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Wearing high heels has become almost like a rite of passage for young girls entering adolescence and adulthood.  The problem is that this particular fashion trend holds so many negative side effects both immediately and later on in life.  As with so many choices we make when we are young, we must often pay the consequences as we age.

Believe it or not, high heels began as a means for wealthy men to protect themselves from the mud and muck on the ground back in the 14th century.  Now, women have adopted the trend simply as a fashion statement.  While those pretty pumps may make your calves look great, the negative effects may not be worth the looks.  So why do high heels get such a bad rap? What problems do they actually cause?

First off, when you stand on your toes and lift your heels off the ground (known as plantarflexion); your ankle is placed in a less stable position which leaves you more prone to spraining the ankle ligaments.  This position also places increased stress on the peroneal and lateral gastrocnemius muscles which are located in the calf and help support the outer side of your ankle.  If these muscles are already weak, then placing more stress on them by wearing high heels can leave you prone to injuring the muscles.  This also leaves you more prone to spraining the ankle ligaments due to having less muscle support to prevent you from “rolling” the ankle.

In addition to ankle injuries, the feet take quite a beating from wearing heels.  Due to the effects of gravity, the toes are forced to take an excessive amount of pressure through a typically narrow toe box.  The pressure placed on the toes from frequent high heel wearing contributes to hammertoes, bunions, corns, calluses, and toe nail problems.  These deformities can become so severe that surgery may be required to realign the joints of the feet.

It is not always the feet and ankles that suffer from the effects of high heels.  The back is often involved as well due to changes in standing posture while wearing heels.  The back ends up in an extension position (bent backward) which places increased strain on the back muscles and can lead to nerve compression if the position is extreme enough or other preexisting back conditions are present.  Due to the changes in posture and pressure while walking in heels, increased torque is placed on the knees. Dr. D. Casey Kerrigan, an engineer and Harvard Medical School graduate, found a direct correlation between knee arthritis and wearing high heels.  Another study found that the degree of heel height made a large difference on the amount of stress placed on the body.  As heel height increased, the amount of stress on the tibialis anterior (a muscle that assists with supporting the arch of your foot and lifting your ankle upward) and the low back increased, thus increasing a person’s risk for pain in these regions.

I know that heels can be very pretty and make you look more feminine, but it is important to weigh the risks.  You might not notice the effects of frequent heel wearing now, but it will likely hit you later in life.  Try to save yourself some future pain. 

Resources:

http://www.sciencedirect.com/science/article/pii/S0169814101000385

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.306.3473&rep=rep1&type=pdf

http://www.logan.edu/mm/files/lrc/senior-research/2012-apr-18.pdf

https://www.nsbe.org/getmedia/bcd209d7-b07e-466f-b911-5da7fd2ffba2/Whats-New-NB1012-(NSBE-Web).pdf.aspx

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If you have been following the recent trends in sport injury treatment or are an athlete yourself, you may have heard reference to PRP.  The abbreviation stands for platelet-rich plasma.  So what exactly does PRP do and how is it effective for healing?

Plasma is a component of blood.  The plasma in blood contains proteins called growth factors that assist with healing. PRP is plasma with a higher concentration of platelets than what is naturally found in blood.  When someone is being prepped to receive PRP injections, that individual’s blood is drawn and platelets are separated from other blood cells in order to produce PRP.  The resulting substance is then injected in the area that requires healing in order to speed the healing process.

This description of the effects of PRP makes it seem like a “cure-all” for healing nearly any ailment of the body.  So what’s the catch?  PRP is still an experimental treatment; therefore, the procedure is typically not covered by insurance and instead conducted at a self-pay rate.  Also, not all of the effects are known.  Stimulating growth in a particular area with PRP may have the potential to trigger the growth of cancer cells, but the validity of this theory is untested and unknown.  Additionally, PRP has been shown to be ineffective for certain conditions.  The discrepancy in effective treatment may be due to the area of the body being effected, the age of the individual receiving the injections, the type of injury (ex. acute or chronic), and the protocol used by the doctor for performing the injections (ex. number of injections in a series).  PRP may even be inhibitory for certain conditions like bone healing due to the nature of bone healing being different from that of muscles and tendons.  A decrease in the healing effects may also occur if the body feels that it is being overstimulated by healing factors and, in turn, shuts off certain healing processes. 

