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Schneck Orthopedics & Sports Medicine | 1

IN THIS ISSUELEGION™ Knee with VERILAST™ Technology

FLATFOOT DEFORMITY:A Common Deformity That Impacts All Ages

HIP BURSITIS

LITTLE LEAGUE SHOULDER:An overuse injury in adolescents

Volume 6 • Issue 1

Specialized Care for People on the Move.

Our skilled rehabilitation program offers services for orthopedic, cardiac, neurological, pulmonary, and medically complex conditions.

Our mission is to maximize functional independence and to facilitatea safe discharge back home. Private suites now available!

Lutheran COmmunity hOme, inC.

812.522.5927 111 West Church Avenue • Seymour

www.LutheranCommHome.org

Gain back

www.lutheranCommHome.org


As a patient of Schneck Orthopedics & Sports Medicine, it will not take long to see our commitment to providing high quality care and excellent customer service. This can be seen through the skillful hands of our surgeons, who pride themselves on great patient outcomes, as well as the great patient experience that our staff assures during your visit and treatment.

In 2014, Schneck Orthopedics & Sports Medicine continued their focus on athletes by welcoming

Dr. Chad Smith in September. Dr. Smith attended the University of Louisville School of Medicine, and finished his fellowship in Sports Medicine at Wake Forest University. Both Dr. Jill Mikles and Dr. Chad Smith work very closely with our two athletic trainers Kelli Hacker and Kyle Coates, to assure the athletes receive the best care and treatment options available.

Many changes are occuring in the world of healthcare. We are focused on making sure that when you or a family member suffer from a musculoskeletal injury or disorder, you have quick and easy access to an orthopedic specialist. Most of our patients are seen the same day or following day, assuring that patients and family members can feel comfortable that they are on the road to recovery. Only the best treatment and care will do – and the best part is having this specialized care right here in your own back-yard. There is no longer a need to drive far to receive the latest and greatest in orthopedic techniques – Schneck Orthopedics & Sports Medicine has brought this technology and state-of-the-art techniques to you for your convenience.

This issue is full of information to help you and your family. Partnering with Schneck Rehab Services, athletic trainers, and Schneck joint-replacement program, we are getting our patients back to their healthy best sooner. How can we help you-get back on the move!

Sincerely,

Nathan Campbell | Practice Administrator

Schneck Orthopedics magazine is designed & published by

Ink Publishing and Design Incorporated.To advertise in the next issue contact

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IN THIS ISSUE

Schneck Orthopedics & Sports Medicine would like to thank the following advertisers for their support of this magazine:

American Sr. CommunitiesBioventusCovered Bridge Health CampusHoosier Christian Village

Lutheran Community Home, Inc.Precision CompoundingSmith & Nephew

4 VERILAST™ Technology

6 Hip Bursitis

10 Our Doctors

12 Our Locations

14 Little LeagueShoulder

16 Flatfoot Deformity

18 Feel Better, Look Better,Have More Energy

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411 West Tipton Street (5th floor)Seymour, Indiana 47274

(812) 524-3311(877) 333-7627 Toll free

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4 | Schneck Orthopedics & Sports Medicine

For any patient considering knee replacement surgery, one primary area of concern is how long the new

implant can be expected to last. While a variety of factors ultimately determine the longevity of an implant, one of the leading causes for knee replacement revision surgery is what surgeons refer to as “implant wear.”

Made up of three main parts, total knee implants consist of a plastic insert positioned between two metal components. Over time, the movement of the metal component sliding against the plastic insert can wear down the plastic and cause it to fail. In some cases, tiny particles of the plastic can accumulate in the joint resulting in a condition known as osteolysis, or the softening of the bone around the joint. When this happens, the implant may shift or loosen, which leads to pain and instability in the joint.

Until now, scientific literature has indicated that knee replacements should be expected to last 10 to 15 years before implant wear becomes an issue. However, as an increasing number of younger, more active patients are having their knees replaced, the surgeons at Schneck Medical Center are constantly looking for new implants engineered for greater endurance.

Enter the LEGION™ Cruciate Retaining Knee made with VERILAST™ Knee Technology – a high performance knee replacement tested to simulate 30 years of wear performance. That’s more than double the length of testing of other knee replacements.

Unlike traditional knee implants which are made from cobalt chrome metal and a high- density plastic, VERILAST™ Knee Technology uses a proprietary metal alloy called OXINIUM™ Oxidized Zirconium and a highly cross-linked polyethylene plastic. When these two surfaces work together in the joint, they do amazing and unprecedented things:

• In rigorous lab testing, medical device maker Smith & Nephew’s LEGION Cruciate Retaining Knee made with exclusive VERILAST Technology was subjected to 45 million cycles, or simulated steps. That’s equal to around 30 years of physical activity under typical conditions.

