What Kobe's probable Achilles tear means for his future

Kobe Bryant was in no mood to answer the only question that mattered, and no one — not even a Boston Celtics fan — could blame him.

Yet as the Los Angeles Lakers star stood there in the Staples Center locker room with teary eyes discussing his night of ill fortune, how he heard his Achilles tendon pop late in the fourth quarter and how this was the toughest moment of his transcendent career, the question eventually came.

"So this isn't the last game that we'll see you play?" a reporter asked after the Lakers downed Golden State to keep their playoff hopes alive.

"Really? Really?" he shot back before making light of the moment.
Yes, Kobe, this is really happening.

Bryant will have an MRI on Saturday to, as the Lakers put it in the news release, "confirm the diagnosis" before later having surgery. The timing, make no mistake, couldn't be more torturous for the 34-year-old who had hinted so many times next season would likely be his last. As one could predict when it comes to Bryant, he hardly sounded like someone who was entertaining the notion that this could be the end.

"(I was) upset and dejected and thinking about this mountain, man, to overcome," he told reporters. "I mean this is a long process. I wasn't sure I could do it. Then your kids walk in, and you're like, 'You know, I've got to set an example. Daddy's going to be fine. I'm going to do it.'

"I can hear (the doubters) already, and it's pissing me off right now thinking about it."
Beyond the fact that the Lakers will now attempt to sneak into the playoffs without him, there's the reality that — based on a brutal body of evidence from NBA players in the past — he may not return until midway through the season that was his supposed swan song. As the Miami Heat's LeBron James tweeted late Friday night, Bryant has played through so much pain that a comeback wouldn't surprise.

But given that Bryant is as diligent a worker and quick a healer as there is in the professional sports world, it's not a matter of whether he can come back as much as it is whether there will be any ripple effect of the injury on his retirement plans. Or, for that matter, the Lakers plans as they pertain to him.

Bryant has one season left on his contract (worth $30.4 million), and would likely return just as the Lakers are facing a free agency period in the summer of 2014 that could have the likes of King James himself on the market. What's more, one has to wonder how center and free-agent-to-be Dwight Howard will assess his situation with this drastically-changed Lakers landscape. Before Bryant's injury, all signs had been pointing to Howard wanting to re-sign with the Lakers.

According to Dr. Asheesh Bedi on the website, SportsMD.com, the typical return from an Achilles tear and surgery is between six and nine months. Bryant mentioned during his postgame discussion with reporters that he'll be doing homework on athletes who have suffered an Achilles tear and, one can assume, proceed to push his way back faster than every man and woman on that list. His goal going forward should be to channel his inner Dominique Wilkins.

As documented in a comprehensive study of Achilles injuries in the NBA by analyst Kevin Pelton (who's now with ESPN), the Atlanta Hawks star tore his Achilles at the age of 32, then returned to play his way onto two more All-Star teams before retiring at the age of 39. The what-not-to-do blueprint comes courtesy of Detroit Pistons great Isiah Thomas, who was forced into early retirement at the age of 32 after tearing his Achilles. More recently, Los Angeles Clippers guard Chauncey Billups, who was 35 at the time, returned 10 months after tearing his Achilles on Feb. 8, 2012.

Ugg Boots Achilles Heel? They May Cause Foot Pain

Podiatrists say popular slipper-like boot can be shear agony on the feet.

The wildly popular Australian boots are everywhere these days--even worthy of "how to wear them" videos on Youtube.

Forest Park Medical Center podiatrist Rachel Verville said that's probably a good idea because if not worn properly the super-comfy boots can be a real pain in the feet.

"The main thing is moderation," Dr. Verville said. "If you only wear them for a few hours every day you should be fine but if you wear them for an extended period of time or multiple days on end you can develop pain."

Dr. Verville sees a growing number of young women experiencing foot pain--she asks them all the same question: What shoes are you wearing?

