Heel Pain

Pain in the heel can be caused by a number of conditions.

Causes of heel pain

Pain within the heel:

- osteomyelitis (infection of bone)
- tumours
- Paget's disease
- arthritis of the subtalar joint

Pain behind the heel:

- ruptured Achilles tendon
- Achilles tendinitis

Pain under the heel:

- tender heel pad
- plantar fasciitis
- plantar calcaneal bursitis

Treatment of heel pain

Treatment will depend on the cause of the heel pain.

For more details please contact:

Dr. Prateek Gupta (Senior Surgeon)

Arthroscopy Surgery Clinic

C2/5 Safdarjung Development Area (SDA),

Aurobindo Marg, New Delhi - 110016

INDIA

Telephones: +91 9810852876, +91 11 26517776

24 x 7 Helpline & Appointment: +91 9810633876

Email: sportsmedicinedelhi@yahoo.com,

sportsmedicineclinics@gmail.com

Website:http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,

http://www.sportsmedicineclinicdelhi.com,

http://www.arthroscopysurgeryindia.com

Lichen Sclerosus

What Is Lichen Sclerosus?

Lichen sclerosus is a chronic inflammatory skin disorder that can affect men, women, or children, but is most common in women. It usually affects the vulva (the outer genitalia or sex organ) and the anal area. While lichen sclerosus appears predominantly in postmenopausal women, this skin condition is also known to develop on the head of the penis in men. Occasionally, lichen sclerosus is seen on other parts of the body, especially the upper body, breasts, and upper arms.

The symptoms are the same in children and adults. Early in the disease, small, subtle white spots appear. These areas are usually slightly shiny and smooth. As time goes on, the spots develop into bigger patches, and the skin surface becomes thinned and crinkled. As a result, the skin tears easily, and bright red or purple discoloration from bleeding inside the skin is common. More severe cases of lichen sclerosus produce scarring that may cause the inner lips of the vulva to shrink and disappear, the clitoris to become covered with scar tissue, and the opening of the vagina to narrow.

Lichen sclerosus of the penis occurs almost exclusively in uncircumcised men (those who have not had the foreskin removed). Affected foreskin can scar, tighten, and shrink over the head of the penis. Skin on other areas of the body affected by lichen sclerosus usually does not develop scarring.

How Common Is It?

Although definitive data are not available, lichen sclerosus is considered a rare disorder that can develop in people of all ages. It usually appears in postmenopausal women and primarily affects the vulva. It is uncommon for women who have vulvar lichen sclerosus to have the disease on other skin surfaces. The disease is much less common in childhood. In boys, it is a major cause of tightening of the foreskin, which requires circumcision. Otherwise, it is very uncommon in men.

What Are the Symptoms?

Symptoms vary depending on the area affected. Patients experience different degrees of discomfort. When lichen sclerosus occurs on parts of the body other than the genital area, most often there are no symptoms, other than itching. If the disease is severe, bleeding, tearing, and blistering caused by rubbing or bumping the skin can cause pain.

Very mild lichen sclerosus of the genital area often causes no symptoms at all. If the disease worsens, itching is the most common symptom. Rarely, lichen sclerosus of the vulva may cause extreme itching that interferes with sleep and daily activities. Rubbing or scratching to relieve the itching can create painful sores and bruising, so that many women must avoid sexual intercourse, tight clothing, tampons, riding bicycles, and other common activities that involve pressure or friction. Urination can be accompanied by burning or pain, and bleeding can occur, especially during intercourse. When lichen sclerosus develops around the anus, the discomfort can lead to constipation that is difficult to relieve. This is particularly common in children. It is important to note that the signs of lichen sclerosus in children may sometimes be confused with those of sexual abuse.

Most men with genital lichen sclerosus have not been circumcised. They sometimes experience difficulty pulling back the foreskin and have decreased sensation at the tip of the penis. Occasionally, erections are painful, and the urethra (the tube through which urine flows) can become narrow or obstructed.

What Causes Lichen Sclerosus?

The cause is unknown, although an overactive immune system may play a role. Some people may have a genetic tendency toward the disease, and studies suggest that abnormal hormone levels may also play a role. Lichen sclerosus has also been shown to appear at sites of previous injury or trauma where the skin has already experienced scarring or damage.

Is It Contagious?

No, lichen sclerosus is not contagious.

How Is It Diagnosed?