• The testing showed that after 5 million cycles, the LEGION Cruciate Retaining knee made with VERILAST Technology reduced 98% of the wear experienced by a knee made with traditional implant materials. And when the LEGION Cruciate Retaining Knee with VERILAST Technology kept “walking” out to 45 million cycles, it reduced 81% of the wear experienced by the conventional knee implant that was stopped after the first 5 million cycles.

LEGION™ Knee with VERILAST™ Technology

SCHNECK ORTHOPEDICS & SPORTS MEDICINE

Using the first knee implant lab tested for 30 simulated years of wear performance

VERILAST™ Technology in the LEGION™ CR Primary Knee System demonstrates superior wear performance in 45 million cycle testing.

Comparison of the mean volumetric wear of Co/CPE after simulating 5Mc of use and VERILAST™ Technology in the LEGION™ CR

Primary Knee System after simulating 45 Mc respectively.

23

81% Reduction in Volumetric Wear

120


ABOUT VERILAST™ KNEE TECHNOLOGY:

Based on laboratory wear simulation testing, the LEGION™ Cruciate Retaining Knee System with VERILAST™ technology is expected to provide wear performance sufficient for 30 years of actual use under typical conditions.

The results of laboratory wear simulation testing have not been proven to predict actual joint durability and performance in people. A reduction in wear alone may not result in improved joint durability and performance because other factors, such as bone structure, can affect joint durability and performance and cause medical conditions that may result in the need for additional surgery. These other factors were not studied as part of the testing.

While they cannot say they’ve eliminated the primary cause of implant failure, Smith & Nephew believes their 20 years of dedicated research are paying off for patients who would like to rediscover their active life after surgery.

ABOUT KNEE REPLACEMENT:

There are potent ial risks with knee replacement surgery such as loosening, fracture, dislocat ion, wear and infect ion that may result in the need for addit ional surgery. Do not perform high impact act ivit ies such as running and jumping unless your surgeon tel ls you the bone has healed and these act ivit ies are acceptable. Early device fai lure, breakage or loosening may occur if you do not fol low your surgeon’s l imitat ions on act ivity level. Early fai lure can happen if you do not guard your knee joint from overloading due to act ivity level, fai lure to control body weight or accidents such as fal ls. Knee replacement surgery is intended to rel ieve knee pain and improve knee funct ions. Talk to your doctor to determine what treatment may be best for you. Addit ional information is avai lable at: www.RediscoverYourGo.com or 1-888-825-2062.

™Trademark of Smith & Nephew. Certain marks Reg. US Pat. & TM Off.

Rediscover Your Go with the latest in knee replacement technologies

The LEGION™ Primary Knee System with VERILAST™ Technology has been lab tested for 30 simulated years of wear performance. This is more than twice as long as other knee replacements.

It’s hypoallergenic and lighter weight – weighing 20% less than traditional knee technology. And it substantially reduces wear – a leading cause of knee replacement failure.

VISIONAIRE™ Patient Matched Technology, is an innovative new procedure that uses your MRIs and X-Rays to create specialized surgical instruments built just for you and your knee implant.

It’s time to put a stop to your chronic knee pain. Ask for the latest in knee replacement technologies.

Go to RediscoverYourGo.com today to find asurgeon who specializes in these technologies

Based on laboratory wear simulation testing, the LEGION Primary Knee System with VERILAST Technology is expected to provide wear performance sufficient for 30 years of actual use under typical conditions. The results of laboratory wear simulation testing have not been proven to predict actual joint durability and performance in people. A reduction in wear alone may not result in improved joint durability and performance because other factors, such as bone structure, can affect joint durability and performance and cause medical conditions that may result in the need for additional surgery. These other factors were not studied as part of the testing.

There are potential risks with knee replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon’s limitations on activity level. Early failure can happen if you do not guard your knee joint from overloading due to activity level, failure to control body weight or accidents such as falls. Knee replacement surgery is intended to relieve knee pain and improve knee functions. Talk to your doctor to determine what treatment may be best for you. Additional information available at www.RediscoverYourGo.com or 888-825-2062.

™Trademark of Smith & Nephew. Certain marks Reg. US Pat. & TM Off.

By Dr. Kris WilliamsSchneck Orthopedics & Sports Medicine

www.rediscoveryourgo.com

www.rediscoveryourgo.com


Bursitis is inflammation of the bursa. There are two major bursae in the hip that typically become irritated and inflamed. One bursa covers the bony point of the hip bone called the greater trochanter. Inflammation of this bursa is called tronchanteric bursitis. Another bursa — the iliopsoas bursa — is located on the inside (groin side) of the hip. This condition is much less common than trochanteric bursitis, but is treated in a similar manner.