"Often times its UGG's," Dr. Verville added that UGG's and knockoff-boots like them are comfortable but with their slipper-like feel they offer no support. "Basically there is a large tendon that runs down the inside of your foot called the posterior tibial tendon and if you wear non-supportive shoes for a long period of time you can develop posterior tibial tendonitis which is tendonitis of that tendon."

Which is painful enough for people to seek medical help.

Katie Taylor wears high heels at work and then slips out of them and into her UGG's on her way home. She wears them with caution and hasn't had any problems.

"They're warm, my feet get cold a lot so I really wanted to have a warm shoe," Katie said. "But also whenever I'm at work I wear really uncomfortable shoes and I change into my UGG's when I can't take the pain from my other shoes."

Dr. Verville also owns a pair of UGG's and says many women wear theirs without socks which can turn the sheepskin lined boots into bacteria traps.

"I suggest one should wear socks," Dr. Verville said. "Just a thin layer of sock inside the boots because if you sweat, moisture develops and athlete's foot and that kind of thing can develop."

So with UGG's and other sensible shoes like them--use a little common sense.

Medical Attention Or Been Hospitalized Because Of Wearing Trendy Shoes

LONDON, 2010 -- One in 10 women in Britain admit they've received medical attention or been hospitalized because of wearing trendy shoes, a survey indicates.

The survey of 3,000 women in Britain who wear high heels was conducted by Hotter Shoes, a British shoe manufacturer.

Nearly half of women say they have twisted their ankle because of their footwear and two-thirds admit wearing shoes that have caused them injury. The most frequently reported injuries caused by shoes were broken ankles, twisted knees, infected blisters, bunions and torn tendons.

"As a comfort shoe maker we were amazed to discover the pain and discomfort that women were prepared to endure for a pair of killer heels or an ill-fitting impulse sale bargain," Lisa McCarten of Hotter Comfort Concept Shoes says in a statement. "Nothing can ruin a day more than sore and tired feet, every person in our design and technical team works hard to ensure that our shoes are stylish and comfortable."

Foot Pain at Night

Q:
I have neuropathy in my feet. It can be extremely painful at night, and it keeps me awake most nights. Is there any way to reduce the pain, and will this ever subside?

— Debbie, Wichita, KS
A:
Neuropathy is a painful and distressing complication of diabetes. In some people, it disappears on its own over a period of about 12 months. In others, however, it persists. There are medicines your doctor can prescribe to relieve your symptoms.

The U.S. Food and Drug Administration has approved two drugs, duloxetine and pregabalin, to treat the foot pain from diabetic neuropathy. Duloxetin is an antidepressant, and pregabalin is used to treat seizure disorders. Both have some side effects. Duloxetin can cause nausea, sleepiness, dizziness, decreased appetite, hot flashes, and constipation. Pregabalin can cause sleepiness and confusion and can also lead to dependence.

You might consider other kinds of treatment too, both traditional and not. In one Australian study, the antioxidant alpha-lipoic acid was shown to reduce pain. And other medications — including some antiseizure medications, antidepressants, and opiates — have been used with some success. Some people have used acupuncture, topical creams containing capsaicin (a substance found naturally in hot peppers), and other alternative therapies. Of course, many of these treatments have not been well studied enough to determine their effectiveness.

I would advise you to consult with your doctor to decide which treatment works best for you. It's important to remember, of course, that none of these medicines cure the underlying cause of neuropathy. That's why it's important to focus on tight glucose management. The basic problem that leads to neuropathy is nerve and blood vessel damage caused by high blood glucose levels.

Learn more in the Everyday Health Type 2 Diabetes Center.

"Knocking Socks Off" Saves Limbs and Lives, New Diabetes Study Shows

During Diabetes Awareness Month, the American Podiatric Medical Association encourages patients to see a podiatrist for regular foot examinations.