Doctors can diagnose an advanced case by looking at the skin. However, early or mild disease often requires a biopsy (removal and examination of a small sample of affected skin). Because other diseases of the genitalia can look like lichen sclerosus, a biopsy is advised whenever the appearance of the skin is not typical of lichen sclerosus.

How Is It Treated?

Patients with lichen sclerosus of nongenital skin often do not need treatment because the symptoms are very mild and usually go away over time. The amount of time involved varies from patient to patient.

However, lichen sclerosus of the genital skin should be treated, even when it is not causing itching or pain, because it can lead to scarring that may narrow openings in the genital area and interfere with either urination or sexual intercourse or both. There is also a very small chance that skin cancer may develop within the affected areas.

In uncircumcised men, circumcision is the most widely used therapy for lichen sclerosus. This procedure removes the affected skin, and the disease usually does not recur.

Prescription medications are required to treat vulvar lichen sclerosus, nongenital lichen sclerosus that is causing symptoms, and lichen sclerosus of the penis that is not cured by circumcision. The treatment of choice is an ultrapotent topical corticosteroid (a very strong cortisone cream or ointment). These creams or ointments may be applied daily for several weeks, which will be sufficient to stop the itching. However, long-term but less frequent applications (sometimes as infrequently as twice a week) will be needed to keep the lesions from reactivating and to help restore the skin's normal texture and strength. Treatment does not reverse the scarring that may have already occurred.

Because prolonged use of ultrapotent corticosteroid creams and ointments can cause thinning and redness of the skin, give rise to "stretch marks" around the area of application, and predispose individuals to vulvar yeast infections, periodic followup by a doctor is necessary.

Young girls may not require lifelong treatment, since lichen sclerosus can sometimes, but not always, disappear permanently at puberty. Scarring and changes in skin colour, however, may remain even after the symptoms have disappeared.

Ultrapotent topical corticosteroids are so effective that other therapies are rarely prescribed. The previous standard therapy was testosterone cream or ointment, but this has been proven to produce no more benefit than a placebo (inactive) cream. Prolonged use of the testosterone cream or ointment can cause masculinization (low-pitched voice, increased coarse facial hairs). Another hormone cream, progesterone, was previously used to treat the disease, but has also been shown to be ineffective. Retinoids, or vitamin A-like medications, may be helpful for patients who cannot tolerate or are not helped by ultrapotent topical corticosteroids.

Tacrolimus ointment has been reported to benefit some patients, but more research is needed to confirm this. Tacrolimus is a steroid-free ointment; it is not a corticosteroid. Tacrolimus has no apparent side effects other than local irritation in some patients.

There are some early indications that different forms of ultraviolet light treatments, with or without psoralens (pills that intensify the effect of ultraviolet A light), may be effective and well-tolerated treatments for some patients with lichen sclerosus on nongenital skin.

Patients who need medication should ask their doctor how the medication works, what its side effects might be, and why it is the best treatment for their lichen sclerosus.

For women and girls, surgery to remove the affected skin is not an acceptable option because lichen sclerosus comes back after removal. Surgery may be useful for scarring, but only after lichen sclerosus is controlled with medication.

Sometimes, people do not respond to the ultrapotent topical corticosteroid. Other factors, such as low oestrogen levels, an infection, irritation, or allergy to the medication, can keep symptoms from clearing up. Your doctor may need to treat these as well. If you feel that you are not improving as you would expect, talk to your doctor.

Can People With Lichen Sclerosus Have Sexual Intercourse?

Women with severe lichen sclerosus may not be able to have sexual intercourse because of pain or scarring that narrows the entrance to the vagina. However, proper treatment with an ultrapotent topical corticosteroid can help restore normal sexual functioning, unless severe scarring has already narrowed the vaginal opening. In this case, surgery may be needed to correct the problem, but only after the disease has been controlled.

Is Lichen Sclerosus Related to Cancer?

Lichen sclerosus does not cause skin cancer. However, skin that is scarred by lichen sclerosus is more likely to develop skin cancer. The frequency of skin cancer in men with lichen sclerosus is not known. It is important for people who have the disease to receive proper treatment and to see the doctor every 6 to 12 months, so that the doctor can monitor and treat any changes that might signal skin cancer.