SYMPTOMSThe first symptom of trochanteric bursitis is typically pain along the outer aspect of the hip. The pain can be felt in the area of the hip right over the bump that forms the greater trochanter. Eventually the pain may radiate down the outside of the thigh. As the problem progresses, the symptoms produce a limp when walking and stiffness in the hip joint. Eventually, the pain will also be present at rest and may even cause a problem with sleeping.

RISK FACTORSHip bursitis can affect anyone, but is more common in women and middle-aged or elderly people. It is less common in younger people and in men.

The following risk factors have been associated with the development of hip bursitis:

• Repetitive stress (overuse) injury. This can occur when running, stair climbing, bicycling, or standing for long periods of time.

• Hip injury. An injury to the point of your hip can occur when you fall onto your hip, bump your hip, or lie on one side of your body for an extended period of time.

• Spine disease. This includes scoliosis, arthritis of the lumbar (lower) spine, and other spine problems.

• Leg-length inequality. When one leg is significantly shorter than the other, it affects the way you walk, and can lead to irritation of a hip bursa.

• Rheumatoid arthritis. This makes the bursa more likely to become inflamed.

• Previous surgery. Surgery around the hip or prosthetic implants in the hip can irritate the bursa and cause bursitis.

• Bone spurs or calcium deposits. These can develop within the tendons that attach muscles to the trochanter. They can irritate the bursa and cause inflammation.

DIAGNOSISThe diagnosis of trochanteric bursitis begins with a medical history and physical examination. Your doctor will want to know when the pain began and which motions cause the pain. A physical examination will be done to determine

HIP BURSITIS

Bursae, are small, fluid-filled sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and

heel. They are positioned between bones and soft tissues, acting as cushions to help reduce friction.


how much stiffness you have in the hip and if you have a limp. Once this is done, X-rays will most likely be ordered to make sure that there are no other abnormalities in the hip.

X-rays will usually not show trochanteric bursitis. If X-rays are suggested, they are to rule out other problems that may be causing your hip pain. Sometimes it is difficult to tell whether the pain you are suffering is from trochanteric bursitis or underlying arthritis of the hip joint. An X-ray may give more information about the condition of the hip joint itself.

NONSURGICAL TREATMENTTrochanteric bursitis is often treated successfully without surgery. Younger patients who have this condition because of overuse can usually be treated by reducing their activities or changing the way they do their activities. Combining this with an exercise program of stretching and strengthening and perhaps a brief course of anti-inflammatory medications will usually resolve the problem.

Your doctor may also prescribe sessions with a physical therapist. Treatments are used to calm inflammation and may include heat or ice applications. Therapists use hands-on treatment and stretching to help restore full-hip range of motion. Improving strength and coordination in the buttock and hip muscles also enables the femur to move in the socket smoothly and can help reduce friction on the bursa.

If rehabilitation fails to reduce your symptoms, an injection of corticosteroid along with a local anesthetic may be helpful

in relieving symptoms of hip bursitis. This is a simple and effective treatment that can be done in the doctor’s office. It involves a single injection into the bursa. The injection may provide temporary (months) or permanent relief. If pain and inflammation return, another injection or two, given a few months apart, may be needed. It is important to limit the number of injections, as prolonged corticosteroid injections may damage the surrounding tissues.

SURGICAL TREATMENTSurgery is rarely needed for hip bursitis. If the bursa remains inflamed and painful after all nonsurgical treatments have been tried, your doctor may recommend surgical removal of the bursa. Removal of the bursa does not hurt the hip, and the hip can function normally without it.

Surgical removal of the bursa can be performed arthroscopical ly. In this technique, the bursa is removed through two smal l incisions. A smal l camera, or arthroscope, is placed under the skin so the doctor can guide miniature surgical instruments and cut out the bursa. This surgery is less invasive, and recovery is quicker and less painful than an open procedure.

Post-operatively, patients begin immediate range of motion of the hip with full weight bearing. Crutches are used for comfort only, typically for only a few days. Sutures are removed in the office after 10 days. Physical therapy or home exercises will be performed for four to six weeks.

Recent studies have investigated arthroscopic bursectomy. In a prospective study of 30 patients who did not respond to conservative treatment (physical therapy, nonsteroidal anti-inflammatory drugs, and corticosteroid injections), surgeons found that arthroscopic bursectomy relieved pain and improved function. Patients’ improvements were usually evident by one to three months after surgery, and the improvements continued throughout the follow-up period. (AAOS Now, June 2007)

Living with pain is not necessary, and with a variety of treatment options here at Schneck Orthopedics & Sports Medicine, we can get you back to the activities you enjoy.

