Rare ankle replacement allows long walks to resume

CHRIS SEGAL / News Herald Writer

PANAMA CITY — Daily walks were put on hold in 2009 when retired Army Sgt. Maj. Mike Mead could no longer suppress the pain in his left ankle.

A total ankle replacement, one of the first done in Bay County in the past decade, has given the career solider relief from the pain and a return to his walks.

Mead took three one-mile walks a day with his dog, at least until this time last year when the pain kept him off the walking paths. He is slowly building up his strength to return to his longer walks. He currently can walk about a mile a day.

Dr. Shayne Jensen of Gulf Coast Podiatry Foot and Ankle Surgery Center, who performed the ankle replacement, said Mead’s pain was caused by a lack of cartilage in his ankle joint, likely caused by osteoarthritis. In July 2010, Mead was implanted with the INBONE Total Ankle Replacement from Wright Medical.

“We have total knee and total hip replacements — why can’t we have total ankle replacements?” Jensen said.

The “second generation” ankle replacements have been around for about 10 years but Jensen waited for the research before performing a total ankle replacement. The research is showing that with the right candidate 10 years out, there is a 70 percent success rate, Jensen said.

“It went really well,” Mead said. “Before the surgery I could not put weight on my left foot. I think the dog got frustrated with me on our walks. I thought I could handle the pain but I finally went to see my doctor.”

Jensen performs 10 to 15 ankle fusions a year, which he said is still the “gold standard” for treating ankle problems. An ankle fusion uses pins and plates to fuse the ankle joint, and patients lose range of motion in the ankle joint.

The total ankle replacement uses an artificial prosthesis to offer patients better mobility.

“It looks good, it healed well and it works,” Jensen said.

For Mead to qualify as an ideal patient for the total ankle replacement he had to give up smoking cold turkey. Jensen explained with replacements there is a higher rate of failure with smokers and he would not consider the total ankle replacement on a smoker.

“It is important to use the right indicators for your patients,” Jensen said. “This is another modality.”

If a patient is obese, diabetic or has several misalignments, the ankle fusion is still the better option, Jensen said.

Mead’s recovery included two weeks when he could not put weight on his ankle and three months of physical therapy. Mead, who has also had a knee replaced, said the ankle replacement was less painful but the recovery took longer. Mead, Jensen and others on the walking path are impressed by the progress made following the total ankle replacement.

Early surgery for ankle fractures may improve outcomes, reduce costs

Sukeik M. Injury Extra. 2010;41:133-134. doi:10.1016/j.injury.2010.07.419.

United Kingdom investigators suggest that hospitals establish a policy of early surgical intervention for ankle fractures, which would improve outcomes and reduce the costs associated with this injury.
Ankle fractures are one of the most common orthopedic injuries, according to Mohamed Sukeik, MD, MRCS, and colleagues at the Cumberland Infirmary, in the United Kingdom. The swelling associated with these fractures causes operative delays. However, a surgical delay of more than 24 hours after injury is linked to longer hospitals stays, which increases costs.
In this retrospective study, the investigators followed 145 consecutive patients who were treated for ankle fractures between January 2008 and December 2008. They excluded patients with talar and pilon fractures. There were 62 men and 83 women. The patients had a mean age of 49 years. To determine surgical delay, the investigators noted the time of emergency department presentation and the time of anesthetic. They reviewed patient notes for inpatient stay and postoperative complications.

The early group included 117 patients who were operated on within 24 hours of presentation. The delayed group included 28 patients operated more than 24 hours after presentation.
The mean inpatient stay for the early group was 3.79 days vs. 8.57 for the delayed group. In 57% of the delayed surgery group cases, swelling caused the delay. Surgery was also delayed because of a lack of operating room time and a lack of fitness for surgery.
Five patients (4.27%) in the early group had wound infections, and one patient had a chest infection (0.85%). In the delayed group, four patients (14.28%) had wound infections; all had ankle swelling.

5th Annual Run for the Paws Walk / Run

5th Annual Run for the Paws Walk / Run
Saturday, January 29th, 2011
Race starts promptly at 8:00 a.m.


