all the time. And so
I think the majority of kind of the very low energy,
kind of lesser ankle sprains never really find their way
into the doctor's office. Those are the ones where you're
the patient kind of twist their ankle. They know they
kind of did something, but they're able to ice it

(11:15):
and take a couple of anti inflammatories and it gets
progressively better over a couple of days. And I think
we see a lot. I think a lot of those
never get seen by the medical community. But the ones
that you have to watch out for are the ones
that you know, very severe sprain. Immediately the patient knows
something bad has happened, it twells and you see a
lot of bruising, and a big indicator is whether the

(11:36):
patient can still bear weight. So if a patient has
no ability to bear weight, you know, you know, ten
to fifteen minutes after the injury, that's usually a little
bit of couse for concern. And you know, usually a
lot of the times the sprains that come in to
see me are some of the some of the worst
ones because that patient realized Matt came to put weight
on this, or it's bad enough I had to go

(11:58):
to the emergency room and get an X ray. Those
kind of so I think there's a wide variability in
how they present, and I think big ones are if
the patient can't really put much weight on it, that's
a little bit of a cause for concern to maybe
seek some medical care.

Speaker 3 (12:13):
Yeah, that's that's really helpful.

Speaker 2 (12:15):
And you mentioned a few things in that answer that
I was gonna sort of ask about it, like, I
don't want to use the word home remedies, but self treating.
You talked about ice. Is it ice or heat that's
good for it? Are en said's okay? Or are you
worried about the swelling with any bleeding in there? And
then what about elevating the foot, Like what are the
kinds of things you would tell somebody to do at home?

Speaker 1 (12:37):
Yeah? Absolutely, you know, And so you know, for an
orthpeedic injury like that, really the name of the game
is to get it elevated, get some ice on there.
You will often see some bruising, and that's indicative that
something was injured below the skin, because there's usually some
bleeding if you injured a ligament or something like that.

(12:57):
Anton inflammatories can be very helpful, things like a leave ibuprofen.
As long as you know a patient can tolerate those medications.
It can be very helpful to start start right away.

Speaker 2 (13:09):
What's an average amount of time it takes one of
the more minor ones that don't necessarily come into your office,
but we're treating these at home. How long should someone
expect that to take to get better?

Speaker 1 (13:21):
Yeah, you know, I would expect, you know, a lot
of times that you have about if you have an
injury like that, the next day maybe a little bit worse,
but hopefully not significantly worse, and if you can still
put weight on it and try those things like ice
and ivyprofen over the course of five to seven days,
you'd expect to see kind of a steady improvement and
symptoms and swelling and you know, starting to regain your

(13:42):
ability to walk without a lamp, those kind of things.
So I would say a steady, you know, progression over
five to seven days is always very very predictive and helpful.

Speaker 2 (13:51):
Great, and you know, the things in our culture seeming
to take on lives of their own, and I think
we're all very familiar with this new wave of pickleball
being kind of like taking over the whole world in
terms of you know, social eventing and getting together and
exercising and playing pickleball. But the other thing that goes

(14:11):
along with that is everybody talks about pickleball injuries. So
are you are we making too much of that? Are
you seeing an uptick of true injuries because of pickleball?
And what's the trend that you're seeing what kinds of injuries?

Speaker 1 (14:27):
Yeah, that's a great and very timely question, and the
answer is yes, we've definitely seen a rise in injuries,
and not just the kind of injuries we typically see
with athletic events. So you know, we'll still see our
ankle sprains, you know, at worse you know, or even
worse than that, you'll see an ankle fractures or foot
fractures that you know a patient could get, you know,

(14:47):
basically playing any kind of sport. But we've also seen
a very significant rise in achilles tendon injuries, calf and
achilles tendon injuries, and the types of injuries that these
pickleball athletes have tended a little bit more unique. So
it's something that the foot and ankle community, in terms
of providers and surgeons, have had a lot of discussion

(15:08):
about over the last eighteen or twenty four months. Kind
of seeing the rise in these different types of achilles
tendon injuries in pickleball players, so.

