SHORTENED VIDEO VERSION OF THIS ARTICLE


ankle sprain

--> ankle sprain

LATERAL ANKLE SPRAIN



A sprained ankle is one of the most common injuries to present to an Emergency Room. Although an injury of this nature may occur on either the inside or outside of the ankle, the lateral ankle sprain (outside) is far more common. This type of injury can be a very troubling problem and if not properly treated may result in chronic pain.

This article will discuss treatment for simple sprains as well as more complex ankle injuries. Some of you who will be reading this are apparently having issues with this type of injury that has not gotten better. Hopefully you will learn the process that is involved in the treatment of more severe sprains to the ankle.

The vast majority of people who sustain this type of injury do not seek medical attention and those that do, in many instances are under treated. Once a patient is seen in the Emergency Room they are generally discharged and told to see a podiatrist or orthopedist for follow-up care; many people do not bother. If there is not proper follow-up this increases the chances of problems going forward. If initial treatment is not aggressive enough this can lead to an instability in the ankle joint and in some cases may require surgical intervention down the road.

The ankle joint is known as a hinged synovial joint meaning the motion of the ankle is limited to an up-down motion also known as dorsiflexion and plantarflexion. Any movement of the foot to the inside (inversion) or the outside (eversion) comes primarily from the subtalar joint which is just below the ankle joint.

The most common form of injury is known as a lateral ankle sprain or inversion sprain. This is where the foot bends inward below the ankle joint. This causes a severe stretching on the outside of the ankle and conversely a jamming effect on the inside of the ankle. An ankle sprain is considered by many doctors to be a partial dislocation of the ankle joint.

SEVERITY OF ANKLE SPRAINS



Ankle sprains are "graded" according to severity.

  • Grade 1 is a minor strain with no tearing of ligaments.
  • Grade 2 is a partial tear of the lateral ankle ligaments.
  • Grade 3 is a full tear of one of the ligaments and possibly even a tear of what is known as the peroneal muscles that run directly underneath the outside of the ankle. Interestingly enough, sometimes a total tear of the lateral ankle ligaments can be less painful than a partial tear and this keeps the patient from seeking medical attention.
lateral ankle ligaments

There are three ligaments that make up the lateral ankle ligaments. (ATFL) Anterior talo-fibular ligament. (CFL) Calcaneal fibular ligament. (PTFL) Posterior talo-fibular ligament. A partial tear of two of the ligaments may end up more problematic than just a complete tear of one ligament.

Most, if not all lateral ankle sprains initially may not be too painful, but as the day progresses, so does the pain and swelling. In addition to pain and swelling there may be eccymosis (black and blue) in the surrounding area. This just represents broken blood vessels and is not an indicator of the severity of the injury. When we as foot specialists examine someone who has sustained an inversion sprain, we examine both the outside and inside of the ankle, the alignment of the foot relative to the ankle, as well as the tendons that surround the ankle.

A fairly common occurrence with severe inversion ankle sprains is possible fracture of the fifth metatarsal base. During the injury, when the foot bends inward, it puts a lot of pressure on the outside of the foot and in many instances can actually fracture part of the fifth metatarsal bone. Many non-footspecialists will not look for this potential problem and a fracture of the fifth metatarsal bone may go undiagnosed.

Additionally, the motion available in the ankle has to be tested as well as the fibula bone along its course. The fibula bone is the long bone on the outside of the leg that forms the outside of the ankle joint. The longer the patient has waited to seek medical attention, the more painful and swollen the ankle will be, making it more difficult for the doctor to adequately examine all parts of the foot, ankle and lower leg that may be involved.

DIAGNOSING ANKLE SPRAINS



Once presenting to the doctor or an Emergency Room, x-rays will be taken. X-rays cannot visualize ligaments or tendons for possible damage, but they are taken to rule out fracture, either to the ankle itself, the fifth metatarsal bone or to the lower leg. It is important to note, that very small "cracks" in bone may not show up initially on x-ray, but if the patient does not respond in the appropriate period of time for an ankle sprain, additional x-rays or even an MRI may have to be considered to look for small fractures. X-rays on the initial exam are also helpful in recognizing abnormal joint alignment as a result of the sustained trauma. If there is a mal-alignment of the ankle joint with no fracture, casting may be required to re-align the ankle joint, otherwise, the patient may have chronic pain in the ankle. Sometimes surgery is also necessary if the ankle cannot be re-aligned through manual means.

normal ankle mortise xray
abnormal ankle mortise xray

The last thing we are looking for with radiographs is an osteochondral defect. What happens here is a piece of bone is chipped off the talus bone, which is the bone in the foot that is basically the bottom portion of the ankle joint. If one is found, in most cases it must be removed surgically. If left alone it can act as an irritant in the joint and thus a source of ongoing pain.