By Dr. Chad SmithSchneck Orthopedics & Sports Medicine

Active Healing Through Orthobiologics

Learn about our knee osteoarthritis treatment therapy at www.SUPARTZprofessional.com

www.SUPARTZprofessional.com


August 28th, 2014 | Schneck Orthopedics & Sports Medicine sponsored a great matchup between two perennial powerhouse football programs, Brownstown Central Braves and Charlestown Pirates.

The game took place at Lucas Oil Stadium, in Indianapolis, the home of the Indianapolis Colts. Our newest Sports Medicine physician, Dr. Smith had the opportunity to be part of the honorary coin flip prior to the game.

Lucas Oil StadiumHigh School Football Matchup

Congratulations to the Brownstown Central Braves

on the win!



Our areas of specialty include:

Arthroscopic Surgery

Carpal Tunnel Release

Foot and Ankle Surgery

Fracture Care

General Orthopedics

Hand Injuries

Minor Office Surgery

Sports Medicine

Total Joint Replacements

Worker ’s Compensation Injuries

Expert Witness

Independent Medical Exams

Independent Medical Opinions

Medical Records Review

Schneck Orthopedics & Sports Medicine

411 West Tipton Street (5th Floor)Seymour, IN 47274(812) 524-3311(877) 333-7627 Toll free


Since 1983, we have been providing orthopedic care to families living in Jackson and the surrounding counties of southern Indiana. Over the years, many things have changed in the medical industry, including the increasingly fast-paced schedules of doctors and patients alike. We are committed to being responsive to you and your family, and our promise to you will always remain the same:

We do not want to just say that we care, we want to show that we care by placing an emphasis on seeing you as quickly as possible. If you have an emergency situation and we have a surgeon in the office, you will be seen that day. If your situation is not an emergency, you will be scheduled for the next business day.

Experienced, board-certified orthopedic surgeons displaying a genuine concern for your health, plus a friendly and skilled staff, is what can be expected every time you visit Schneck Orthopedics & Sports Medicine.

When it comes to caring for musculoskeletal system disorders (bones, joints, muscles, ligaments and tendons), only the best treatment and care will do. Rest assured that you will always be given the same level of care we would extend to our own families.

Do not hesitate to contact us with any questions regarding your orthopedic health!

Specialized Care for People on the Move.

(812) 524-3311www.SchneckOrtho.com




Dr. David Laitinen graduated from Purdue University in 1974 with a degree in Pre-Med, and graduated from Emory University with his medical degree in 1978. Following an internship at Ohio State University, he finished his residency at Riverside Methodist Hospital and the Columbus Children’s Hospital in Columbus, Ohio, and Ohio State University Hospital before establishing Seymour Orthopedics as a solo practice in 1983. Dr. Laitinen is certified by the American Board of Orthopaedic Surgery in 1985 and is a Fellow of the American Academy of Orthopaedic Surgeons.

Medical Society Memberships:

American Academy of Orthopaedic SurgeonsIndiana Orthopedic SocietyIndiana State Medical SocietyJackson County Medical Society

Dr. Laitinen and his wife, Debbie have three children, Tyler, Reid and Kelsey. His favorite pastimes are playing golf, reading, traveling and working Sudoku puzzles.

David Laitinen, M.D.

Dr. Kris Williams graduated from Indiana University in 2000 with a degree in Biology, and Midwestern University Medical School in 2004. Following an internship at Midwestern University, he finished his residency at St. James Hospital, Northwestern University Hospital, Christ Hospital, and Shriner’s Hospital for Children among other teaching hospitals in the Chicago area, before joining Seymour Orthopedics in 2009. Dr. Williams has extensive training in joint replacement surgery, orthopedic trauma, and sports medicine surgery. He is a board-certified physician in 2005 by the National Board of Osteopathic Medical Examiners, and is a board-certified orthopedic surgeon by the American Osteopathic Academy of Orthopedics.


American Osteopathic Academy of OrthopedicsAmerican Osteopathic Association

Dr. Williams grew up in Southern, Indiana. His family originally settled in Seymour in 1846. He and his wife, Stacey, and their three sons, Mason, Kameron, and Tyler have many friends and relatives in the area, and his favorite pastimes are hunting, fishing, camping, and biking. He also enjoys playing in his band, “Bad Medicine”.

Kris Williams, D.O.

our doctors


Dr. Jill Mikles received her Doctor of Osteopathic Medicine degree and completed her residency at Kansas City University of Medicine and Biosciences. She completed her Orthopedic Surgery Sports Medicine Fellowship at University of Illinois Chicago. She joined Schneck Orthopedics & Sports Medicine in September 2013.Dr. Mikles has extensive training in joint replacement surgery and sports medicine.