Speaker 2 (15:15):
They're actually bringing out newer injuries that we haven't been
seeing as much of.

Speaker 1 (15:22):
Yeah, you know, when it comes down to it, if
somebody tears their achilles while they're playing pickleball, you know,
at on its head, it's still an achilles tint and rupture.
But yeah, but the way the way it ruptures, the
way it looks on MRI, and sometimes the way we
fix them surgically if it comes to surgery, is just
a little bit different than some of the more traditional
ruptures we've seen in different patient populations.

Speaker 2 (15:46):
And is there any discussion in your when you have
these about prevention? Is there a way for somebody to
prevent these injuries with pickleball or is it just part
of the nature of the way we play the game
or it just stretching before and how at all? Like,
is there anything we can do to minimize some of
these injuries that are occurring?

Speaker 1 (16:08):
Yeah, I think that's a great question, and that's what
you know, we're trying to as a as a financal
community kind of come up with a kind of a
consensus what we should be telling these patients. But in general,
patients that play pickle ball, I just tell them, hey,
just make sure you're hydrated, make sure you stretch, stretch
out achilles and caff really well. And the biggest thing
is to make sure you are smart about how you

(16:30):
increase your activity, because we've seen a lot of injuries
and some pickaball players that maybe hadn't hadn't done any
kind of sports or athletic you know, regular athletic things
in a while, and so they're not quite used to
that degree of that degree of activity, and they might
go out and play three hours because pickaball's blast. I mean,
I don't know if you ever played it, you know,
it's pretty fun and you can get right into it

(16:52):
and pick it up quickly. And so I think a
lot of it as people are kind of going over
to the equivalent of having not, you know, run in
a year and then try and run ten miles.

Speaker 2 (17:01):
You know, that's a great way of thinking about it.
And you're just reminded of you don't have to win
to every point, right, like you don't have to go
from zero to sixty, right. So that's a great point.
You know, these are people that are finding a new
fun way to get exercise and you have to maybe
you know, recognize what conditioning you're into starts.

Speaker 3 (17:19):
So that's a great, great point.

Speaker 2 (17:21):
We did have a question that was submitted about a
teen athlete who plays a lot of basketball intends to
get a lot of ankle injuries, and sort of the
question is one, does getting an ankle injury, presumably on
the same side over and over again, like once a

(17:42):
year or once every other year, does that lead to
long term complications that we need to be aware of?

Speaker 3 (17:48):
And is there.

Speaker 2 (17:49):
Something you tell your high school athletes to do to
prevent these injuries during basketball or other types of sports.

Speaker 1 (17:59):
Yeah, so that is a great question, and my answer
may be a little long because there's a lot to
kind of tease out there, but in general, basketball tends
to be a bad one for ankle springs, and a
lot of times there's nothing an athlete can do about it.
If they're jumping up for a rebound and land on
somebody's foot. There's no amount of stretching or training that
can prevent an ankle spray. When that pain when that

(18:21):
athlete's whole body comes down and the ankle is bent
that way, right, And so if you and so you know,
it's usually you know, our You can get sprains in
any sport, but basketball players are notorious for it. And
you know, if you have a bad ankle sprain, those
low ankle ligaments that we talked about, they often tear
or you know, they rupture, but unlike an ACL, they

(18:42):
often will scar down in a competent position. And that's
why patients that sprain their ankle don't always get surgery,
whereas if a lot of athletes tear their ACL a
lot of times, they're looking at surgery if they want
to restore their stability to their knees. So the whole
concept of conservative management of ankle spraying when we mobilize
brace physical therapy is to try to get those ligaments

(19:03):
to scar down in a competent position and strengthen the
ankle so that it doesn't happen again. The big worry
is if somebody develops something called recurrent instability or chronic
instability where they start to have their ankle and they
can't trust it. Those ligaments have just been injured too
many times and they develop this this chronic latdal ankle
instability where their ankle turns too easily and you can

(19:24):
usually pick these athletes out. They're usually always taped to
always have a brace on when they're playing, but we
worry about them long term because we see a lot
of ankle arthritists later in life for untreated ankle instability
where the ankle has been unstable for you know, millions
of steps over the course from twenty to thirty years.

Speaker 2 (19:45):
That's a great point and I'm a very helpful answer,
So thank you. We're going to take another break here.
When we get back, we are going to talk a
little bit about some interesting things that you are doing
in your practice. You're listening to Center It on Health
with Baptist Health here on newsraatee whas. I'm your host,
doctor Jeff Tublin. We're talking tonight with doctor John Lewis
from Louisville Orthopedic Clinics.

Speaker 3 (20:06):
We'll be right back.

Speaker 2 (20:17):
Welcome back to Centered on Health with Baptists Help here
on news radio eight forty whas. I'm your host, doctor
Jeff Tublin. And if you're just joining us, we're talking
tonight with doctor John Lewis from the Louisville Orthopedic Clinic.
We're talking about foot and ankle injuries and we spent
a lot of time on things that we know very well,
such as sprains and injuries like that from athletes. But

(20:40):
I want to talk a little bit about some stuff
that's going on here locally in our community, and that's
ankle replacement.

Speaker 3 (20:47):
And I think even when I.

Speaker 2 (20:49):
Heard about that, I was like, we actually replace an ankle, So,
I mean, I'm excited to hear.

Speaker 3 (20:56):
What is this?

Speaker 2 (20:56):
Is this a new thing? Is it just something that's
blossom that has always been there? What's the story with
ankle replacement surgery?

Speaker 1 (21:04):
Yeah, it's a great question. And ankle replacements so you know,
in turns on its head. It's the same concept as
a knee replacement or a hip replacement. You take a
joint that has gotten bad arthright is so no cardilage left,
it's a painful, stiff joint, and you replace the main
weight bearing portion of the joint with man made pieces

(21:25):
that are made out of plastic and metal. And the
entire goal of an ankle replacement, just like a knee replacement,
is pain relief and restoring function. There's been a long
history with ankle replacements. The first ones were started many
years ago, seventies or eighties, and had not the best results.
For a lot of reasons. The ankle is a very
complex joint, it's a very small joint. It's much harder

(21:46):
to replace than a hippraa knee. And then it really
started to come back in the in the nineties and
two thousands, and over the last twenty five years has
really taken over as not only an alternative but a
gold standard for ankle frank arthritis in patients that are
good candidates for it.

Speaker 2 (22:04):
So how do you decide that a patient is a
good candidate for Who out there listening with an ankle
arthritic complex should be thinking, well, maybe that's something I
should be thinking about. What should they have tried? When
do you kind of bring the conversation up about it?
What's your triggers?

Speaker 1 (22:23):
Yeah, and so you know, if somebody who develops ankle arthritis,
the number one reason a patient will develop ank arthritis
is prior trauma. So either you know, a bad fracture,
multiple multiple strains with long standing instability. And so the
patient population is a little different than hitting the arthritis.

(22:44):
The average age of onset of symptomatic arthritis is much younger.
It's in the midfield.

Speaker 3 (22:48):
Yeah, that's a great point.

Speaker 1 (22:49):
Yeah, Yeah, So it's usually in younger patients. And traditionally,
in the past, the only way to treat ank arthritis
was a fusion, where we actually fuse the ankle joint,
which is good for pain relief but really limits motion.
And we used to think that once we fused an ankle,
the patient would be good, they never have another problem.
But we we follow those patients for a long time,

(23:11):
and we know that those patients can have problems years
down the road. They'll start to develop. Ourthrightis in other
areas of the foot because all of that pressure that
the ankle normally saw got delivered to other areas of
the foot. So anchor replacement has become a very very
good option for a lot of patients. And the patients
that we think are acceptable frank replacement has changed over
the twenty years, and so now you know, the patients

(23:34):
that would be good candidates rank replacement tend to be
the same patients that would be reasonable candidates for any
other type of joint replacement in terms of their overall health,
their overall functional status, their ability to recover from surgery,
those kind of things. But you know, we as we've
seen patients that get younger with ankle replacements. You know,
we replace patients ankles that are much younger than we

(23:55):
used to do just even fifteen years ago, because we've
seen how well they can do if it's done in
a thought full and appropriate manner.