Race Info

• PANCAKE BREAKFAST!!!!  This year in addition to the usual bagels and Gatorade, the Civil Air Patrol will be holding a fundraiser pancake breakfast on-site!  For a $5 contribution to the CAP you will get pancakes, sausage, eggs, OJ, and coffee!  Plus, they are hosting the award ceremony in the hangar and giving tours. 
• Pets are allowed to participate with their guardians, but must be up to date with their vaccinations, be able to complete the distance of the event, and must be on a non-retractable leash at all times.  The retractable leashes are not permitted due to tripping concerns that we have experienced in previous years.
• Please arrive early to allow yourself time to park, register, pick up your timing chip, and get to the start line.  Day-of registration WILL CLOSE AT 7:45 a.m. TO MAKE SURE EVERYONE HAS TIME TO GET THEIR CHIP AND GET TO THE START.  If you arrive after 7:45, there is no guarantee that you will be timed and included in the event results!
• We encourage participants to bring items for the pets at the Humane Society Naples, items that they are always in need of are cat litter, laundry detergent, bath towels, paper towels, hand sanitizer, canned dog food, and dryer fabric softener sheets.  They do not need dry food. 

Bay to Breakers: 100 Years and Running

Countdown begins as "The World's Most Unique Footrace" turns 100; get ready to run on Sunday, May 15, 2011; race limit of 50,000

From Ryan Lamppa, Running USA

SAN FRANCISCO - (January 6, 2011) - With five months until race day, runners from all over the world, of all shapes and sizes, and of all intensities are readying themselves for what is known as the most unique footrace in the world. The100th running of Bay to Breakers will take place on Sunday, May 15, 2011, and up to 50,000 runners will participate in this quintessentially San Francisco event.

"Looking back at the past 100 years of Bay to Breakers, the only thing that comes to mind is the word 'iconic,'" saidAngela Fang, general manager of the race. "Bay to Breakers is an all encompassing event that unites best-in-class athletes with enthusiastic fans and creates the spirit that is San Francisco."

Originally known as the Cross City Race, Bay to Breakers was first held on January 1, 1912. In its first year, 186 runners started the race at Embarcadero and Market streets, and only 121 runners completed the race. The winner of the first race was Robert Jackson "Bobby" Vlught, who won with a time of 44 minutes, 10 seconds. Since then Bay to Breakers has grown to be one of the largest footraces in the world with more than 50,000 participants and close to 100,000 spectators annually. The 12K race, also home of the world records (33:31 and 38:07), has grown to be a celebration for everyone and exemplifies The City's irrepressible color and its affection for eclectic traditions.

At Expo this year, a race retrospective exhibit of Bay to Breakers will be held on May 13-14, 2011. The retrospective will include photos, rare memorabilia and a historical timeline from 1912-2011. This historical display will kick-off the weekend's festivities and will begin to generate the excitement as runners build towards race day.

On Sunday, May 15, 50,000 runners, including Bobby Vlught's grandson, will be propelled into the 100th running of Bay to Breakers. At the finish line, runners will receive a race t-shirt, and for the first time in race history, all registered finishers will receive a commemorative medal representing the 100th running of the race. In this year's race, men who beat Vlught's 1912 winning time of 44:10 and women who beat the 50:45 winning time of the first female winner, Dr. Frances Conley from 1971, will have their race numbers retired.

Along the USA Track & Field certified 12K (7.46 miles) course, Bay to Breakers will host entertainment from the past 10 decades, offering a fun and lively atmosphere for participants and spectators alike. At 7:00am runners will start at the base of the San Francisco Bay, and progress to the City's famousHayes Street Hill. Around the 2.5-mile mark runners climb an 11.15 percent grade between Fillmore and Steiner streets, bringing them to the highest point in the race, approximately 215 feet above sea level. The remainder of the course gradually flows alongside the Panhandle and through Golden Gate Park and ends at the Pacific Ocean.

Alcohol and floats are not allowed at the 100th running of the Bay to Breakers. Neighborhood associations, city officials, police and race organizers have determined alcohol and floats create a threat to public safety. At the 100th running, additional police and private security will be added to enforce applicable laws. There will be multiple checkpoints on the race route to remove any floats and alcohol. Only registered participants will be allowed on the course.

This change was made to ensure everyone has a safe, fun and challenging 100th celebration race. These new regulations will not be reversed.

The completion of Bay to Breakers and the celebration of the centennial will be commemorated at Footstock this year. The merriment will move from its former location at the Polo Fields to the soccer fields for the 2011 race and will feature food booths, entertainment and exciting festivities as a celebration of the incredible 100 years Bay to Breakers has had, and 100 more to come.

For more information, go to: www.baytobreakers.com

6 Tips for Turning Resolutions Into Reality

Coach Jenny Hadfield 
For Active.com

It’s New Year’s resolution time again and a chance to make positive changes in your life. This year, use Coach Jenny’s Evolution-Resolution system and make good on those resolutions.