In the majority of cases initial x-rays will be negative for any bone pathology. Due to the expense involved, an MRI is usually not performed on initial treatment (unless a fracture is suspected and not seen on x-ray). Some institutions may consider doing a diagnostic ultrasound to check the integrity of the ligaments and tendons surrounding the ankle. This is an inexpensive and quick test.

ANKLE SPRAIN TREATMENT



The treatment protocol for ankle sprains has changed dramatically over the last decade. Years ago the treatment of choice was rigid immobilization. This meant putting on a cast with the foot in proper alignment to the leg in order to allow the ankle to heal over time. Experience has shown that over immobilization, particularly in Grade 1 and Grade 2 sprains may lead to scar formation in the healing ligaments and tendons and can leave the patient with chronic pain. The only time a cast becomes mandatory is if there is an associated fracture with the ligament damage, or quite simply, the patient cannot bear weight on the foot. The use of crutches and remaining non-weightbearing on the foot would also be introduced at this time.

The alternative to a rigid cast would then be a soft supportive cast to help keep the swelling down, which will reduce pain, and to bear weight as tolerated. Within a few days, the soft cast may be replaced with an Aircast or other more mobile type brace which will allow the patient to start range of motion exercises in the ankle joint (as tolerated) in an effort to reduce scarring and maintaining motion in the ankle joint.

In Grade 2 and Grade 3 sprains after about one week, the patient may want to start on a regimen of physical therapy. The purpose of which is to help facilitate the healing process, reduce edema, pain and increase motion in the joint, thus getting the patient healed quicker.

Grade 1 ankle sprains are treated a little bit different. Most of you are familiar with R.I.C.E. (Rest, Ice, Compression, Elevation). This along with anti-inflammatory medication (assuming you can tolerate them) is all that is necessary. Within a few days the ankle should feel better and each day should bring further improvement.

In an otherwise healthy individual Grade 1 ankle sprains take about one month to resolve themselves. A Grade 2 sprain in most cases will take upwards of two months and sometimes slightly longer while a Grade 3 sprain may take upwards of six months to fully resolve. This is not to say that you will not be walking, but more than likely you will need to ambulate with some form of ankle support, women in particular, will not be able to wear certain types of shoes and both men and women will have to refrain from certain athletic activities.

ICE OR HEAT FOR LATERAL ANKLE SPRAIN?



There is the ongoing debate of whether ice or heat is better for injuries such as a sprained ankle. Various doctors have different opinions. My feeling is that ice is necessary for the first 24 hours, simply to reduce swelling which will reduce pain. Cold clamps down blood vessels and reduces the amount of blood flow to an area and in this instance will then reduce swelling. The problem is that blood flow to an area is the way the body heals all types of injuries. It does so by bringing nutrients to the traumatized area. After 24 hours, when the swelling (and pain) have stabilized, it is time to discontinue ice and switch over to heat. Generally moist heat works better than heat from a device like a heating pad. By applying heat to the area, the blood vessels in the area dilate (open up) and more blood is able to flow into the area and begin the healing process.

ANKLE SPRAINS THAT DO NOT GET BETTER



In general, if you reach a point where you are not seeing further improvement each week and you are still having difficulty walking then it is time for further investigation. The guidelines given above are not carved in stone. If progress is not being made each and every week, particularly if you are having physical therapy, then a re-evaluation is necessary.

At this point an MRI would be indicated as this test will show damage to soft tissue meaning ligament, tendon and muscle. An MRI may also show a fracture that was not visible on x-ray. An osteochondral lesion (defect in bone from trauma) may also be visible. It is important to correlate any abnormal findings to the area where the patient is experiencing pain, as an MRI may show old injuries which are not part of the present problem.