Then what conditions are treated with PRP and where has it been effective?  PRP has been shown to be effective in the treatment of chronic tendon injuries, especially lateral epicondylitis (tennis elbow).  Its effectiveness on chronic Achilles tendonitis or patellar tendonitis has demonstrated some positive trends, but it is unclear if PRP is more effective than traditional treatments.  Despite the publicity and trend toward using PRP for sport related injuries, there is no definitive proof that these injections provide any change or enhancement in the healing process for acute (recent) injuries to muscles and ligaments.  However, the treatment continues to be utilized for acute sport injuries and the research continues.  PRP has been used to assist with healing in surgeries for rotator cuffs and knee ligament repairs, knee arthritis, and fractures; however, the evidence is either inconclusive or demonstrates little to no changes in the rate of tissue healing.  One Italian study even showed an inhibitory effect when used for treatment of a rotator cuff injury.

It is important to note that if someone chooses to receive PRP injections for his/her particular condition, the injection itself will not cause immediate relief of symptoms like one would expect from cortisone.  There will likely be pain at the injection site, the area should then be immobilized for approximately 7-10 days, ice and anti-inflammatories should be avoided, and return to sport (if that is the intention) should be slow.  As stated previously, PRP injections are still being researched.  As more studies are done, there will be more evidence to rely on in order to determine the effectiveness of this particular treatment.

Resources:

http://orthoinfo.aaos.org/topic.cfm?topic=A00648

Platelet Rich Plasma (PRP) – Lecture by Christopher T. Donaldson, MD at Saint Francis University

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The majority of people who undergo a total joint replacement will see a physical therapist for rehabilitation following the surgery.  Despite this fact, there are some surgeons who will not refer to outpatient physical therapy after certain total joint replacements like the hip.  Even with referral to outpatient physical therapy, if sufficient strength is not reached prior to discharge, then various complications can arise.

Despite the fact that not all surgeons refer patients for outpatient therapy after a total hip replacement, physical rehabilitation following this surgery is very important.  Recovery after a total hip replacement may not take as long as a total knee replacement, but that does not make rehab any less valuable.  Outpatient therapy is necessary to regain full strength, mobility, and function.  Home therapy, where a physical therapist comes to a patient’s home and provides treatment, is helpful for STARTING the process of improving function, range, and strength; but according to the study, “Interventions Used by Physical Therapists in Home Care for People After Hip Fracture”, the majority of home therapy does not address any resistance training or higher level exercises.  In other words, full strength is not gained following a standard bout of home therapy which is likely why individuals are not regaining their full function following a hip fracture or total hip replacement. 

If an individual attends outpatient physical therapy, strengthening and regaining normal function become the top priority.  The outpatient setting is ideally equipped with weights, bands, machines, etc. geared toward gaining function and strength which are typically not found in a standard home.

While individuals who undergo a total knee replacement are often referred to outpatient therapy, not regaining full strength during the course of treatment could leave an individual prone to further damage.  The damage to which I am referring will likely affect the non-operated knee.  If the right knee had a total knee replacement but full strength was not gained, then the left knee will have to do more work to compensate for the right knee’s remaining weakness.  With sufficient physical therapy that is geared toward addressing quadriceps muscle strength and overall knee and hip function, damage to the opposite knee can be avoided.  If a person has arthritis or pain in both knees and the right is replaced, sufficient strengthening of the right knee can prolong the function of the left knee and even prevent the need for a knee replacement on the left.

These points are important to understand in terms of your rehabilitation following a total joint replacement.  With the way healthcare works, you have to be an advocate for your own healing and recovery so don’t hesitate to talk to your doctor if you are concerned that you are not receiving the rehabilitation you need.

Resources:

http://www.jospt.org/doi/abs/10.2519/jospt.2005.35.7.424#.VRKvffnF9qU

http://onlinelibrary.wiley.com/doi/10.1016/S0736-0266(03)00052-4/abstract

https://clinicaltrials.gov/ct2/show/NCT00997776

http://ptjournal.apta.org/content/88/2/199.full.pdf+html

 

 

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Disclaimer:  The information in this medical library is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website.