American Osteopathic Academy of OrthopedicsAmerican Osteopathic AssociationAmerican Orthopaedic Society for Sports Medicine (AOSSM)American Osteopathic Academy of Sports Medicine (AOASM)Arthroscopy Association of North America (AANA)

Dr. Mikles is an avid runner, participating in numerous marathons, including the 2011 Boston Marathon, and half marathons. She was also an athlete in college, leading her Southern Illinois University Edwardsville team to two NCAA Basketball tournament appearances. She enjoys baking, pilates, and traveling. She hopes to one day travel to all 50 states.

Jill Mikles, D.O.

Dr. Jason Woods received his undergraduate education from Indiana University in Bloomington. He received his doctorate degree from the Dr. William M. Scholl College of Podiatric Medicine in North Chicago, Illinois. He then went on to complete his podiatric medicine and surgery residency at the University of Pittsburgh Medical Center (UPMC) in Pittsburgh, Pennsylvania. Dr. Woods is board eligible in foot surgery and reconstructive rear foot and ankle surgery by the American Board of Podiatric Surgery. He joined the staff of Schneck Orthopedics & Sports Medicine in 2013.


American College of Foot and Ankle SurgeonsAmerican Society of Podiatric SurgeonsAmerican Podiatric Medical AssociationIndiana Podiatric Medical Association

Dr. Woods and his wife, Kelly, have two daughters. He enjoys spending time with his family, running, cycling, playing sports, and playing guitar. He and his wife are avid sports fans and passionate supporters of Indiana University Athletics. They are excited to be living in southern Indiana in Hoosier Country.

Jason Woods, D.P.M.

Chad Smith, M.D.

Dr. Chad Smith received his Doctor of Medicine degree from the University of Louisville School of Medicine and completed his orthopedic surgery residency at the University of Toledo Medical Center. He completed his Orthopedic Sports Medicine Fellowship at Wake Forest University. Dr. Smith has extensive training in joint replacement surgery and sports medicine.


Indiana Medical AssociationOrthopaedic Trauma AssociationAmerican Orthopaedic Society for Sports Medicine

Dr. Smith grew up in Buckner, Kentucky. He loves spending time with his family, particularly outdoors, at the beach or at the pool. He also enjoys traveling, playing basketball, golf, softball, and tennis, and even working on home renovation and restoration projects.


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Schneck Orthopedics& Sports Medicine

411 West Tipton Street (5th floor)Seymour, IN 47274 | (812) 524-3311

Schneck Family Care North Vernon1245 N. Street (Hwy. 3)North Vernon, IN 47265 | (812) 524-3311

Schneck Family Care Scottsburg1366 North Gardner StreetScottsburg, IN 47170 | (812) 524-3311

Schneck Family Care Salem403 S. Main Street, Suite 142Salem, IN 47167 | (812) 524-3311

Nathan CampbellPractice Manager

Our Staff works as a team to provide medical expertise,

as well as old-fashion courtesy and compassion.

our locations

Visit us at www.schneckortho.comOffice (812) 524-3311 Toll free (877) 333-7627



Schneck Orthopedics & Sports Medicine periodically hosts free seminars on Total Joint Replacements, as well as other new orthopedic techniques. Call our office or check our website for upcoming seminars and health fairs.

Schneck Orthopedics & Sports Medicine is also a part of Schneck Medical Center’s Speakers Bureau. If you have a civic organization or group that is looking for a program related to any area

of orthopedics or sports medicine, call (812) 524-3311 to discuss topics and locations for your event. There is no charge to have a surgeon present a program to your organization.

Office (812) 524-3311Toll free (877) 333-7627


SEMINARS & SPEAKERS BUREAU

SCHNECK ATHLETIC TRAINERS

Kelli is a graduate of Concord University in West Virginia, where she grew up. She has a Bachelor of Science in Athletic Training and a minor in Biology. Kelli has experience in Athletic Training at the high school, hospital, clinical, and minor-league professional levels. Her husband, Greg, is the Assistant Head Football Coach, Defensive Coordinator, and Strength and Conditioning Coordinator for the Seymour Owls Football Program. They reside in Seymour along with their daughter, Skylar, and son Tre’. Her hobbies include spending time with family, music, travel, sports, snowboarding, reading, and writing. Ultimately, she would like to further her education and one day be published.

