Category: Orthopedic Surgery

Hammertoes is a very common condition. Learn all about it in this month’s featured infographic. Dr. David Larson, Fellowship Trained Foot & Ankle Surgeon at Integrated Orthopedics, specializes in all forms of foot and ankle injuries and surgeries, including hammertoe.

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At the start of the New Year, many people decide to start a running program. We treat a lot of runners in our orthopedic and sports medicine practice and see a lot of the more common running injuries, with both new and long-time runners.

Running is a fantastic cardio workout, but if you’ve never run before – or are getting started again after an injury or break – it’s good to be aware of the more common running injuries.

Foot Mechanics & Running

During running, the foot is active in both the landing and push-off phase. It absorbs the shock of impact when landing and controls the forces generated by running during push-off. Most running injuries can be linked to one of these two functions.

Common Running Injuries

Here are the most common injuries runners experience and tips to prevent these injuries from occurring:

Plantar Fasciitis:
This is probably the most common running injury. It is usually due to overtraining, especially hill work and speed work; and not stretching the calf muscles. The plantar fascia – a think band of tissues that stretches from the toes to the heel – is prone to tearing when overworked. This tearing results in inflammation. The slow blood supply to the fascia hinders healing and results in a chronic condition.

To prevent plantar fasciitis, follow these tips:

  • Wear the right shows with good arch support and heel cushioning
  • Stretch the Achilles tendon regularly
  • Keep at a healthy weight
  • Increase your running gradually and alternate running with other activities
  • Try to minimize going barefoot at home which puts stress on the feet

Achilles Tendinitis:
This large strong tendon runs from the heel to the calf and propels you forward while running. Overworking the Achilles tendon results in inflammation.

A couple good ways to ward off Achilles tendinitis are:

  • Tennis ball roll: Loosen your plantar fascia by rolling a tennis ball under each foot. The muscles and tendons along the bottom of your foot exert pressure from below on the Achilles. This exercise helps keeps things loose.
  • Foam roller: You can increase the flexibility in your lower legs with a foam roller, rolling it over the front and back of the lower legs. This release tightness and tension.

Stress Fracture:
The most common runners’ stress fracture is to the tibia, or shin bone. This type of fracture occurs with issues related to the landing or push-off phase of running.

Here are a few tips to prevent shin fractures:

  • Do exercises to keep calf muscles healthy – do calf raises to strengthen them and stretches the loosen these muscles
  • Avoid muscle fatigue in the legs – when muscles fatigue, weight distribution shifts and the bone takes increased weight and impact
  • Don’t shift from soft trails to hard surfaces rapidly
  • Wear shoes with good shock absorbance

Runners Knee:
When the foot is not stable and lands in an uncontrolled way, runner’s knee can develop. It can also be caused by a biomechanical issue such as the patella being larger on the outside than it is on the inside, or a patella that easily dislocates. Worn cartilage in the knee joint also reduces shock absorption. High-arched feet can be a culprit as well as flat feet.

To prevent runner’s knee, follow these tips:

  • Run on soft surfaces
  • Do not increase mileage more than 10 percent per week
  • Gradually increase hill work
  • Go to a specialty running shoe store to get fitted for the proper shoes for your foot and gait
  • Incorporate exercises that strengthen the quadriceps muscles to improve patellar tracking
  • Stretch your hamstrings and calves to prevent over-pronation (too much inward rolling of the foot)

For many, losing weight – especially those extra holiday pounds – is a New Year’s resolution. Here’s some information to consider on obesity’s impact on knee health from a recent study.

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Always warm-up before jogging or injury occurs…

Faron Kostyk – an investor originally from Alberta, Canada – came to see Brian Gruber, MD, MBA, board certified orthopedic surgeon, for knee pain that had been ongoing and progressively getting worse. He was unable to continue to participate in activities he enjoyed such as skiing and running.

“I was referred to Dr. Gruber by my regular doctor, who felt that my injury could best be addressed by an orthopedic surgeon,” stated Faron.

Upon physical exam and testing, Dr. Gruber diagnosed Faron with a torn meniscus and anterior cruciate ligament (ACL) injury. While some meniscus and ACL injuries can be treated conservatively, in Faron’s case surgery was the best option to achieve the results he was seeking.

Upon completing surgery and physical therapy, Faron hoped to have significantly better knee health and a return to the activities he enjoyed doing.

“Surgery definitely improved the quality of my life and improved my knee health,” said Faron. “My daily activities are better now, including walking and kneeling.

Faron completed physical therapy at Integrated Orthopedics’ in-house physical therapy clinic. The goal of offering onsite physical therapy to Integrated Orthopedics’ patients is to provide them with the most coordinated care possible. Team physical therapists meet regularly with Dr. Gruber and the other physicians in the practice to review a patient’s progress. This model ensures that the physicians are kept in the loop on a patient’s physical therapy progress at each step of the way.