Start With a Specific and Realistic Goal

Goals that are too lofty don’t stick and can be overwhelming. Go with a realistic goal and aim low. For example, train to run and participate in a 5K in May. The race makes the goal specific. Plus, it is very realistic to train to run a 5K in four to five months. 

• Make it stick: Register for the race. It will keep you accountable to your resolution and keep you going.

Follow a Realistic Training Program

The number one way to reach a running goal is to follow a training program that matches your current level of fitness and build from there. You will progress faster and reach your goals more quickly and with less risk of injury and burn-out.

• Make it stick: Do a personal inventory of your activity. Match your current activity level to the first few weeks of the training program. Less is more in the first month of training.

Break it Down

Break your resolution into a few smaller, more digestible pieces (check points) throughout the year. For instance, start with a 10-week run-walk program on your journey to learning to run continuously. It is a smaller and more achievable goal and will lead to the next goal of running the race.

• Make it stick: Set one goal for spring (5K) and one more for the fall (losing 15 pounds). Connect the two with smaller mini-goals to get you to the first, then the second.

Let Your Goals Evolve

Change takes time. Getting active and losing weight are fantastic goals, but they take time. Put your mini-goals into your calendar and focus on one at a time. Be patient and persistent. There will be ups and downs; but if you stick with it and stay on target you will reach the next check point.

• Make it stick: Stay motivated by keeping a log or diary and look back every few weeks to see your progress. You may not notice change over a few days, but a few weeks makes a big difference. 

Reward Yourself

Treat yourself to a massage or special gift when you reach a mini-goal. It is a great way to stay motivated and celebrate reaching the next checkpoint.

• Make it stick: Put your major- and mini-goal somewhere you can see it daily.

Surround Yourself With Support

Join a group, program or club. Tell everyone you know about your goals. You’ll have a built-in motivational source, plenty of friends to chat with along the way and someone to get you going when you’re not inclined.

• Make it stick: Invite your support team to celebrate reaching your mini-goals. Positive reinforcement goes a long way in staying on track.

Tips on Choosing Running and Jogging Shoes

Running and jogging exert brute force on your feet, legs, hips and spine. Proper shoe selection is very vital to protecting these from injury or long-term problems.

Some general tips:

• Fit the shoe to your longest toe, which is often your second toe.
  
• Shoes should be comfortable when you first try them on. Don't buy shoes and plan to "break them in" by wearing them.
  
• Take the same socks you'll use for jogging. They should fit well, be made without seams, which could cause irritation to the foot. If you use extra-thick socks while running, select shoes with enough room. Socks should be made mostly out of synthetic materials which "wick" moisture away from the foot. This reduces the chance of developing blisters
  
• The shoe should grip your heel firmly.
  
• While the shoe is on your foot, you should be able to wiggle all your toes.
  
• You should have at least 1/4 inch of space beyond your longest toe.
  

Weight, foot structure, and running regimen are all deciding factors. Be mindful that all shoes have a different shape, and sizes and widths are not uniform from shoe to shoe.

Consider whether a special insert will be placed in your shoe, and whether your running style is flat-footed or on the balls of the feet.

Shoes should provide cushioning for shock absorption, and ought to be able to fully bend at the ball of the foot area.

Damage Control

Feeling sore and achy after your last run? When to press on and when to back off.By Liz PlosserFrom the December 2010 issue of Runner's World 

It can make you limp down the stairs or struggle to get out of your chair. But that doesn't mean muscle soreness is all bad. "Muscles go through physical stress when we exercise, and the discomfort that stress causes may be perfectly normal," says Allan Goldfarb, Ph.D., a professor of exercise physiology at the University of North Carolina-Greensboro. In fact, muscle soreness is often a good thing. "It's proof your body is adapting and growing fitter," Goldfarb says. "You're reprogramming your muscle structure and making weaker cells stronger."

This can make your job as a responsible runner who wants to avoid injury tricky. If you park yourself on the couch after feeling any inkling of tenderness, your training could come to a standstill. But if you push through the pain, you might hurt yourself. So how do you toe the line between a healthy dose of creakiness and pain that's a sign of trouble?

ON THE RUN
Sometimes the physical stress of exercise manifests itself as soreness while you're still running. That's because the action of running pushes your body's weight downward—and even the most cushy shoes can't alone handle the shock. "Some of the force goes back into your muscles," Goldfarb says. "That shock-absorption process releases chemicals that can activate pain receptors."

