Gymnast Foot Problems: Could It Be Your Back?
POSTED ON 11/18/2015 IN Research BY Christopher Centeno
At Regenexx, our focus is always treating the whole athlete. One of the unfortunate things that happens in our modern world of orthopedic hyper-specialists is that injured athletes are broken down into their parts that hurt. The knee guy sees someone with knee pain, the foot and ankle specialist sees someone with foot pain, and the spine surgeon evaluates someone with back pain. Sometimes it's a bit like that old adage of the blindfolded men examining various parts of the elephant. Such was the case with Sarah, a 12 year old with gymnast foot problems who had specialists focus on her toe and heel pain as if that was happening in isolation; it wasn't. Thankfully, Dr. Schultz recognized that there were other causes that could be treated that explained why her feet were such a chronic recurring issue.
It's amazing how many times we've seen patients with hip, knee, ankle, and foot pain who have had surgeries on these parts when the real cause was an irritated nerve in their low back. I would venture to guess that hundreds of millions are wasted each year on unnecessary surgeries on the wrong body part based on pain in that area and without anyone ever asking the question of whether that pain might be caused by the spine. How can a pinched nerve in the back convince both doctor and patient that the problem is really in the foot? Having had a neck issue causing severe shoulder pain, I can tell you that I would have bet a large sum that I had a shoulder problem. Why? The nerves that go from the neck to the shoulder or the back to the foot, when compressed, don't generally cause neck or back pain, they cause pain in the area that they serve in the extremities. You're body is completely and utterly unable to tell the difference. So if I could reach into your spine and pinch one of these nerves in the right way, you would be convinced that some part of your shoulder, arm, hand, hip, thigh, knee, leg, ankle, or foot was seriously injured!
Dr. Schultz first evaluated Sarah last month, who was a gymnast who had two injuries in 2014 - a stress fracture of the left heel and an injury to the big toe joint. Both were immobilized with casts. When Dr. Schultz saw her, she had a 3 month history of pain in the other toe joint which her doctors also tried to immobilize, but that didn't work as well. She also had a 6 month history of low back pain.
Dr. Schultz's exam was more extensive than the cursory variety she had received in the surgeon's office. He quickly realized that the L5 nerve in her back was a contributing factor to her toe pain as when this nerve is irritated it's felt by the patient in the big toe. In addition, she also had laxity in the ligament that holds the toe joint stable, another issue completely missed by the sports surgeon. This loose ligament will allow the joint to move excessively, causing more wear and tear injuries to that structure, which over the long haul can lead to arthritis. Her ankle was also unstable, another overlooked significant issue for a gymnast. Finally, the joints in her back were also injured. Dr. Schultz injected the patient's own super concentrated blood platelets into her toe joint and ligaments and injected the growth factors isolated from those platelets (platelet lysate) into the low back facet joints and around that irritated L5 nerve. This is an e-mail he just received from her father:
From: Eberts, Kirt A
Sent: Monday, November 16, 2015 4:29 PM
To: John Schultz
Subject: Status Update - Sarah Eberts
Hi Dr. Schultz, I wanted to write you about the good progress my 12-year old daughter has made since you treated her left back facets and MTP1 joint on her left foot on 10/28. She took one week off of all gymnastic activity, mostly because it hurt to walk after the foot injections (crutches were a life saver going through the airport). When she resumed she went slowly and this past Sunday she was able to do a “mock” competition in all the events – with no pain whatsoever! So after only about 2.5 weeks post treatment she is able to perform all her gymnastics activities. Previously, as you know, we struggled for months. This puts her in great shape to get ready for competition in January. I wanted to thank you again for bending over backwards to get her in so quickly. You and your staff are amazingly talented.
So not only was Dr. Schultz able to help diagnose what was really wrong by looking at the whole athlete and spending more than 2 minutes performing an exam, he was also able to use precise injections of this gymnast's platelets to help her mend herself. So after months spent in boots, casts, and in rehab to no avail, we were able to provide a quick way to get this particular athlete back into the sport she loves! In addition, we believe it was no accident that she kept injuring her toe and heel, because an irritated nerve in the back will cause the muscles in the leg to fire in weird ways, removing their natural ability to protect the foot and ankle.
The upshot? All too often our modern surgery specialization system and the ever shrinking amount of time devoted to each patient results in problems being missed. We have set our practice up in a way that allows the doctor to spend a solid hour of face to face time and we look at all aspects of what might be going wrong in the body of an athlete, not just the bright shiny object of the area that hurts!
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