High Ankle Sprains

High Ankle Sprains: What’s the difference?

Ankle sprains are common injuries. In fact, they are one of the most common injuries encountered in the United States. But what is the difference between a common ankle sprain and a high ankle sprain? And why do athletes with a high ankle sprain seem to be out for a longer period of time? The reason lies in the anatomy of the ankle and the different ligaments injured in a common vs. high ankle sprain.

The ankle is made of three bones in the lower leg: the tibia, the fibula, and the talus. These bones act together to form the ankle joint, which typically sustains loads three times a person’s body weight with normal daily activity. The soft tissues that surround the ankle allow for its stability and motion. The ligaments, in particular, stabilize the ankle.

Diabetic Foot Ulcers

Diabetic Foot Ulcers:  The Facts

During their lifetime, 15 percent of people with diabetes will experience a foot ulcer and between 14 and 24 percent of those with a foot ulcer will require amputation. Diabetes is the leading cause of lower extremity amputations in the United States occurring among people with diabetes. Each year, more than 82,000 amputations are performed among people with diabetes.

After an amputation, the chance of another amputation within 3 to 5 years is as high as 50 percent. The 5 year mortality rate after amputation ranges from 39 to 68 percent.

Prevention and Treatment of Diabetes Foot Problems

According to the National Diabetes Education Program (NDEP), a partnership among the National Institutes of Health, the Centers for Disease Control and Prevention and over 200 organizations, including the American Podiatric Medical Association, comprehensive foot care programs can reduce amputation rates by 45% to 85%. A comprehensive foot care program would include:

  • Early identification of the high risk diabetic foot

  • Early diagnosis of foot problems

  • Early intervention to prevent further deterioration that may lead to amputation

  • Patient education for proper care of the foot and footwear

If you are  diabetic, call Annapolis Foot and Ankle Center for a diabetic foot exam.  Amputations CAN be avoided with proper preventative care.

Morton's Neuroma

Morton's Neuroma

If you sometimes feel that you are "walking on a marble," and you have persistent pain in the ball of your foot, you may have a condition called Morton's neuroma. A neuroma is a benign tumor of a nerve. Morton's neuroma is not actually a tumor, but a thickening of the tissue that surrounds the digital nerve leading to the toes.


Morton's neuroma occurs as the nerve passes under the ligament connecting the toe bones (metatarsals) in the forefoot.

Morton's neuroma most frequently develops between the third and fourth toes, usually in response to irritation, trauma or excessive pressure.

The incidence of Morton's neuroma is 8 to 10 times greater in women than in men.


  • Normally, there are no outward signs, such as a lump, because this is not really a tumor.

  • Burning pain in the ball of the foot that may radiate into the toes. The pain generally intensifies with activity or wearing shoes. Night pain is rare.

  • There may also be numbness in the toes, or an unpleasant feeling in the toes.

Runners may feel pain as they push off from the starting block. High-heeled shoes, which put the foot in a similar position to the push-off, can also aggravate the condition. Tight, narrow shoes also aggravate this condition by compressing the toe bones and pinching the nerve.


During the examination, your physician will feel for a palpable mass or a "click" between the bones. He or she will put pressure on the spaces between the toe bones to try to replicate the pain and look for calluses or evidence of stress fractures in the bones that might be the cause of the pain. Range of motion tests will rule out arthritis or joint inflammations. X-rays may be required to rule out a stress fracture or arthritis of the joints that join the toes to the foot.


Initial therapies are nonsurgical and relatively simple. They can involve one or more of the following treatments:

  • Changes in footwear. Avoid high heels or tight shoes, and wear wider shoes with lower heels and a soft sole. This enables the bones to spread out and may reduce pressure on the nerve, giving it time to heal.

  • Orthoses. Custom shoe inserts and pads also help relieve irritation by lifting and separating the bones, reducing the pressure on the nerve.

  • Injection. One or more injections of a corticosteroid medication can reduce the swelling and inflammation of the nerve, bringing some relief.

Several studies have shown that a combination of roomier, more comfortable shoes, nonsteroidal anti-inflammatory medication, custom foot orthoses and cortisone injections provide relief in over 80 percent of people with Morton's Neuroma. If conservative treatment does not relieve your symptoms, your podiatrist may discuss surgical treatment options with you. Surgery can resect a small portion of the nerve or release the tissue around the nerve, and generally involves a short recovery period.

Balance Braces

Are you at risk for a fall?

• Over 14 million American adults aged 65 and older experience a fall each year
• Every 15 seconds, an older adult is seen in an emergency room for a fall-related injury
• In 2010, such falls resulted in direct costs to the US healthcare system of over $30 billion dollars
• More than 20,000 of those falls resulted in death

Establishing and maintaining proper balance is one of the keys to reducing the risk of falls. In fact, good balance can often counteract the effects of other risk factors such as diminished muscle strength, dizziness and environmental obstacles among others. Patients who are prescribed and rigorously follow a comprehensive balance training & exercise program will realize an outstanding degree of falls risk reduction.

The Moore Balance Brace is extremely effective in improving balance, when worn, and reducing the risk of falls. It is soft and easily fits into most shoes.

If you are experiencing balance problems or perhaps have had multiple falls, visit one of our physicians to be evaluated for a Balance Brace.

Platelet Rich Plasma

What Is Platelet-rich Plasma (PRP)?

Although blood is mainly a liquid (called plasma), it also contains small solid components (red

cells, white cells, and platelets.) The platelets are best known for their importance in clotting

blood. However, platelets also contain hundreds of proteins called growth factors which are very

important in the healing of injuries.

PRP is plasma with many more platelets than what is typically found in blood. The

concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10

times greater (or richer) than usual.

To develop a PRP preparation, blood must first be drawn from a patient. The platelets are

separated from other blood cells and their concentration is increased during a process called

centrifugation. Then the increased concentration of platelets is combined with the remaining


How Does PRP Work?

Although it is not exactly clear how PRP works, laboratory studies have shown that the increased

concentration of growth factors in PRP can potentially speed up the healing process.  To speed

healing, the injury site is treated with the PRP preparation.

PRP can be carefully injected into the injured area. For example, in Achilles tendonitis, a

condition commonly seen in runners and tennis players, the heel cord can become swollen,

inflamed, and painful. A mixture of PRP and local anesthetic can be injected directly into this

inflamed tissue. Afterwards, the pain at the area of injection may actually increase for the first

week or two, and it may be several weeks before the patient feels a beneficial effect.

What Conditions are Treated with PRP? Is It Effective?

According to the research studies currently reported, PRP is most effective in the treatment of

chronic tendon injuries - such as chronic Achilles tendonitis is promising. Much of the publicity

PRP therapy has received has been about the treatment of acute sports injuries, such as

ligament and muscle injuries. PRP has been used to treat professional athletes with common

sports injuries.

In our practice we commonly use PRP in the treatment of:

  • Plantar fasciitis

  • Achilles tendonitis

  • Tendon injuries

  •  Arthritis

  •  Ankle ligament injuries

The risks associated with PRP are minimal: There may be increased pain at the injection site,

but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be

no different from that associated with cortisone injections.

Subchondroplasty Procedure

Subchondroplasty® Procedure

The SCP® Procedure is a minimally-invasive surgery that targets and fills subchondral bone defects, often referred to as Bone Marrow Lesions (BML). These often-painful defects are in the spongy cancellous bone that underlies the cortical bone. The procedure is usually performed along with arthroscopy ("scoping") of the nearby joint, allowing your surgeon to visualize and treat findings inside the joint.

How Do I Know If the SCP® Procedure Is Right for Me?

You may have a defect in the bone adjacent to your joint called a chronic Bone Marrow Lesion (BML). Many surgeons believe that chronic BML will not heal without intervention.  BML can only be seen on MRI. Only your doctor can tell you if you have this condition.

Surgical Procedure Overview

During the procedure, your surgeon will use fluoroscopy (intraoperative X-ray) to place a small, drillable cannula in the area of the bone defect. Your surgeon will then deliver AccuFill® Bone Substitute Material (BSM), which is an engineered calcium phosphate mineral compound, into the defect, where it hardens with properties that mimic cancellous bone. During the healing process, the AccuFill® BSM is resorbed and is replaced with new bone.

What is AccuFill BSM?

AccuFill BSM is an engineered calcium phosphate mineral compound. It flows readily to fill the subchondral defect and hardens quickly into a biomimetic implant once injected. AccuFill BSM mimics the properties of cancellous bone and is replaced with new bone during the healing process.

Ankle Equinus

Normal range of motion in the ankle is measured in the supine position (on your back) with knees extended. Force is applied to the forefoot, aimed at moving the toes and forefoot toward the knee. This motion at the ankle is called dorsiflexion. To measure the amount of dorsiflexion an imaginary line is drawn down the lateral or outer side of the leg and foot. Range of motion is considered normal when the patient is able to reach a 90 degree angle plus an additional 10 degrees. Any measurement shy of 90 degrees is considered to be equinus. Remember, anMeasuring equinus accurate measurement of equinus requires the correct positioning of several joints and some degree of biomechanics training.

Nail Fungus 101

Conditions that can be mistaken of Nail fungus
1. Lines and ridges:They may worsen during pregnancy. A large groove down the center of the nail can be caused by nail biting.
2. Senile nails: As you age, the nails become brittle, develop ridges and separation of the nail layers at the end of the nail. Try to avoid cleaning solutions, and don't soak the nails in water.
3. Whitish or yellowish nails due to onycholysis. This means separation of the nail from the nail bed. The color you see is air beneath the nail.