You can minimize midrun soreness by making sure you are in good shoes that aren't too worn (replace them every 400 to 500 miles) and choosing softer running surfaces when possible. And consider doing the next day's easy run on the treadmill, which has more give to help your recovery. When soreness escalates beyond slight discomfort, back off the pace (take walk breaks) and distance (take a shortcut or stop running and walk the remaining miles). Follow up with at least one rest or cross-training day—don't try to make up for the missed mileage.

AFTERSHOCK
You may feel fine during and right after a workout, only to discover you're quite sore a day or two later. "The gradually increasing discomfort that peaks 24 to 48 hours after activity and disappears five to seven days later is called delayed onset muscle soreness (DOMS)," says Carol Torgan, Ph.D., an exercise physiologist in Bethesda, Maryland. DOMS usually occurs when the leg muscles have performed an eccentric contraction (which increases tension on a muscle as it lengthens). Speedwork, races, long runs, or any type of workout you're not used to are other causes. "Intense or new activities put a lot of stress on muscle cells," Goldfarb says. "Some of those cells are strong from your regular workouts, but when you work your body in a new way, you hit some cells that are weaker. The weaker ones develop microtears." This damage causes achiness. The good news is that once your muscles repair themselves and grow stronger, they are more resistant to damage for up to eight weeks.

While it's okay to do an easy run while you're dealing with DOMS, hold off on doing another intense workout for a few days. And expect to feel a little stiff during the first mile or so. It's important at this point to recognize the difference between a Wow, I really pushed myself and a worrisome Oww, I really hurt. "If the soreness lasts longer than a week, it develops into pain, or there is any sign of swelling or redness, see a doctor," Torgan says.

That said, running or racing your best does not necessarily mean hobbling for the ice pack afterward. "If you are perfectly trained for a race, you may not be sore afterward because you didn't stress your muscles in a new way to lead to damage," Torgan says. "If you think of times that you were really sore after a race, typically there's an element that you didn't properly train for, such as not enough hill work. Or you raced significantly faster than your training pace."

AGE LIMIT
As our muscles become conditioned to certain activities, they are less likely to become sore. "Muscles that are stressed will rebuild and adapt and cause less discomfort over time," Torgan says. "Think of it as a survival mechanism." There is, unfortunately, an exception to this rule. As we age, we become more prone to pain. There are two reasons, according to Goldfarb. First, we lose muscle cells—typically because of inactivity, but also just because, shoot, that's part of the aging process. That means there are fewer cells to recruit during a workout. The ones that are engaged will work overtime to get you to the finish line, but they'll also suffer the repercussions: tears and inflammation. Aging also slows down the body's muscle-repair mechanisms. "The protective processes in muscles are down-regulated and our connective tissue doesn't work as well," Goldfarb says.

That's why even the most talented masters runners take extra rest days and spend more time cross-training than they did in their younger years. You can still work hard and perform well as you age—so long as you prioritize recovery.



What a Relief

Achy, sore, tender muscles? Six ways to ease the hurt

ICE BATH Sitting in a cold tub for 10 to 20 minutes after a hard run helps flush out waste products and reduce swelling and tissue breakdown, Allan Goldfarb, Ph.D., says. You can also apply an ice pack to individual sore spots.

HEAT THERAPY "When muscle temperature is increased, blood flow increases, bringing nutrient-rich blood to the damaged muscle," Goldfarb says. Wait 24 hours after a run to apply heat.

ACTIVE RECOVERY Twenty to 30 minutes of low-impact exercise increases blood flow to muscles to reduce trauma and re-establish the body's pH level, Goldfarb says. Cross-training the day after an intense workout can help you recover from a race, speed session, or long run, Carol Torgan, Ph.D., says.

MASSAGE Researchers in Australia found that sports massage may help reduce muscle soreness by as much as 30 percent. "Massage may increase blood flow to the damaged muscles and enhance recovery," says lead study author Ken Nosaka, Ph.D.

GENTLE STRETCHING "Stretching loosens muscles while lengthening them, and this allows them to relax and get back full range of motion," Goldfarb says. Hold gentle stretches for about 30 seconds at a time, postrun.

NSAIDS Aspirin, ibuprofen (Advil and Motrin), and naproxen sodium (Aleve) alleviate muscle soreness by preventing the body from making prostaglandins, substances that control pain and inflammation. "The problem is that NSAIDs slow the repair process by disrupting the re-synthesis of proteins, so use them sparingly," Goldfarb says.