SURGICAL TREATMENT OF ANKLE SPRAINS



In cases where the ATFL (anterior talo-fibular ligament) and the CFL (calcaneal fibular ligament) are both torn, this may require surgical intervention to repair the ligaments as a tear in two ligaments may be creating an instability in the ankle joint and thus continued pain. (See diagram) The third lateral ankle ligament is the PTFL (posterior talo-fibular ligament). A tear of just the ATFL generally does not have to be repaired as one tear in most cases will not cause ankle instability. The most common procedure done for lateral ankle tears is the Brostrom procedure which is a primary repair of the torn ligaments using suture anchored into the fibula bone. This will be followed by casting for as long as six weeks, but some authorities are now suggesting casting for as little as three weeks and then physical therapy, again, in an effort to create better motion in the joint. It should be pointed out, that by nature of the procedure, there will be some limitation of motion following this procedure. This occurs because the post-surgical ligaments are tighter than the pre-trauma ligaments.

Other surgical procedures done may require repair of the peroneal tendon on the outside of the ankle and if it determined that there indeed is an osteochondral defect, then that piece of bone may have to removed as well, usually via ankle arthroscopy.

MEDIAL ANKLE SPRAINS



Medial ankle sprains as the name implies, are sprains on the inside of the ankle. This is a far less frequent injury then lateral ankle sprains because the mechanism of injury is far less common. This type of injury will occur primarily in athletea because they find themselves in awkward foot positions when doing their sport, along with being off balance many times. This type of injury is usually due to an eversion type of injury where the foot bends outward from the ankle (the exact opposite of an inversion sprain). Examples that might cause eversion sprains include a gymnast who continually misses a "landing" and the foot bends outward, or perhaps a soccer player who is running up and down a field that is all "beat up" causing the foot to over stretch and rotate outwards.

In addition to eversion injuries being less common than inversion injuries the ligament on the inside of ankle, known as the deltoid ligament is a much stronger ligament than the lateral ankle ligaments. Actually, there is a superficial and deep deltoid ligament and therefore is stronger than any of the lateral ankle ligaments singularly.

deltoid ligament
Injuries to this ligament are more the result of external rotation of the foot relative to the ankle (the foot twists outward, while the leg remains stationary). This can occur as previously stated when the foot does evert (bends outward).

When making a diagnosis of medial ankle sprain the mechanism of injury is important to know. This will alert your doctor to look at the inside of the ankle, as well as the outside. Unfortunately in most sporting events the injury is a result of a collision and all the athlete remembers is ending up on the ground.

The treatment for a medial ankle sprain is basically the same as already discussed for lateral ankle sprains. Initially x-rays will be taken to rule out fracture and to view the ankle morTise (the alignment of the ankle itself). Examination of the posterior tibial tendon is necessary as they pass just inferior to the inside of the ankle joint. These tendons have a greater propensity to "stretch" than to tear. Immobilization with an early return to weight bearing as tolerated by the patient is the standard course of therapy and once again should the patient not heal in an acceptable period of time further studies such as an MRI may be needed.

One difference in medial ankle sprains versus lateral ankle sprains is the use of orthotics. Orthotics nave the tendency to invert the foot and in doing so will reduce the strain on the deltoid ligament. This should make walking more comfortable and the healing process quicker. On the outside of the ankle an orthotic will cause a stretching of the soft tissue structures and this of course can exacerbate the problem of lateral ankle sprains.

RESUMING ATHLETIC ACTIVITY



The question always asked by athletes is when can they return to their activity. This is not an easy question to answer. Due to the complexity of ankle sprains as previously described, there is no cookie-cutter rule. The biggest concern is returning to athletic activity too soon and re-injuring the ankle, possibly worse than the original injury. Depending on age, weight and overall health, many people will experience chronic tenderness in an ankle that is clinically healed, particularly those individuals who have sustained repeated ankle sprains.



In my practice, when I feel a patient is clinically healed I first have them put the ankle to the "test" to make sure it will hold up to the rigors of their sport. I have them do some light running and other mobility exercises. Their response will allow me to give them advice going forward. Some will return to their normal activities in no time, while others will be forced to reduce their athletic activity and even have to use some sort of mobility brace just to stabilize the ankle with the expectation that over time the ankle will further improve.