Speaker 2 (24:03):
And you mentioned, you know, which is so interesting that
this is a different population in terms of age, a
lot of younger patients.

Speaker 3 (24:11):
So you know, I'm picturing, you know.

Speaker 2 (24:13):
Somebody in high school or college age getting this replacement surgery.

Speaker 3 (24:19):
How long do they last?

Speaker 1 (24:21):
Yeah, that's a great question, And you know, that's the
question I pretty much get every time with the patient
having ankle replacement. And you know, we have twenty twenty
five year longitudinal data on a lot of knee and
hip replacements. We don't necessarily have that for the modern
ankle replacement systems we have now, so we usually tell
patients we hope, you know, twelve to fifteen years. But

(24:42):
that's kind of a moving target because if you replace
an ankle in a seventy five year old, you know,
ten years, you know, just by the natural courses of
life eighty five, the amount of stress are put on
that ankle is very different than ten years after you
do it in a fifty year old. So, but in
general we usually tell patients we hope to get fourteen
fifteen years out of it.

Speaker 2 (25:01):
So it's possible that somebody who gets it really young
might have a re redoce some time in their life.

Speaker 1 (25:09):
That's right, And we have ways to revise an ankle replacement,
which wasn't really possible twenty five years ago.

Speaker 2 (25:16):
Interesting, and what about the recovery? What is there is
like with a knee or a shoulder. I would imagine
there's some type of rehab that would go along with that.
What's that look like for an ankle replacement.

Speaker 1 (25:28):
Yeah, it's a little bit slower than a hip or
knee replacement. Typically, if you have a hip or knee replacement,
the surgeon is going to want you mobilizing and putting
weight on it pretty much the day at surgery. It's
all the different for an ankle replacement, and a lot
of it is actually bounded by concern over the wound healing.
There's just not a lot of muscle around the ankle,
and the incisions just he a little slower. So most

(25:50):
patients that I do an ankle replacement on I will
not allow to start putting weight on it until two
to four weeks after surgery, So it's a little different
recovery early on than a hippernewe replacement. But it's actually
a lot faster than an in confusion, which I don't
typically don't let them put weight on it for two months.

Speaker 2 (26:06):
Oh, that's interesting, And just in terms of volume of injury.
You know, when I was growing up, there were certain
seasons where people played certain sports. But I feel like
over time, you know, some of these sports are now
year round and you don't get these like natural breaks
to like lay off your foot or this or that.

(26:27):
If you're a basketball player and people are playing year round,
are you seeing that leading to more is the repetitive
use of it leading to more injuries? Or are we
building in enough rest for these athletes to prevent unnecessary injuries?

Speaker 1 (26:42):
Yeah, And I think it's a big concern for UH
with fetists, particularly sports medicine as well. You know, these kids,
these young athletes, exactly like you said, they're year round,
and they're cross training less because they're not playing as
many different sports, you know, so we started to see
a lot of problems with little leaguers, you know, with
their elbows. You know, that's been a problem for ten

(27:03):
or fifteen years, and now we have you know, you know,
let's just say soccer players, you know, and they play
year round soccer and then the winter they're playing on
hard surfaces. And we've seen kind of an increase in
some kind of more I mean, you know, common type
of injuries and overuse patterns, but they seem to be
getting a little bit more prevalent just because the kids

(27:23):
don't get a break typically m.