Kyle graduated from Indiana University with a Bachelor of Science in Athletic Training. He graduated from Eastern

Kentucky University in 2006 with a Master of Science in Sports Marketing and Management. Kyle graduated from Brownstown Central High School in 2001. He lives in Seymour with his wife, Holly, and two sons, Grady and Cooper. His hobbies include exercising, watching and playing sports, outdoor activities, and do-it-yourself projects. Kyle is an avid fan of the Cincinnati Reds, Indianapolis Colts, and Indiana Hoosiers.

Kelli Hacker and Kyle Coates



There has been an increase in youth sports injuries since 2000, particularly in baseball. Unfortunately,

this epidemic of injuries is caused by repetitive stress, specialization, and professionalism of a sport. Specialization leads to playing a specific sport year-round. This increases an athlete’s risk for traumatic and overuse injuries. Almost half of sports injuries in adolescents stem from overuse. Professionalism is taking young kids and training them like they are professional athletes with year-round activity, but even professionals take time to rest.

Little League Shoulder (LLS) is an overuse injury to the growth area of the humerus (the upper arm bone) at the shoulder joint. It is caused by too much throwing, repeated

overhead throwing, using improper mechanics, or lack of muscle strength and endurance. It is unfortunately being diagnosed with increasing frequency in young athletes. Male baseball pitchers and tennis players are the most commonly affected. A study from the Children’s Hospital Boston led by Dr. Benton Heyworth discovered that half of the 95 patients diagnosed with LLS were only 12 or 13 years old. Ninety-seven percent of the affected athletes were baseball players and 86% of those players were pitchers.

The most common symptom of LLS is shoulder pain with overhead athletics. Swelling, trouble lifting the arm, and decreased speed and control while throwing are also signs of LLS. Many patients will also have elbow pain, shoulder

An overuse injury in adolescentsLittle League Shoulder:

By Dr. Jill MiklesSchneck Orthopedics & Sports Medicine


weakness, or other mechanical symptoms. Another common injury that can be associated with LLS is a torn ligament in the elbow, which may require Tommy John surgery. In Dr. Heyworth’s study, 30% of affected players had decreased range of motion at the shoulder, especially with internal rotation. Patients with an internal rotation deficit were three times more likely to experience an injury recurrence six to twelve months after returning to play.

Fortunately, treatment for LLS does not require surgery. The treatment is rest and physical therapy. Sometimes, it is necessary for a player to change field positions after returning to play. The average time for returning to play is 4.2 months. There is low risk of permanent injury, but continuing to play with LLS could lead to growth arrest or angular deformity at the shoulder. The shoulder needs to be rested until activities can be done pain free. Prevention of LLS can be achieved with correction of pitching mechanics, enforcement of pitch counts, and avoiding breaking ball pitches until skeletal maturity. Little League Baseball has developed guidelines for young pitchers to help reduce the risk of injury. (Table 1)

Dr. James Andrews, a well-known orthopedic sports medicine surgeon to the stars, has published a book entitled “Any Given Monday: Sports Injuries and How to Prevent Them, for

Athletes, Parents, and Coaches – Based on My Life in Sports Medicine” in an effort to keep kids on the playing field and out of the operating room or on the sidelines. In his book, he states that simply giving kids a break could prevent most of these repetitive injuries. He recommends at least two months off but three-to-four months is preferable to recover from a specific sport. He pleads to give kids time to recover. He is concerned with the younger and younger age athletes coming in with torn ligaments.

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Table 1:Recommended Pitch Counts by Age and Associated Rest Periods

AGE OF ATHLETE

PITCH LIMITS PER DAY

# OF PITCHES THROWN

DAYS OF REST

17–18 105 1–20 0

13–16 95 21–40 1

11–12 85 41–60 2

10–under 75 61+ 3

The bottom line is to give the superstars of tomorrow a break and let them just be the kids of today.

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Flatfo ot D efo r m ity:

By Dr. Jason WoodsSchneck Orthopedics & Sports Medicine

Flat feet can be, but are not always, painful. The most common location for pain, initially, is on the inside (or medial aspect) of the hind foot and ankle along the posterior tibial tendon (PTT). Pain in this region is commonly referred to as “shin splints”. The PTT has the difficult and demanding job of supporting and stabilizing the arch of the foot and inverting the foot as we walk. When someone has a flat foot structure due to their underlying bony architecture, it makes the job of the PTT much more difficult. This often leads to inflammation with resulting pain to the PTT. With time, damage can occur to the tendon due to overuse and strain. The tendon becomes thicker and begins to have tears within its structure, increasing the symptoms experienced by patients. A poorly functioning PTT is unable to support the medial arch, causing the arch to progressively collapse. This collapse further potentiates pain and inflammation. Patients often start to complain of pain on the outside (or lateral) aspect of the hind foot as the deformity progresses. With time, this deformity transitions to a supple, reducible deformity to one that is more rigid as joints of the hind foot become more arthritic. If the mal-

alignment continues to progress, the ankle itself can start to tip outwardly (or laterally) leading to arthritic changes to the ankle joint.

Treatment of flatfoot deformity is guided by symptoms. Painless flat feet, often times seen in children, may not require any treatment at all. When feet become painful, however, evaluation and treatment is indicated. Many times, simply supporting the arch with arch support devices, called orthotics, is all that is needed. Anti-inflammatory medication can be helpful in calming the inflammation to the damaged tendons. Removable braces may be useful to support the foot and ankle and allow for a decrease in symptoms. Physical therapy is also useful to increase the strength of the foot and ankle invertors and to improve flexibility of the Achilles tendon. In some cases, surgery may be required to realign the foot when non-operative treatment fails.

The goals of surgery in children center around realigning mal-aligned joints, which allow more normal function to soft tissue structures. Sometimes direct repair of damaged

A common patient complaint in my office is decreased arch height, often called flat feet. Children and adults alike can have flat feet. Flat feet are defined as a decrease in the normal height of the longitudinal arch or instep of the foot.

This abnormal structure predisposes one to develop problems with numerous structures within the foot and ankle.

A Common Deformity That Impacts All Ages.


tendons is necessary. In adults, surgical principles are the same with supple, reducible deformities. Damaged tendons sometimes are damaged beyond repair, in which case tendon transfer may be employed successfully. As the deformity becomes more rigid with time due to joint damage, fusions of arthritic joints may become necessary.

If you or a loved one is experiencing pain associated with flat feet, evaluation early on is in one’s best interest. As time progresses, damage to underlying tendons and joints make flat feet more problematic.

CAS E S T U DY :13 year old male presents complaining of left ankle and hindfoot pain for 1 year duration. He experiences pain on a daily basis to the medial left ankle and lateral left hind foot that is aggravated with increased activity. He has been treated non-operatively by another provider with over the counter shoe inserts, followed by custom orthotics, ankle braces, NSAIDs, and physical therapy. Despite appropriate intervention, the patient continues to have pain that is limiting ability to participate in sports and physical activities. On physical exam, he has exquisite tenderness along the posterior tibial tendon. X-rays reveal significant pes planus foot structure with significant uncovering of the talonavicular joint and abduction of the forefoot and midfoot on the rearfoot. After counseling the patient and parents on options, surgical reconstruction is performed consisting of an Evan’s calcaneal osteotomy, Cotton medial cuneiform osteotomy, and Achilles tendon lengthening. The patient is non-weightbearing in a cast for 6 weeks. Following this, weight-bearing as tolerated in a cast boot is permitted for 4 weeks. The patient is then allowed to transition into normal shoes as tolerated at 10 weeks post-op. The patient is permitted to resume exercise at approximately 4 months, increasing duration and intensity gradually as tolerated. Anterior/Posterior radiographs demonstrating pre-op (left) and post-op (right) alignment of the foot following pediatric flatfoot reconstruction. Note the significant improvement in alignment of the hindfoot joints in the transverse plane.

Lateral radiographs demonstrating pre-op (top) and post-op (bottom) alignment of foot follow pediatric flatfoot reconstruction. Note the significant improvement in alignment of the hind foot joints and restoration of normal arch height.

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1675 W. Tipton StreetSeymour, IN 47274

Living here hasits advantages.

Meals prepared based on your preferences. Non-stop activities. And a staff always ready with a smile and a helping hand. That’s Covered Bridge Health Campus. Come see just how good life can be at Covered Bridge – stop by or call to schedule a personal tour.

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Want to feel better, look better, and have more energy? Moving more and eating better is the best place to start.

Why move more and eat better?

Being physically active and making smart food choices is good for your health. But that is not the only reason to move more and eat better. It can also help you:

- Have more energy. - Look good in hip, trendy clothes. - Tone your body (without losing your curves). - Reduce stress, boredom, or the blues. - Feel good about yourself.

LOOK GOOD AS YOU GET F I T

If you avoid physical activity because you do not want to ruin your hairstyle, try:

- A natural hairstyle - A style that can be wrapped or pulled back - A short haircut - Braids, twists, or locs

T I PS ON MOV ING MORE

Physical activity can be fun! Do things you enjoy, like:

- Dancing - Hiking - Roller blading - Walking - Playing Sports - Bicycling - Swimming - Group Fitness Classes

If you can, be physically active with a friend or a group. That way, you can cheer each other on, have a good time while being active, and feel safer when you are outdoors.

Find a local school track or park where you can walk or run with your friends, or join a recreation center so you can work out or take a fun fitness class together.