For more details please contact:

Dr. Prateek Gupta (Senior Surgeon)

Arthroscopy Surgery Clinic

C2/5 Safdarjung Development Area (SDA),

Aurobindo Marg, New Delhi - 110016

INDIA

Telephones: +91 9810852876, +91 11 26517776

24 x 7 Helpline & Appointment: +91 9810633876

Email: sportsmedicinedelhi@yahoo.com,

sportsmedicineclinics@gmail.com

Website:http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,

http://www.sportsmedicineclinicdelhi.com,

http://www.arthroscopysurgeryindia.com

Lupus

What Is Lupus?

The immune system is designed to attack foreign substances in the body. If you have lupus, something goes wrong with your immune system and it attacks healthy cells and tissues. This can damage many parts of the body such as the:

• Joints
• Skin
• Kidneys
• Heart
• Lungs
• Blood vessels
• Brain.

There are many kinds of lupus. The most common type, systemic lupus erythematosus, affects many parts of the body. Other types of lupus are:

• Discoid lupus erythematosus – causes a skin rash that doesn’t go away
• Subacute cutaneous lupus erythematosus – causes skin sores on parts of the body exposed to sun
• Drug-induced lupus – can be caused by medications
• Neonatal lupus – a rare type of lupus that affects newborns.

Who Gets Lupus?

Anyone can get lupus, but it most often affects women. Lupus is also more common in women of African American, Hispanic, Asian, and Native American descent than in Caucasian women.

What Causes Lupus?

The cause of lupus is not known. It is likely that many factors trigger the disease.

What Are the Symptoms of Lupus?

Symptoms of lupus vary, but some of the most common symptoms of lupus are:

• Pain or swelling in joints
• Muscle pain
• Fever with no known cause
• Red rashes, most often on the face
• Chest pain when taking a deep breath
• Hair loss
• Pale or purple fingers or toes
• Sensitivity to the sun
• Swelling in legs or around eyes
• Mouth ulcers
• Swollen glands
• Feeling very tired.

Less common symptoms include:

• Anemia (a decrease in red blood cells)
• Headaches
• Dizzy spells
• Feeling sad
• Confusion
• Seizures.

Symptoms may come and go. The times when a person is having symptoms are called flares, which can range from mild to severe. New symptoms may appear at any time.

How Is Lupus Diagnosed?

There is no single test to diagnose lupus. It may take months or years for a doctor to diagnose lupus. Your doctor may use many tools to make a diagnosis:

• Medical history
• Complete exam
• Blood tests
• Skin biopsy (looking at skin samples under a microscope
• Kidney biopsy (looking at tissue from your kidney under a microscope).

How Is Lupus Treated?

You may need special kinds of doctors to treat the many symptoms of lupus. Your health care team may include:

• A family doctor
• Rheumatologists – doctors who treat arthritis and other diseases that cause swelling in the joints
• Clinical immunologists – doctors who treat immune system disorders
• Nephrologists – doctors who treat kidney disease
• Hematologists – doctors who treat blood disorders
• Dermatologists – doctors who treat skin diseases
• Neurologists – doctors who treat problems with the nervous system
• Nurses
• Psychologists
• Social workers.

Your doctor will develop a treatment plan to fit your needs. You and your doctor should review the plan often to be sure it is working. You should report new symptoms to your doctor right away so that treatment can be changed if needed.

The goals of the treatment plan are to:

• Prevent flares
• Treat flares when they occur
• Reduce organ damage and other problems.

Treatments may include drugs to:

• Reduce swelling and pain
• Prevent or reduce flares
• Calm the immune system
• Reduce or prevent damage to joints.

Alternative treatments are those that are not part of standard treatment. No research shows that this kind of treatment works for people with lupus. You should talk to your doctor about alternative treatments.

What Can I Do?

It is vital that you take an active role in your treatment. One key to living with lupus is to know about the disease and its impact. Being able to spot the warning signs of a flare can help you prevent the flare or make the symptoms less severe. Many people with lupus have certain symptoms just before a flare, such as:

• Feeling more tired
• Pain
• Rash
• Fever
• Stomach ache
• Headache
• Dizziness.

You should see your doctor often, even when symptoms are not severe. These visits will help you and your doctor to:

• Look for changes in symptoms
• Predict and prevent flares
• Change the treatment plan as needed
• Detect side effects of treatment.

It is also important to find ways to cope with the stress of having lupus. Exercising and finding ways to relax may make it easier for you to cope. A good support system can also help. A support system may include family, friends, community groups, or doctors. Many people with lupus have found support groups to be very useful. Besides providing support, taking part in a support group can make you feel better about yourself and help you to keep a good outlook.