Speaker 2 (27:26):
And so just sort of rounding out this kind of
part of our conversation. You know, we live in Louisville,
you grew up here. You know, we don't have a
lot of professional sports teams like you did when you
were doing your training. And you know, the closest, one
of the closest teams to uts is Cincinnati with the Bengals.
I know there's a lot of fans and you know,
with Joe Burrow having turf toe, I think when we

(27:47):
all first heard that term, we were like, what, like,
how can he be out for X amount of time
for a toe?

Speaker 3 (27:54):
Like, what what is turf toe? And what is that?
What does that mean for Joe Burrow?

Speaker 1 (28:01):
Yeah, it's a great question. And you know, obviously, like
you Cincinnati fan. I hated for Joe Burrow, but so
a turf toe And I still remember when I was
growing up hearing that and being like, how can that
put somebody out for a season? So turf toe, it's
kind of it sounds kind of like a benign thing,
but what it is, it's an injury to a very
important ligament complex on the bottom of your big toe joint.

(28:24):
And it is incredibly important for explosive push off, cutting, jumping,
those kind of things. So if somebody so a turf
toe injury is usually a rupture or tear of that big,
strong ligament that lives on the bottom of the big toe.
And if you are a professional athlete where a millisecond
makes the difference whether you make that first down or

(28:45):
get the throw off, it can be devastating. They can't
they can't perform at a high level because they lack
that explosive push off on the big toe.

Speaker 2 (28:55):
And is it surgery that fix it, or time or
rehab or exercise what fixes the turf tie?

Speaker 1 (29:02):
Yeah, And it depends on the severity of the injury.
So somebody, if you see an NFL player or a
professional athlete going down because they're having surgery, it typically
indicates that they had a complete rupture of that ligament,
but it's not uncommon to see partial ruptures or ruptures
that are not completely unstable, and some of those can
be managed not operatively. Typically they're out from the sport

(29:25):
for a while, but you can get a discard down
and heal without surgery. But a lot of these injuries
in these higher level athletes, they're complete ruptures that won't
necessarily heal on their own without surgery.

Speaker 2 (29:36):
Well, even though I want to ask you about every
single injury I've had on my fantasy football team, I'm
not going to do that, and I will I will
take that conversation offline with you. But we're going to
take our final break here and I want to let
everybody know you are listening tonight to send It on
Health with Baptist Health here on news radio eight forty
whas our guest this evening, doctor John Lewis with the

(29:58):
Louisville Orthopedic Clinic, talking to us about foot and ankle injuries.

Speaker 3 (30:02):
We'll be right back after this, Brave.

Speaker 2 (30:12):
Welcome back to Centered on Health with Baptist Health here
on news radio eight forty whas I'm your host, doctor
Jeff Toblin, and tonight we're talking with doctor John Lewis
from the Louisville Orthopedic Clinic about foot and ankle injuries.
I want to remind everybody to download the iHeartRadio app
to re listen to this show or any of our
previous segments, and also to have access to all the

(30:34):
other features that the app has to offer. So, doctor Lewis,
I want to ask you about a couple of things
we hear just kind of commonly thrown around us and
find out exactly what they are or what we should
be paying attention to. So, when somebody says they have
a stress fracture, what does that actually mean? What is

(30:54):
a stress fracture versus a fracture? And how does it
imply what the injury means in terms of tree and recovery?

Speaker 1 (31:02):
Sure, yeah, and so there's some definitions there that are helpful. So,
a true acute fracture is when a bone suffers an
injury that exceeds its normal capacity to stay intact. So,
you know, you get in a car wreck and you
break your ankle. The bone was normal, but it took
a load that would break anybody's ankle. So it's a

(31:23):
normal fracture. A stress fracture refers to when a load
results in a fracture that in and of itself shouldn't
have been enough to break the bone, and so it's
more of a repetitive over use type injury where the
repetitive over use nature built up enough injury to the
bone that it eventually fractured. So, but there was never

(31:44):
an acute injury that exceeded that bones a building to
stay unbroken. Yeah, and stress fractures are they're actually really
a wide spectrum. So you can have things that are
called stress responses where X rays look normal, but if
you get an MRI, you can start to see some
signal in the bone where the bone is unhappy, there's
some inflammation there, and then that can increase and increase

(32:06):
and increase all the way till you actually see it
a true fracture of the bone.

