Orthopedic Q&A: ACL Recovery, Hip Pain, and Foot Problems | OEP375 - Ortho Eval Pal: Optimizing Orthopedic Evaluations and Management Skills

Episode Transcript
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Speaker 1 (00:00):
Hello everyone and welcome to episode 275 of the
OrthoDal Pal podcast.
I'm your host, paul Markey.
Today we're going to go throughit for the PDQ&A, where we talk
about medical benefits, oursocial and moral needs, and then
we're also going to be talkingabout recovering after ACL
injury.
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(01:37):
Today, I thought we would justthrow down some questions that
we get either on our YouTubechannel, on our Facebook page or
even through the fan mail thatwe get through our podcast.
Sometimes I'll even get these,as you know, just random emails
people will send me.
So we have three questions thatwe're going to try to answer

(01:58):
today, and one of them was a 22year old male who says I have
pain, just like the man in thevideo.
And the video is one of agentleman where I'm
demonstrating the classic signsof hip arthritis.
And this young man says could Ihave hip arthritis also?
And first of all, if you're 22years old, it's probably not

(02:21):
likely that you could have hiparthritis.
But there are other issues thatcould cause the same signs and
symptoms that look just like hiparthritis, so that inability to
flex the hip to 90 degrees ormore, or the inability to
internally rotate the leg.
It's difficult to get to thesocks, difficult to put shoes on

(02:43):
and adduction can be painfulalso.
So you could also have a labraltear, which could cause these
very similar symptoms.
Usually there's an identifiableclick that happens with this.
You could have a cam lesion orsome sort of femoral acetabular

(03:04):
impingement type syndrome.
So usually when you're a littleyounger like this, it's more
likely to be these, the lastones that I talked about, not
likely to be some sort of anarthritic condition.
So if the symptoms continue, Iwould I would definitely, you
know, get an MRI.
Sometimes if we're suspiciousof a labral tear, an MR

(03:26):
arthrogram is a little moreeffective in identifying a
lesion in the cartilage of thelabrum and identifying that.
So that's probably thedirection I would go in.
So speaking to a medicalprovider about getting to an
orthopedist and having thisidentified can be very helpful.
Oftentimes, if the tear is notvery big or it is not, you know,
all that significant, then anintra-articular injection can be

(03:49):
very helpful in a situationlike this and it can also help
rule in that the problem is anintra-articular issue.
All right, there's questionnumber one.
Number two Can I have both aMorton's neuroma and a
metatarsalgia?
And I get this question moreoften than any other question, I
believe, on my YouTube channel,and the answer to that is yes,

(04:12):
you could definitely have both.
Why?
Because they can both beirritated the same way.
A tight calf can causeoverpressure in the forefoot,
you can have splaying of theforefoot, you could lose that
transverse metatarsal arch,which all can contribute to this

(04:33):
Cumulative trauma.
Starting to increase walking orrunning mileage, maybe uneven
surfaces, maybe climbing hills alot Anything that puts a lot of
pressure on the forefoot cancause both of these to happen.
Some people just moresusceptible to getting one than
the other.
Now I need to talk a little bitabout metatarsalgia because it's

(04:54):
kind of a junk term.
It encompasses a lot of otherdiagnoses such as sesamoiditis,
capsulitis of themetatarsophalangeal joint.
You could have a plantar platetear predislocation syndrome.
Any of these more specificdiagnoses fall under the realm

(05:14):
of metatarsalgia and actuallyMorton's neuroma has been
categorized under metatarsalgiain the past also, so you can
have a little bit of both.
For sure, your Morton's neuromais going to cause more of a
paresthesia into the third andfourth toes most typically, but
it can happen in a second also.
Issues under metatarsalgia canhappen from one through five, so

(05:36):
that's more common but nottypically cause any paresthesia.
Usually your Morton's neuromawill give you like a sharp,
shocking type of discomfort also.
So that's how you differentiate, you know, between the two of
them.
I treat them very similarly.
I usually use an orthotic.
I like to do gastroctolius,stretching on all of these folks

(06:04):
.
No off of a two by four, ormaybe the bar in a gym, you know
, like the base of a squat rackor something like that.
I don't like to hang off ofthat forefoot because it just
aggravates all of those tissuesquite a bit, especially early on
.
Orthotics, metatarsal reliefpads and reestablishment of that

(06:27):
transverse metatarsal arch canbe super helpful than ultimately
trying to rebuild the abilityto flex the intrinsics in the
foot.
So that's how I would answerthat question.
And yes, many people do haveboth.
You don't see it very often,but a fair number of folks do
get it All right.

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Speaker 2 (07:23):
Is there any chance of recovery from an ACL injury
without surgery?
And so this really depends onwhat you mean by recover from,
okay.
So the ACL itself will, if cutin half or if torn, will not

(07:45):
heal itself back up.
It's very, very unlikely thatwill happen, okay.
The other thing we need toremember is that what are the
secondary restraints lookinglike?
So a couple of weeks ago I had apatient come in.
He had a skiing injury.
I assessed his knee and it wasvery clear that he had a grade

(08:08):
three anterior instability.
I could grab a hold of thattibia, translate it anteriorly.
It was super loose, there wasno end point.
And come to find out when hehad surgery.
We definitely suspected ameniscus tear.
But when he had surgery it wasnot.
The meniscus was not repairable, it was shredded.
So you know, not having thatmeniscus tear will cause some

(08:30):
extra instability in the knee.
So we know that the secondarystructures like the menisci,
like the capsule, like theconformity of the femur on the
tibia, all of these things canhelp support the knee.
Also, the dynamic structures,you know your hamstrings, your
quads, popliteus all of thesestructures help to dynamically

(08:53):
and statically support the leg.
So if you tear your ACL andyou're not a very active person.
You don't do a lot of highspeed cutting and pivoting type
activities We've seen people dowell without an ACL.
Now it is, you know, likelythey're going to develop early
arthritis in the future, but youknow.
But can an athlete get back toplaying sports without an ACL?

(09:16):
We have seen people do it,people with good secondary
structures, and they've notdamaged any other structure but
the ACL.
If they can build enoughstrength, proprioception and
maintain good stability, theycan get out there and play
sports.
Not many will, okay, but somecan.
So the people who will be ableto get away without having the

(09:39):
ACL repaired will be yournon-athletes.
People doing slower activities,more in a straight plane
Runners will do better thanpeople who play cutting sports
okay.
So it really depends.
When you say recovering from um, most people will recover from
it, but they won't regrow thatACL on their own.

(10:00):
So, uh, there we have it, folks.
Three orthopedic questions andanswers.
Um, again, these are answersfrom Paul and from my experience
, and so if you have anyquestions or comments you'd like
to add, I hope you have a greatday, be kind to each other and
take care.

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Orthopedic Q&A: ACL Recovery, Hip Pain, and Foot Problems | OEP375

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