Bethesda, MD (Vocus) November 17, 2010

The number of Americans diagnosed with diabetes continues to rise toward record levels, with an estimated one in three adults predicted to have the disease by the year 2050 according to the Centers for Disease Control. Because many serious complications from diabetes present in the lower limbs, proper foot care for those with the disease is a vital step to keeping the disease in check. In fact, a new study on foot care for people with diabetes conducted by Thomson Reuters confirms that care by a podiatrist can drastically reduce the incidence of diabetes-related hospitalizations and amputations.

"During November's Diabetes Awareness Month, it's important to realize that simple lifestyle changes can go a long way toward staying healthy with diabetes. These include eating right, being active, monitoring blood glucose, and checking your feet daily," said Dr. Kathleen Stone, president of the American Podiatric Medical Association (APMA). "Diabetic foot complications are the leading cause of non-traumatic, lower-limb amputation in the U.S. Remembering to 'knock your socks off' at every doctor's visit will help to catch any potential lower limb complications early."

According to preliminary results from the Thomson Reuters study, those with diabetes who received care from a podiatrist had a nearly 29 percent lower risk of lower limb amputation, and 24 percent lower risk of hospitalization, than those who did not. APMA's "Knock Your Socks Off" campaign, running during Diabetes Awareness Month, aims to encourage everyone with diabetes and those at risk for the disease to remove their shoes and socks and inspect their feet and visit a podiatrist for a foot exam.

Feet should be checked regularly for signs and symptoms of diabetes to help prevent serious complications. Symptoms in the feet such as redness, tingling and cuts that are not healing can lead to diabetic ulcers and even possible amputation without prompt medical care.

"The Thomson Reuters study results show that just one visit to a podiatrist can drastically reduce the chance of a tragic diabetes-related amputation. There is now no question that a podiatrist must be a part of everyone's diabetes management team," Dr. Stone said. The APMA-sponsored study was conducted using Thomson Reuters' MarketScan Research Databases, which house fully integrated, de-identified health-care claims data extensively used by researchers to understand health economics and outcomes. Studies based on MarketScan data have been published in more than 130 peer-reviewed articles in the past five years.

Founded in 1912, the American Podiatric Medical Association (APMA) is the nation's leading and recognized professional organization for doctors of podiatric medicine (DPMs). DPMs are podiatric physicians and surgeons, also known as podiatrists, qualified by their education, training and experience to diagnose and treat conditions affecting the foot, ankle and structures of the leg. The medical education and training of a DPM includes four years of undergraduate education, four years of graduate education at an accredited podiatric medical college and two or three years of hospital residency training. APMA has 53 state component locations across the United States and its territories, with a membership of close to 12,000 podiatrists. All practicing APMA members are licensed by the state in which they practice podiatric medicine.

Why Does My Achilles Tendon Hurt?

You don’t have to be an accomplished athlete to suffer Achilles tendon injuries. They can occur from performing minor household tasks, such as climbing a ladder. Achilles tendon weakness is common in adults and prompt treatment when symptoms occur can prevent more serious injury.

The Achilles tendon is the longest and strongest tendon in the body, but is subjected to considerable wear and tear. When the tendon becomes inflamed from overuse or too much sudden stress, tendonitis can weaken it over time and cause microscopic tears. Going without treatment only increases risk for further deterioration and possible rupture.

Pain, stiffness and tenderness in the area are the main symptoms of Achilles tendonitis. Pain occurs in the morning, improves with motion, but gets worse with increasing stress and activity.

In addition to athletes, Achilles tendonitis is common for anyone whose work routine puts constant stress on the feet and ankles. Achilles tendon injuries happen most often to less conditioned, “weekend warrior” athletes who overdo it.
When pain and other symptoms indicate possible Achilles tendonitis, a thorough diagnosis is necessary to determine the extent of the trauma and evaluate the flexibility and range of motion in the tendon. Treatment options depend on the extent of the injury.

They include:
• Casting to immobilize the Achilles tendon and promote healing
• Ice to reduce swelling
• Non-steroidal anti-inflammatory medication to reduce pain and inflammation
• Physical therapy to strengthen the tendon
• Surgery, if other approaches fail to restore the tendon to its normal condition

Recreational activities involving jumping and running are the major cause of Achilles tendon injuries. In sports like basketball and tennis, muscles and tendons in the back of the leg are prone to injury from an imbalance that occurs from a lot of forward motion. As a result, the frontal imbalance can weaken the tendon unless stretching exercises are performed regularly.

The best way to prevent Achilles tendon injuries is to warm up gradually by walking and stretching. Further, it’s best to avoid strenuous sprinting or hill running if you are not in shape for it.

Popular Flip-Flop Sandals Linked to Rising Youth Heel Pain Rate

Many of us wear flip-flop sandals throughout the year; however, their popularity among teens and young adults is responsible for a growing epidemic of heel pain in this population.

We’re seeing more heel pain than ever in patients 15 to 25 years old, a group that usually doesn’t have this problem. A major contributor is wearing flip-flop sandals with paper-thin soles everyday to school. Flip-flops have no arch support and can accentuate any abnormal biomechanics in foot motion, and this eventually brings pain and inflammation.

Wearing sandals with reasonably strong soles and arch support is recommended. Especially for girls and young women, thicker soled sandals with supportive arches might not be considered stylish, but if you want to wear sandals most of the time, you’ll avoid heel pain if you choose sturdier, perhaps less fashionable styles.
It is estimated that 15 percent of all adult foot complaints involve plantar fasciitis, the type of heel pain caused by chronic inflammation of the connective tissue extending from the heel bone to the toes. Tight calf muscles and wearing inappropriate footwear are common contributing factors.

The pain is most noticeable after getting out of bed in the morning, and it tends to decrease after a few minutes and returns during the day as time on the feet increases. Not all heel pain, however, is caused by plantar fasciitis. It also can occur from inflammation of the Achilles tendon, bursitis, arthritis, gout, stress fractures, or irritation of one or more of the nerves in the region. Therefore, diagnosis by a foot and ankle specialist to rule out other causes is advised.
Initial treatment options for heel pain caused by plantar fasciitis should include anti-inflammatory medications, padding and strapping of the foot and physical therapy. Patients also should stretch their calf muscles regularly, avoid wearing flat shoes and walking barefoot, use over-the-counter arch supports and heel cushions, and limit the frequency of extended physical activities.

Most patients with plantar fasciitis respond to non-surgical treatment within six weeks. However, surgery is sometimes necessary to relieve severe, persistent pain. To find out what is happening with your child feet don’t wait to see your foot specialist at Central Kansas Podiatry Associates today.

Advice to High Heel Wearers

The doctors at CKPA offer the following advice to those who insist on wearing sky high heels. We suggest not wearing heels that are higher than 2 inches. It’s very difficult, not only on the foot, but the knees and low back. The way the shoes put pressure on the front part on your feet, it applies compression on your toes and irritation to the nerves in the toes.
The bones in the ball of the feet, called sesamoids, can be damaged or broken. Constant pressure on the feet can result in thickening of tissues around the nerves of the toes, called Morton’s Neuroma, causing pain, stinging or numbness in the toes.

Foot Pain.…Make it STOP!!

Patients often ask, “How much pain will I have after surgery?” This is a very difficult question to answer because everyone experiences pain differently. This also makes testing someone for pain difficult. Everyone experiences pain at different levels and have different thresholds for tolerating pain. Pain is often difficult to locate. When our bodies experience a pain, it sends the signal through our brain through nerve fibers. Small nerve fibers called delta fibers send 90% of the pain signals to the brain to specific locations in the cortex of the brain. Testing these fibers shows us where the pain is coming from. Small nerve fiber testing is a painless test that can show where the pain is coming from in about 20 minutes. An EMG tests for nerve damage. Pain occurs before the nerve is damaged. By testing the small nerve fibers, it locates accurately with 95% sensitivity where the pain is before there is permanent damage. This leads to earlier and more effective treatment. If you are experiencing pain that is not responding to traditional treatment, consult with your physician to see if you are a candidate for small nerve fiber testing.