Think you do not have time for physical activity? The good news is that you can be active for short periods of time throughout the day and still benefit. When fitting in physical activity, remember that any activity is better than none. So try to move more by making these small changes to your daily routine:

- Get off the bus or subway one stop early and walk the rest of the way (be sure the area is safe).

- Park your car farther away and walk to your destination.

- Walk to each end of the mall when you go shopping.

- Take the stairs rather than the elevator or escalator (make sure the stairs have working lights).

- Put physical activity on your to-do list for the day. For example, plan on exercising right after work, before you can get distracted by dinner or going out.

T I PS ON EAT ING BETTER

Eating right can be hard when you do not feel like cooking or there is a fast food place on every corner. Here are some simple things you can do to eat better:

- Start every day with breakfast. Try a low-fat, whole-grain breakfast bar; fat-free or low-fat yogurt; or whole-grain toast or bagel spread with a little peanut butter, jam, or low-fat cream cheese.

- Eat more fruits and vegetables, and choose whole grains like 100 percent whole-wheat bread, oatmeal, or brown rice instead of refined grains like white bread and white rice.

- Choose low-fat or fat-free milk instead of whole milk or a milkshake.

- Order a plain hamburger (without sauce or mayonnaise) or a grilled (not fried) chicken sandwich. Skip the fries and try a salad with fat-free or low-fat dressing instead.

- Go easy on mayonnaise, creamy sauces, and added butter.

Article Source: N

ational Institute of Health.

TIP: Day-to-day activities can cause salt build-up in your hair. To remove salt, shampoo with a mild, pH-balanced product at least once a week.


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GET BACK TO YOUR SELF(ie)

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Moving Forward Rehabilitation is designed to restore abilities following a hospital stay. Our goal is to return our participants home safely.

- Do not keep a lot of sweets like cookies, candy, or soda in the house. Too many sweets can crowd out healthier foods.

- Rather than eliminate your favorite home-cooked foods, prepare them in slightly different ways: bake chicken instead of frying it; cook with extra herbs rather than extra butter; and reduce the amount of salt you use.

Many people think that bigger is better. We are so used to value-size servings that it is easy to eat more than our bodies need. Eating smaller portions will help you cut down on calories and fat (and might save you money too).

Even take-out and high-fat foods can be part of a balanced diet, as long as you do not eat them every day and do not eat too much of them. Here are sensible serving sizes for some favorite foods:

- French fries: one small serving (equal to a child’s order) - Shrimp fried rice (as a main dish): 1 cup - Cheese pizza: two small slices or 1 large slice

OUT ‘N ’ ABOUT

You can hang out with your friends and still make healthy food choices. Try these tips when you are out ‘n’ about:

- Encourage your friends to make healthy choices with you. If you are all on the same page, it might be easier for you—and your friends—to avoid temptation.

- Order vegetable toppings on pizza instead of salty, high-fat meats like pepperoni or sausage.

- Share popcorn (and skip the added butter) at the movies instead of getting your own bag, or order the smallest size. You will save money too!

- Choose bottled water instead of soda and other artificially sweetened beverages like punch or natural fruit juices.

- Munch on pretzels or vegetables at parties instead of fried chips or fatty dips.

- If you drink wine, beer, or other alcohol, limit yourself to one drink. Alcohol has lots of calories but little nutritional value.

-

TIP: Many food labels say “low-fat,” “reduced fat,” or “light.” That does not always mean the food is low in calories. Sometimes fat-free or low-fat muffins or desserts have even more sugar than the full-fat versions. Remember, fat-free does not mean calorie-free, and calories do count!

TIP: Do you eat in front of the TV out of habit? Do you eat when you are bored, nervous, or sad? Be aware of when, where, and why you eat, and try to eat balanced meals throughout the day. Instead of reaching for that cookie, do something else, like calling a friend or taking a walk.

YOU CAN DO I T !

Set doable goals. Move at your own pace. Let your family and friends help you. Allow for setbacks, and be sure to celebrate your successes. Keep trying – you can do it!

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You can count on us for all of your therapy needs.

621 S. Sugar StreetBrownstown, IN 47220

(812) 358-2504WWW.HOOSIERCHRISTIANVILLAGE.ORG

Hoosier Christian Village not only offers a great retirement lifestyle, but also specializes ina wide array of inpatient and outpatient therapy services. Designed with a progressive team

approach in mind, our Reclaim Rehabilitation program will help you regain strength and restore function following a stroke, surgery or other injury. Call us today for more information!

(812) 358-2504

Physical Therapy • Speech Therapy • Occupational Therapy Orthopedic Rehabilitation • Cardiac Rehabilitation • Pulmonary Rehabilitation

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