“Our model integrating physical therapy with our orthopedic clinic and surgery ensures our patients receive not only highly coordinated care, but optimal recovery times,” said Brian Gruber, MD, MBA, board certified orthopedic surgeon and founder and lead physician of Integrated Orthopedics. “If there are challenges or issues with physical therapy, we identify and troubleshoot them immediately.”

“The physical therapy team at Integrated Orthopedics is fantastic,” said Faron. “From PT to the entire office staff, everyone is compassionate, friendly and professional.”

Faron is now back to doing many of the activities he enjoys. He is grateful for Dr. Gruber’s technical skills as a surgeon. “Dr. Gruber is a great communicator and genuinely cares about his patients. He and his team have changed my life,” he shared.

About Meniscal Tears

Meniscus tears are among the most common knee injuries. Athletes are most at risk for these injuries; however, anyone at any age can tear a meniscus. Sudden meniscus tears often happen during sports. Often squatting and twisting the knee cause the tear, or direct contact, like a tackle.

Older people are more likely to have degenerative meniscus tears rather than a sports-related tear. Cartilage weakens and wears thin over time and aged tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear.

About Anterior Cruciate Ligament (ACL) Tears

Another common knee injury is an anterior cruciate ligament (ACL) sprain or tear.

Athletes who participate in high demand sports like soccer, football and basketball are more likely to injure their anterior cruciate ligaments. The anterior cruciate ligament can be injured in several ways:

  • Changing direction rapidly
  • Stopping suddenly
  • Slowing down while running
  • Landing from a jump incorrectly
  • Direct contact or collision, such as a football tackle


This month is National Diabetes Month. It’s important to inform your doctor about all of your medical conditions, especially prior to surgery. Diabetes is an especially important condition for your doctor to know about!

National Diabetes Month

Our bodies change as we age – some subtle changes, some more obvious. However, many of us can remain active, healthy and vibrant throughout their lives.

In fact, our physiologic age can often be younger than our chronological age – often due to diet and lifestyle factors combined with our genetics.

Let’s look at the effects of aging on the muscles, bones and joints. Then, we’ll explore some ways to counteract the effects of aging on these parts of your body.

Aging Muscles:

  • Muscles shrink and lose mass as they age – this is a natural process. However, living a sedentary lifestyle accelerates the process.
  • Muscle fibers also decrease with age, making it take longer for our muscles to respond as we age.
  • Tissues get stiffer with age and less able to tolerate stress. This is due to the decrease in the water content of tendons.
  • The heart muscle is less able to propel large quantities of blood to the body and we tend to tire more easily as we age and recover less quickly.
  • Our metabolic rate – how quickly we convert food into energy – slows with age. The effects can be obesity and an increase in “bad” cholesterol levels.

Aging Bones:

  • During our lifetime, our bones are consistently going through a process of absorption and formation called “remodeling.” The balance between absorption and formation shifts with age, resulting in loss of bone tissue.
  • Bones become less dense with age as the mineral content decreases.
  • With loss of bone mass, common age-related conditions like osteoporosis can develop, a condition responsible for nearly all hip fractures in older men and women.
  • Arthritis can develop from loss of cartilage between the bones, which occurs with age.
  • As we age, our ligaments, connective tissue become less elastic and we lose flexibility.

Aging Joints:

  • Changes in tendons and ligaments with aging result in less joint flexibility and motion.
  • As cartilage breaks down with age – which cushions our joints – the joints can become inflamed and arthritic.

Slowing the Progression of Age-Related Orthopedic Conditions

Now that we’ve covered the effects of aging on the muscles, bones and joints, let’s look at ways to counterbalance them.

Disuse is often the biggest culprit in our musculoskeletal system’s aging.

And, guess what? The most sedentary group of Americans is older than 50. The right lifestyle choices will go a long way to combat aging on the musculoskeletal system.

  • Stretching – Regular stretching will help to maintain joint flexibility.
  • Weight Training – Increases your muscle mass and strength. Maintaining muscle mass will allow you to do your daily activities much easier with less exertion.
  • Aerobic Exercise – Studies show that just 30 minutes of moderate aerobic exercise a day can help maintain your body’s response time, deliver and use oxygen efficiently and keep your heart muscle strong.
  • Healthy Diet – You are what you eat, so make sure to load up on nutrient dense real foods and get adequate amounts of lean protein in your diet.

When the Effects of Aging Occur

The body does age even with all the right lifestyle choices. Its muscles, joints and bones will change with age. As an orthopedic surgeon, we work with many patients over 50-years-old to help them manage age-related orthopedic conditions and stay active. Sometimes surgery is needed, but more than not, non-invasive treatments can manage these conditions, including:

  • Regenerative Medicine (Platelet-Rich Plasma Therapy and Stem Cells)
  • Injection Therapy (Steroid and Hyaluronic Acid)
  • Physical Therapy

If you’re not hanging out with us over on Snapchat, take a quick look at this video our team produced. We hope this “sneak peek” entices you to come on over and join us on Snapchat each Tuesday and Thursday for an insider’s look into the OR and orthopedic surgery!

Snapchat: bfgorthodocaz — or click on the Snapchat icon in the upper-right corner of this website.