Learning more about lupus is very important. Studies have shown that patients who are informed and involved in their own care:

• Have less pain
• Make fewer visits to the doctor
• Feel better about themselves
• Remain more active.

What Do Pregnant Women With Lupus Need to Know?

Women with lupus can and do have healthy babies. There are a few things to keep in mind if you are pregnant or thinking about becoming pregnant:

• Most women with lupus carry their babies safely.
• Pregnant women with lupus should see their doctors often.
• Lupus can flare during pregnancy.
• Quick treatment during a flare can keep the mother healthy.
• Doctors can help prevent flares.

For more details please contact:

Dr. Prateek Gupta (Senior Surgeon)

Arthroscopy Surgery Clinic

C2/5 Safdarjung Development Area (SDA),

Aurobindo Marg, New Delhi - 110016

INDIA

Telephones: +91 9810852876, +91 11 26517776

24 x 7 Helpline & Appointment: +91 9810633876

Email: sportsmedicinedelhi@yahoo.com,

sportsmedicineclinics@gmail.com

Website:http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,

http://www.sportsmedicineclinicdelhi.com,

http://www.arthroscopysurgeryindia.com

Knee Problems

What Do the Knees Do?

The knees provide stable support for the body. They also allow the legs to bend and straighten. Both flexibility and stability are needed to stand, walk, run, crouch, jump, and turn. Other parts of the body help the knees do their job. These are:

• Bones
• Cartilage
• Muscles
• Ligaments
• Tendons.

If any of these parts are injured, the knee may hurt and not be able to do its job.

What Causes Knee Problems?

Mechanical knee problems can be caused by:

• A direct blow or sudden movements that strain the knee
• Osteoarthritis in the knee, resulting from wear and tear on its parts.

Inflammatory knee problems can be caused by certain rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus (lupus). These diseases cause swelling which can damage the knees permanently.

How Are Knee Problems Diagnosed?

Doctors diagnose knee problems by using:

• Medical history
• Physical examination
• Diagnostic tests (such as x rays, bone scan, CAT scan, MRI, arthroscopy, and biopsy).

Arthritis in the Knees

The most common type of arthritis of the knee is osteoarthritis. In this disease, the cartilage in the knee gradually wears away. Treatments for osteoarthritis are:

• Medicines to reduce pain, such as aspirin and paracetamol (acetaminophen)
• Medicines to reduce swelling and inflammation, such as ibuprofen and nonsteroidal anti-inflammatory drugs (NSAIDs)
• Exercises to improve movement and strength
• Weight loss.

Rheumatoid arthritis is another type of arthritis that affects the knee. In rheumatoid arthritis, the knee becomes inflamed and cartilage may be destroyed. Treatment includes:

• Physical therapy
• Medications
• Knee replacement surgery (for a seriously damaged knee).

Cartilage Injuries and Disorders

Chondromalacia occurs when the cartilage of the knee cap softens. This can be caused by injury, overuse, or muscle weakness, or if parts of the knee are out of alignment. Chondromalacia can develop if a blow to the knee cap tears off a piece of cartilage or a piece of cartilage containing a bone fragment.

The meniscus is a C-shaped piece of cartilage that acts like a pad between the femur (thigh bone) and tibia (shin bone). It is easily injured if the knee is twisted while bearing weight. A partial or total tear may occur. If the tear is tiny, the meniscus stays connected to the front and back of the knee. If the tear is large, the meniscus may be left hanging by a thread of cartilage. The seriousness of the injury depends on the location and the size of the tear.

Treatment for cartilage injuries includes:

• Exercises to strengthen muscles
• Electrical stimulation to strengthen muscles
• Surgery for severe injuries.

Ligament Injuries

Two commonly injured ligaments in the knee are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). An injury to these ligaments is sometimes called a “sprain.” The ACL is most often stretched or torn (or both) by a sudden twisting motion. The PCL is usually injured by a direct impact, such as in an automobile accident or football tackle.

The medial and lateral collateral ligaments are usually injured by a blow to the outer side of the knee. This can stretch and tear a ligament. These blows frequently occur in sports such as football or hockey.

Ligament injuries are treated with:

• Ice packs (right after the injury) to reduce swelling
• Exercises to strengthen muscles
• A brace
• Surgery (for more severe injuries).