Speaker 3 (32:11):
And what is it?

Speaker 2 (32:13):
In that sort of same mindset, what is a shin splint?
We hear people say of a shin split? What is
that an injury? Is that a stretch?

Speaker 3 (32:20):
What is a splint?

Speaker 1 (32:23):
Yeah, it tends to be kind of a stress reaction
to the front of your tibia. Or your shinbone. And
it can range from just what we call a periostitis
where you have some like repetitive stress inflammation of the
lining of the bone, and it can progress all the
way to a true kind of partial either like a
stress fracture or a partial fracture of the front part

(32:45):
of the shinbone, and that can the treatment of those
can be very variable based on the severity, and imaging
can help can help decide what needs to be done
to those.

Speaker 2 (32:56):
And I'm not sure if this is something that you
actually treat as an orthopedis or maybe you do. But
what is plantar fasci itis? I mean, I think people
who have it, like they will tell you, like it's
really painful. So what's happening with plantar fascia itis and
how do we treat that?

Speaker 1 (33:16):
Yeah, it's a very very common problem we see in
the office. It's basically the plant of fascia or the
plant or appa neurosis is a very strong band of
tissue at the bottom of the foot. It originates at
the bottom of the heel and extends all the way
down the foot and it just helps give you helps
hold up the arch and give you mechanical advantage when
you're walking, so it has a lot of biomechanical important

(33:40):
structures for the foot, but it can become inflamed and thickened,
typically where it attaches to the heelbones. That's why patients
typically have heel pain. It can be a miserable problem patients.
It's often really bad in the mornings. The patients will
get up out of bed and have to hobble to
the bathroom. And it's one of those things where each

(34:00):
step isn't misery, but each step hurts, so it can
kind of make your day miserable. Yeah, the good news
is a lot of times we can make it to
go get it to go away with some things like
insert stretching anti inflammatories, but it could take a while,
and it can take a couple of months, and it's
it's not a fun thing, and it's more common than

(34:21):
you'd think.

Speaker 2 (34:23):
Does it ever require surgery or is it always some
non invasive way to usually take care of it.

Speaker 1 (34:29):
It occasionally needs surgery, but the vast majority of patients
that present our office that at Planner fasciats don't end
up having surgery, probably well under five percent.

Speaker 3 (34:38):
Oh well, that's good. That's good news.

Speaker 2 (34:41):
So one of the things that comes up a lot
when it comes to and I know we're talking about
the foot and ankle, but you know, I've had other
guests on my show of a orthopedis and one thing
that comes up a lot is the trend of PRP
or platelet rich plasma, And I was wondering if you
to share kind of with our listeners what that is

(35:02):
and does it work in the foot and ankle. Is
it something that you use, Just maybe tell us a
little bit about what that is.

Speaker 1 (35:11):
Yeah, Yeah, you know purapy or platelet platelet rich plasma,
as you described, it is a process where, uh, the
patient's own peripheral blood is drawn usually from you know,
the arm, and it's spinn that it's spun down in
a specific centrifuge, and uh the platelet rich plasma is
then is then concentrated and then injected into a body part,

(35:33):
whether it's a joint or a tendon sheaf. And the
whole concept behind it is that you are using the
patient's own, uh, own healing factors and own you know
chemicals that there that that their body produces to try
to induce a healing response. We find it to be
most helpful in situations where you have a structure that

(35:57):
is not horribly degenerative but inflamed, and so if you
can calm down that inflammatory reaction, the pain will often
go away. So in the foot, in the ankle, we'll
see it can be useful in achilles tendonitis plantar fasciitis
is typically the two most common things we'll see, and
for some of my upper extremity colleagues, it'll be used for,
you know, rotator cuffs things, tennis elbow, those kind of things.

