Dr. Vivek R Nayak

The ankle, despite being one of the smaller joints, plays a crucial role as it bears the brunt of a person’s weight. Due to improper gait or injuries, the ankle often gets sprained. This can be a recurring problem in older people. Therefore, over a period of time, the ankle gets unstable and can cause chronic symptoms including pain, imbalance resulting in recurrent falls. Read on to know more about some causes, symptoms, and management techniques for ankle instability.

Causes: The ankle has ligaments which stretch to allow for ankle movement. When this ligament stretches beyond the limit, then it can tear or stretch. Therefore, sportspersons like basketball and football players, gymnasts who tend to use their ankle a lot are at a much higher risk of developing ankle instability over a period of time.

Symptoms: The most common symptom of ankle instability is when a person is unable to stand firm. This pain is worse in people wearing heels or walking on uneven ground. Patients may experience swelling, stiffness, and excruciating pain.

Management: Ankle instability is an acute problem but the recovery time is limited too, so the symptoms disappear over a period of time. However, in some people, especially sportspersons, it may lead to a chronic condition which needs immediate attention. Few remedies for getting relief from ankle pain are mentioned below:

1. Ice: For pain relief, icing the ankle is an excellent option. Applying a cold pack for about 10 to 15 minutes about 2 to 4 times per day is an effective way to relieve the pain, stiffness, and swelling.
2. Rest: Ligament injuries often heal on their own, and sportspersons may be advised to stay off of the game for about a week or two, to give it time for self-repair.
3. Compresses: Using an elastic wrap or compression ice wrap for a few hours can help in relieving ankle instability.
4. Pain killers: Non-steroidal anti-inflammatory drugs like ibuprofen can help in reducing both the inflammation and pain from the ankle injury.
5. Exercise: Increasing the strength and flexibility of the ankle via exercise is a great way to reduce chances of further sprain. Rotating the ankles, standing on one leg, etc., are some effective ways to do this.
6. Surgery: If none of the above-mentioned remedies work, a surgery may be required which is only in severe and/or chronic cases.

Ankle instability is quite common but is equally easy to manage. In case you have a concern or query you can always consult an expert & get answers to your questions!

Wrist fracture is a medical term used to describe a broken wrist bone. Wrist is composed of 8 small carpal bones and lower ends of the two forearm bones - Radius & Ulna. The fracture may occur in any of the 10 bones that make up the wrist. While some fractures can be severe, most fractures are tiny in nature. The fractures, which are severe, tend to render the bone unstable and a cure for this condition might require a surgery. Open fractures occur when the broken bone spike juts out through the skin. This might lead to an infection in the wounded region. 

Causes of Wrist Fracture

1. The most basic cause of a wrist fracture is injury. Any fall on your outstretched hand (FOOSH) and you might have to nurse a fractured wrist. This type of fracture is common among sportsmen. 
2. People suffering from osteoporosis have a high risk of getting a wrist fracture. 
3. Traumatic accidents might also cause severe wrist fractures. 
4. Repetitive use of wrists leads to inflammation of the tendons present in the wrists (tendonitis). 

Symptoms of Wrist Fracture

A wrist fracture has symptoms that can be extremely painful. The pain escalates whenever you try to move your wrist or flex it, even if you are just flexing your fingers. Sometimes your hand or arm may even become extremely numb when you fracture the wrist. The muscles in the area become tender and swell up. It is almost impossible to move the wrist after it gets fractured. The fracture causes the wrist or rather the hand to appear deformed. The most common deformity being a Dinner fork deformity (Colles' Fracture). The area around the fracture may experience bruising and a fractured wrist also affects the blood flow in the area. You might even injure your ligaments, tendons, muscles or nerves. 

To confirm and check the level of severity, you are generally asked to get an X-Ray done. In order to get a more detailed look at the fracture, you might have to undergo CT or MRI scans as well. Usually, in order to treat a fracture, you will have to wear a splint or a cast and move your hand as least as possible. But keep moving your fingers otherwise they might get stiff. 

Most cases of wrist fractures recover well with a very good return to function.

The hip joint is a ball and socket joint made up of the round head of thigh bone (femoral head) with the cup shaped socket (acetabulum) of the pelvis and Perthe’s Disease is an affliction of the hip joints in growing children. It is much more common in boys than girls, and occurs most commonly in children aged between 4 to 10 years. The cause of this problem is still unidentified.

In Perthes disease, changes affect the femoral head which can be seen on X-ray. These changes occur in three stages over 18 months to 2 years:

1. The blood supply to part of the femoral head is disturbed, causing loss of bone cells.
2. Softening and collapse of the affected bone
3. Re-establishment of the blood supply, repair and remodeling of the femoral head.

Limping is the most common symptom. The limp may become more persistent and pain may develop. Examination of the child by the orthopaedic surgeon generally shows restriction of hip movement. The nature of Perthes disease is variable. Severity depends on the child’s age, and the extent of femoral head involvement. Older children, girls, and those with greater involvement of the femoral head are likely to require more complex treatment. Treatment aims to reduce pain and stiffness, and prevent femoral head deformity.

All children need regular review by the orthopaedic surgeon through the duration of the disease. Not all children require active treatment. Many will make a good recovery with only symptomatic treatment. This may involve restriction of activity such as running and high impact sports. Swimming is encouraged. Some children may require exercise in slings and springs, or the application of plaster casts to the lower limbs. Some children will require surgical management.

Children with Perthes Disease are otherwise healthy, but may be affected by physical restrictions. By middle age, one third of those affected have no symptoms, one third have intermittent hip pain, and one third would develop arthritis requiring treatment.

Also known as Median Nerve Compression, Carpal Tunnel Syndrome is characterized by a sensation of tingling and numbness in the hands or the arm caused due to a strained nerve of the wrist. This condition occurs due to stress which affects the functioning of the part of median nerve, situated along the wrist.

Various Causes of Carpal Tunnel Syndrome:
Constant movement of the hands in activities such as typing on the computer
Pregnancy
Arthritis

Various Symptoms of Carpal Tunnel Syndrome:
The symptoms of this syndrome start to show up when there is excessive pressure build up in the median nerve of the wrist. You may experience-

1. A sensation of numbness
2. A sensation akin to the pain experienced when needles are inserted into the skin
3. Pain (mostly at night)

The build- up of pressure can occur due to a number of reasons. They are

1. Painful injury
2. Fracture
3. Tenosynovitis (a condition that affects the tendons along the sides of the thumb)
4. The compression of the nerve may develop anywhere, and not necessarily the wrist only.

Diagnosis of Carpal Tunnel Syndrome:
Doctors base their diagnosis of the condition on the symptoms and certain tests. These include-

1. Phalen’s test (a test that is carried out to determine any pain or numbness in the fingers within one minute of this activity)
2. Wrist flexion/median nerve compression test
3. Tinel’s test (a test that is used to diagnose irritated nerves)
4. Few nerve enlargements may be revealed by an ultrasound, X-Ray, MRI scan, CT scans etc. The doctor generally recommends any of the above tests to determine carpal tunnel syndrome.

Important measures that help treat the condition are

1. Getting ample rest
2. Educating yourself on the various symptoms
3. Knowing certain activities or movements that trigger symptoms
4. Attending physiotherapy sessions
5. Physiotherapy as an important form of treatment for Carpal tunnel syndrome
6. Extensibility of muscle as well as soft tissue
7. Strengthening the forearms and the ability to grip things and pinch too
8. Maintaining posture and performing hand agility exercises can improve the hand movement
9. Mobilization of the Carpal bone and stretching of the flexor retinaculum (a fibrous band near one’s wrist) so as to widen the carpal tunnel
10. Gliding training for nerves/ tendons for unrestricted motion
11. Endurance training for strengthening the upper limb as well as the wrist

 In case you have a concern or query you can always consult an expert & get answers to your questions!

Are you aware of the importance of vitamin D in your body, and why you should keep away from vitamin D deficiency? Vitamin D, referred to as the sunshine vitamin, is produced by your body in response to your skin’s exposure to sunlight. It is found naturally in certain food items such as egg yolks, fish liver oils, and fish. Vitamin D is essential for strong bones as it helps your body in using calcium from your diet.

Causes of vitamin D deficiency
There are various reasons that lead to vitamin D deficiency. The most common ones are as follows:

1. It happens when you are a vegan and do not consume any animal-based products, as it is common in foods like fish, egg yolks, beef liver, and fortified milk.
2. You have limited exposure to sunlight, in such a case your body fails to make required vitamin D
3. If you spend a lot of time indoors or live in the northern latitudes, or wear robes and covering as part of religious requirements, you may become vitamin D deficient.
4. In case you have dark skin, as a pigment known as melanin reduces your skin’s ability to make vitamin D based on your exposure to sunlight.
5. Aged adults having a dark skin tone are more likely to suffer from vitamin D deficiency.

Symptoms

1. The primary symptoms of vitamin D deficiency include muscle weakness and pain in the bones.
2. In some people, the symptoms are not prominent.

Management of vitamin D deficiency

• The treatment of vitamin D deficiency aims at getting more vitamin D via diet and health supplements.
• Usually, there is no consensus about vitamin D levels that are required for optimal health, and it depends on a person’s health condition or age.
• The recommended dietary allowance of vitamin D is stated to be 600 international units for all people within the age of 70.
• For people above the age of 70, the allowance is stated to be 800 international units.
• It is also possible for a doctor to prescribe over 4000 international units for correcting vitamin D deficiency.

It is recommended for you to consult a doctor regarding vitamin D deficiency in case you do not spend enough time in the sun, or when you always cover your skin by applying sunscreen, which restricts the production of vitamin D. You may need to take vitamin D supplements, as prescribed by the doctor.

In case you have a concern or query you can always consult an expert & get answers to your questions!