Tendon Injuries and Disorders

The three main types of tendon injuries and disorders are:

• Tendinitis and ruptured tendons
• Osgood-Schlatter disease
• Iliotibial band syndrome

Tendon injuries range from tendinitis (inflammation of a tendon) to a ruptured (torn) tendon. Torn tendons most often occur from:

• Overusing a tendon (particularly in some sports). The tendon stretches like a worn-out rubber band and becomes inflamed.
• Trying to break a fall. If thigh muscles contract, the tendon can tear. This is most likely to happen in older people with weak tendons.

One type of tendinitis of the knee is called jumper’s knee. In sports that require jumping, such as basketball, the tendon can become inflamed or can tear.

Osgood-Schlatter disease is caused by stress or tension on part of the growth area of the upper shin bone. It causes swelling in the knee and upper part of the shin bone. It can happen if a person’s tendon tears away from the bone, taking a piece of bone with it. Young people who run and jump while playing sports can have this type of injury.

Iliotibial band syndrome occurs when a tendon rubs over the outer bone of the knee causing swelling. It happens if the knee is overused for a long time. This sometimes occurs in sports training.

Treatment for tendon injuries and disorders includes:

• Rest
• Ice
• Elevation
• Medicines such as aspirin or ibuprofen to relieve pain and reduce swelling
• Limiting sports activity
• Exercise for stretching and strengthening
• A cast, if there is a partial tear
• Surgery for complete tears or very severe injuries.

Other Knee Injuries

Osteochondritis dissecans occurs when not enough blood goes to part of the bone under a joint surface. The bone and cartilage gradually loosen and cause pain. Some cartilage may break off and cause sharp pain, weakness, and locking of the joint. A person with this condition may develop osteoarthritis. Surgery is the main treatment.

• If cartilage fragments have not broken loose, a surgeon may pin or screw them in place. This can stimulate new blood flow to the cartilage.
• If fragments are loose, the surgeon may scrape the cavity to reach fresh bone and add a bone graft to fix the fragments in position.
• Research is being done to investigate cartilage and tissue transplants.

Plica syndrome occurs when bands of tissue in the knee called plicae swell from overuse or injury. Treatments for this syndrome are:

• Medicines such as aspirin or ibuprofen to reduce swelling
• Rest
• Ice
• Elastic bandage on the knee
• Exercises to strengthen muscles
• Cortisone injection into the plicae
• Surgery to remove the plicae if the first treatments do not fix the problem.

What Kinds of Doctors Treat Knee Problems?

Injuries and diseases of the knees are usually treated by an orthopaedist (a doctor who treats problems with bones, joints, ligaments, tendons, and muscles).

How Can People Prevent Knee Problems?

Some knee problems (such as those resulting from an accident) can’t be prevented. But many knee problems can be prevented by doing the following:

• Warm up before playing sports. Walking and stretching are good warm-up exercises. Stretching the muscles in the front and the back of the thighs is a good way to warm up the knees.
• Make the leg muscles strong by doing certain exercises (for example, walking up stairs, riding a stationary bicycle, or working out with weights).
• Avoid sudden changes in the intensity of exercise.
• Increase the force or duration of activity slowly.
• Wear shoes that fit and are in good condition.
• Maintain a healthy weight. Extra weight puts pressure on the knees.

What Types of Exercise Are Best for Someone With Knee Problems?

Three types of exercise are best for people with arthritis:

• Range-of-motion exercises. These exercises help maintain or increase flexibility. They also help relieve stiffness in the knee.
• Strengthening exercises. These exercises help maintain or increase muscle strength. Strong muscles help support and protect joints with arthritis.
• Aerobic or endurance exercises. These exercises improve heart function and blood circulation. They also help control weight. Some studies show that aerobic exercise can reduce swelling in some joints.

For more details please contact:

Dr. Prateek Gupta (Senior Surgeon)

Arthroscopy Surgery Clinic

C2/5 Safdarjung Development Area (SDA),

Aurobindo Marg, New Delhi - 110016

INDIA

Telephones: +91 9810852876, +91 11 26517776

24 x 7 Helpline & Appointment: +91 9810633876

Email: sportsmedicinedelhi@yahoo.com,

sportsmedicineclinics@gmail.com

Website:http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,

http://www.sportsmedicineclinicdelhi.com,

http://www.arthroscopysurgeryindia.com