Speaker 2 (36:21):
And this is something that's done in the office, not
having to go to have surgery somewhere.

Speaker 1 (36:28):
Oh that's correct, Yeah, it's you do it in the office.
It takes a twenty five minutes. Yeah, yeah, for sure.

Speaker 3 (36:34):
Yeah, I mean.

Speaker 2 (36:34):
It's it's a nice concept when you think of I mean,
it's your own body, so your own material. So you know,
that's a reassuring thing. But is it expensive? Is it
covered by insurance when it's done?

Speaker 1 (36:47):
Yeah, And that's kind of the big problem with PRP
is there's actually some decent data out there in the
medical journals that it can be helpful for things like
plantofasc itis and achilles tendonitis, but it's the insurance in
general insurance will not cover it, so there is an
out of pocket cost. And so typically, you know, when
I talk with patients about it as an alternative if

(37:09):
they have something that is not getting better. We're not
interested in any kind of surgical management. It's an option
that has some decent data to help it. It's certainly
not a cure all, but the risk is very, very low.
It's your own body products. It's basically two needlesticks, So
you know, it can be a useful a useful tool
to use in certain patients if that's the route they

(37:31):
want to.

Speaker 2 (37:31):
Go, and just kind of you know, wrapping up sort
of this this concept of treatment and where we're going.
You know, it's interesting how different fields of medicine sort
of share from each other about different things. And in
GI we're using a lot of biologics. We've seen stem
cell use for different things. Are these things finding their

(37:52):
way into orthopedics and into specifically the treatment of the
foot and ankle. Do you use growth factors or stem
cells or biologics in your practice.

Speaker 1 (38:01):
Yeah, it's a great question, and you know, for a
fair amount of foot and ankle procedures, we have to
deal with a lot of bone healing issues, whether it's
a fracture that's not healing, or occasionally, if we have
our threatic segments in the book, we have to do
a fusion of certain bones in the foot, and those
bones don't want to go together. So the whole point

(38:22):
of the procedures to try to maximize the chance that
that can occur. And so often during that surgery, I
will take a little bit of bone graft from that
patient's own bone somewhere. Sometimes we'll take stem cells from
the iliac crests to get progenitor cells that ideally, if
you put them in the sight of the bone that's
having trouble healing, that will start to they will start

(38:45):
to differentiate or materialize into bone, into cells that want
to create bone. So there's a lot of a lot
of that in bone work, in in ankle and foot
procedures and PRPs. You know, the same kind of I
would put lump that in kind of the same kind
of growth factor type type armamentarium. We also typically will

(39:09):
have there are some growth factors that we will use
that are commercially available at the time of surgery for
these types of things as well.

Speaker 3 (39:19):
That's fantastic.

Speaker 2 (39:20):
Well, I know that we are very fortunate to be
having your group join us at Baptist and I know
our patients are going to love having you treat them,
and so thank you for sharing with us all of
this fantastic information about orthopedics and about the foot and ankle.

Speaker 3 (39:37):
That's going to do it.

Speaker 2 (39:38):
For tonight's segment of Centered on Health with Baptist Health,
I'm your host, doctor Jeff Talblin, and I want to
thank our guest, doctor John Lewis with Louisville Orthopedic Clinic,
for sharing so much valuable information with us tonight. Have
a great weekend and enjoy the rest.

Speaker 3 (39:52):
Of the week. This program is for informational purposes only.

Speaker 2 (39:59):
It should be relied upon as medical advice. The content
of this program is not intended to be a substitute
for professional medical advice, diagnosis, or treatment.

Speaker 1 (40:08):
This show is not designed to replace the physician's medical
assessment and medical judgment.

Speaker 3 (40:13):
Always seek the advice of your physician with any questions
or concerns you may have related to your personal health
or regarding specific medical conditions. To find a Baptist Health provider,
please visit baptistealth dot com,