Want more information? CLICK HERE








download from Apple Store
Get it on Google Play




Amazon foot store


Orthotics for multiple types of foot pain
best buy in a pre-made orthotic
click link below


SuperStepOrthotics


Orthotics for heel and arch pain for those who must wear dress shoes
click link below


redithotics


Childrens orthotics for children who outgrow orthotics quickly
click link below


childrens_orthotics


Topical pain reliever
click link below


blu-mjk


Relief for nail fungus
click link below


clotrimazoil







I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis.

Jennifer

Hunterville, NC
….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!

Liesbeth

NY
I am really, really impressed with your plain-speak explanations for the various conditions.

Jacqueline

NJ
This was an extremely helpful site. I have an appointment on the 18th and your info. Was right on target…..

Jack

Fla
A well organized site containing much information written in a manner that the average reader can comprehend.

Jean

Ontario, Canada
I found your website and articles most interesting.

Andrew

Fla.
Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.

Judy

(location unknown)
I came to your website, footspecialist.net via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.

L.W.

New York
You have an amazing and extremely informative site. I enjoyed looking through all of the data and stats.

Yvette

Memphis, TN
Thanks again so much for the information in the article. Very interesting.

Anna

Scotland
Great article. I have had plantar fasciitis since I was in high school……..

J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Tennessee
Thanks for the Response, you hit it on the head.

Steve

Redondo Beach, CA
Thank you for your time and expertise in answering my question…..

LH

(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….

Joe

(location unknown)
First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.

Pete M.

(location unknown)
Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....

Carol

Denison, TX
Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,

Dawn

West lafayette, IN
Dear sir...no doubt you get positive comments re your site...May I please be added to the list of your admirers. In all of my years of web surfing I would say your site is right there with the very best. Thank you for taking the time to write the terrific info you provide and for putting things into laymen terms for us mere mortals. I pray you have much on going success and thank you again for a deed well done. As for me I did not find much help for my symptoms and will continue on my quest. Were you anywhere in the South I would make and appointment...Thanks again dear sir...m.e.

Michael E.

Tampa, Florida 33624
Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....

Kelly

Texas
Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624


Thanks for a most interesting website, which has helped a lot.

Steve

UK


Dear Dr.Mitnick

I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.

I thank you for putting together this incredible website.

Regards,

Dragica W.

Edmonton,Canada


....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!

Roxy

South Africa


You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT


First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.

Steve

Placentia, California


First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)

Unknown

Unknown location


I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location


I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA


I used to work for a podiatrist (front desk) back during summers in college years ago, so I know the benefits of good care. Again, I want to thank you for an EXCELLENT website. It was so great to get to your site (top of google search) and actually find all the answers I needed EASILY and QUICKLY! Clearly you put a ton of work into it and I really appreciate it.

All the best,

Victoria

Alameda, California


By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!

Anonymous


Thank you for your very interesting and informative site!

Anonymous




Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN


Thanks very much for the wonderful informative site.

Catherine

New Zealand


Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!

Sincerely

Josette


Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

Arizona
I searched the internet everywhere for a clear description and illustration of my symptoms/problem. http://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

Florida
1st of all THANKS A LOT for your great site......

Anna

Poland
Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!

M P

South Carolina
Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....

Natalie

unknown location


...Thanks for your fantastic service.

Gary

Arlington, VA


Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA


Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!

Pam

location unknown


Great insights! Thanks Doc, you're the best.

Glen

location unknown


I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.

Bre

location unknown


Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous




Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous




Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.

Anna

Poland




Thanks for taking time to read and answer so many questions. It is truly a public service!

Esh

Seattle, WA


I just wanted to say that I am very greatful for this website!!

Bonnie

location unknown




Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.

Bill

New Jersey




Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

Debbie

location unknown




Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.

Chrissy

location unknown




Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!

Tracy

Evansville, IA




Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

location unknown




Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.

-Sunny.

location unknown




Thank you very much for the information, I will consider it. Excellent web site.

Jackie

San Diego, CA




Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY




Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown




THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS




thanks again, this site is very helpful.

mark

Boston, MA




Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.

Michelle

Colorado




Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.

annielou

Colorado


Wonderful advice

by: Anonymous

This is the best site for foot problem info.


Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

Canada
I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......

Bonnie

location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!

Nancie

Wisconsin
Thank you for your response. You have provided some great insight (to my question)....

Julie

location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!

Renae

North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown


Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida
Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey


Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown


I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC


Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA


I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown