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Foot and Ankle Healthy Living with Foot and Ankle Arthritis

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					                                                          “Healthy Living with
                                                         Foot and Ankle Arthritis”
                                                        The Orthopedic Specialty Hospital




               “The Arthritis Team”                            What is Arthritis?
 Primary                                           • “Wear and Tear”
                                      Physical
    Care
                                      Therapist
Physician




                                      Orthopedic
Nutritionist                          Surgeon




                                                        Why Diagnosis Important?
                What is Arthritis?                 • Is it arthritis?
  • “Why is it                                     • Explore treatment options
    painful?”                                      • Optimal pain relief!




                                                                                            1
          Making the Diagnosis                    Treatment Options
                                              The right combination for you

 •   Pain everyday                  •   Medications
 •   Lifestyle                      •   Injections
 •   Swelling                       •   Braces
 •   Stiffness                      •   Physical therapy
 •   Deformity                      •   Weight loss
 •   X-ray                          •   Nutrition consult
                                    •   Surgery




                                                       Medications
                    Medications
                                   • Over the counter meds
• Why?                                             “1st Generation”
     Decrease
                                        Tylenol         Ibuprofen             Naprosyn
       • Pain
       • Swelling




                    Medications                             Injections
• Prescription meds
                “2nd generation”




                                                            Corticosteroids




                                                                                         2
                   Braces
  Goal – limit motion through painful joints




Limit ankle and/or foot   Shoe insert/orthosis
        motion




     Physical Therapy Evaluation
                                                 Flexibility
 •   Flexibility            • Weight
 •   Strength               • Lifestyle
 •   Walking Pattern        • Goals
 •   Shoes




                                                               3
Before you strengthen…..

Polish the joint




      Slow, rhythmic, light
           resistance
                              Strength




                                         4
    Light weight



                   50-100 reps

    GRADUAL increase




Walking Pattern




                                 5
6
                             Lifestyle
          What activities can you do successfully now?

Bracing   What activities would you like to do?




            Pace Yourself to Prevent Pain
                   and Stiffness
            •   Create a manageable schedule
            •   Alternate heavy tasks with light tasks
            •   Change positions frequently
            •   Plan rest breaks during your activities




                                                          7
                     Modify Activities




Modify Activities   Modify Activities




                                         8
Modify Activities   Modify Activities




Modify Activities   Modify Activities




Modify Activities




                                        9
         Apply Heat and/or Cold
   Heat – increases blood circulation

   Cold – decreases inflammation and pain

                15 minutes maximum                                              TOSH Nutrition Team




        Obesity Trends* Among U.S. Adults
                BRFSS, 1991-2005                                Attaining a healthy body weight
           (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)


 1991
                                                                Too much weight:
                                     1995
                                                                • Increases load on joints
                                                                     – 10 lbs overweight increases load on
                                                                       knee by 30-60 lbs w/ each step
             No Data     <10%        10%–14%        15%–19%     • Worsens arthritis
2002
                                   2005
                                                                • Post-surgery complications
                                                                • Increases the risk of diabetes,
                                                                  heart disease

           20%–24%          ≥25%           ≥30-34%




           Weight Control:                                          Tasty and Healthy Eating for Life
        Understanding the energy                                • Color from fresh fruit & vegetables
                                                                • Real whole grains
           balance equation                                     • Wild Fish
                                                                • Organic turkey, chicken, eggs
                                                                • Lean red meat
ENERGY in                                 ENERGY out            • Low fat, unsweetened dairy
Eating too much                           Moving too little     • Unprocessed soy
                                                                • Flavors from nuts, seeds, dried fruit, herbs,
                                                                  spices, olives, capers, delicate oils, cheese
                                                                • Your Favorites




                                                                                                                  10
  Color from Veggies & Fruit                    Add Flavors to Your Plate!
                                            •   Olive oil
                               Salads       •   Vinegars
                                            •   Lemon juice
           Soups                            •   Herbs
                                            •   Pesto
                                            •   Hummus
                                            •   Salsa
                                            •   Nuts & Seeds
                   Buy them local!
                                            •   Cheese
                   Buy them organic!
                                            •   Fruit
                   Eat them fresh!          •   Avocado
                   Eat them daily!
Veggies                                     •   Sea salt
                                            •   Pepper




 Color and Flavor Your Snacks!                     Combine Protein with it!




                                          Trans Fats & other Cheap Ingredients in our Food
          Eat Real Grains!                                        (processed from corn, soy, cotton, wheat)
                                        TRANS FAT                              HIGH FRUCTOSE CORN SYRUP
                                        Chemically processed                   Chemically processed sugar
                                        vegetable oils with bad                from corn: sweetest, cheapest,
                                        effect on blood lipids!                and worst sugar!

                                        Check the ingredient list!             Check the ingredient list!
                                        Granola Bar                            Granola Bar
                                        Ingredients: enriched flour, sugar,    Ingredients: enriched flour, high
                                        soybean oil, partially hydrogenated    fructose corn syrup, sugar, palm oil,
                                        soy and corn oils…                     coconut oil

                                          So…is it all good for us if it is trans fat and HFCS free??




                                                                                                                       11
Eat Real Food – Avoid the Junk!          Inflammation: Food is Medicine!
GROCERY STORE:                           • DAMAGING…                                        • HEALING…
AVOID THE MIDDLE

PRODUCTS:
AVOID LONG INGREDIENTS LIST
AVOID TRANS FATS
AVOID HFCS
AVOID NON-FAT & LIGHT

RESTAURANT:
AVOID FAST FOOD
AVOID FRIED FOODS
AVOID SUPER-SIZED MEALS




 More Healing Foods & Flavors                                        Enjoy your Favorites
                                                                            in small amounts
 Reduce damage and inflammation          A Little HANDFUL
                                                                                              TIPS FOR FAVORITES…
                                                                                              Favorite “little” dish!
                                                                                              Enjoy without distraction!
                                                                                              Enjoy it slowly!
                                                                                              Don’t let it become a habit!
                                                                                              Pair it with fruit!
                                                                                              Pair it with yogurt!
                                                                                              Get on with your day!




 What to Drink and How Much…                   Healthy Eating – Healthy Living
                                                                  Color!                Consider Organic!
                                           Be Physically Active




                                                                  Flavor!                   Buy Local!
                                                                      Make healthy eating a priority!
                    3 to 5 TIMES A DAY                                          Reduce             Eat Out
                                                                                                                Cook & Eat
                                                                                                                 Together




                                                                              Portion Sizes        Wisely
     NO SUGAR…NO CALORIES…NO CAFFEINE…                                                            Eat Slowly!
           MAKES YOUR CELLS HAPPY
                                                                   Veggies, Soups, Salads            Stop
                                                                                                    Multi-
                                                                  Eat Breakfast   Be Consistent    tasking!
                                                                   Monitor your Progress!           Eat Intuitively




                                                                                                                             12
                                                    Resources
   Drug – Nutrient Interactions                     Weight Loss Community Class & individual consults for weight loss
                                                    call IHC at: 314-2918

NSAID                                               Great Food Books:                       Cookbooks & Magazines
                                                    Mindless Eating: Wansink                The Healthy Kitchen: Weil and Daley
• Avoid alcohol!                                    Hope’s Edge: Moore Lappe
                                                                                            The Wellness Kitchen: UC Berkeley
                                                    Harvest for Hope (A Guide to Mindful
• Aspirin: increased need for fluids, folate, and      Eating): Goodall                     Small Plates: Marceau-Henderson
  vitamin C                                         Ending the Food fight: Ludwig and
                                                       David/Rostler
                                                                                            Keep it Seasonal: Wayte
                                                                                            With a Measure of Grace: Spalding
  – Increase fruit and vegetables!                  The Eco Foods Guide: Barstow
                                                                                              and Castle
                                                    The Omnivore’s Dilemma: Pollan
  – Increase daily fluid intake ~10 cups/day        What to Eat: Nestle                     Spices of Life: Simonds
                                                                                            Eating Well Magazine (quarterly
• Attention with anti-coagulants: garlic extract,   Intuitive Eating: Tribole and Resch
                                                    Volumetrics: Rolls and Barnett            publication)
  ginger, gingko, horse chestnut, vitamin E         Healthy Aging: Weil
                                                    Slow Food Nation: Petrini
                                                    Food Fight: Citizen’s Guide to a Food
                                                       and Farm Bill: Imhoff




Read the
Ingredient List




   When conservative treatment
   no longer works . . .
                                                                              Surgery
                                                        • Appropriate candidate
    Surgery                                             • Select best procedure
                                                        • Specialized surgeon




                                                                                                                                  13
          When to operate??
                                                        Benefits

                                            Level of function and pain relief
Risks                            Benefits
                                            Level if foot/ankle worked normally
                                            Level after proposed surgery




                                                   Surgical Options
                   Risks
                                              •   Arthroscopic “clean-up”
        Pain                                  •   Cartilage restoration
        Recovery                              •   Osteotomy
        Limited weight bearing                •   Foot reconstruction
        Surgical risks                        •   Ankle fusion
                                              •   Ankle replacment




               Arthroscopy                    Cartilage Restoration
• Joint clean-up
• Not very helpful if
  deformity present
• Symptom relief
    30-80%
    3-12 months




                                                                                  14
        Osteotomy                    Foot Reconstruction




      Ankle Fusion                   Ankle Replacement




Fusion or Replacement                When to operate??

  •   Individual
  •   Existing deformities
  •   Previous surgeries     Risks                         Benefits
  •   Age
  •   Weight
  •   Activity level




                                                                      15
              Functional Level                                    Functional Level
100%                                                      100%
                        If ankle normal                                If ankle normal
             Now
                                          After surgery                                  After surgery




                                                                 Now




    0%                                                     0%




              Functional Level                                    Functional Level
100%                                                      100%
                                                                       If ankle normal

                                                                                         After surgery



                        If ankle normal   After surgery
             Now                                                 Now




    0%                                                     0%




    Post Surgical Physical Therapy
•   Splint/Cast
•   Limited weight bearing till bones heal
•   Strengthening
•   Gait training
Any physical therapy and nutritional
modifications done before surgery can improve
your rehab following surgery




                                                                                                         16
                                                     What can you do now?
             Question and Answers

    •   Physician
                                                            • Group classes in the pool
    •   Physical Therapist
    •   Nutritionist                                        • Land exercise classes
    •   Surgeon                                             • Self help home study
    •   Utah Arthritis Program Resource Specialist




              Contact Information
•       Drew H. Van Boerum, M.D. - 314-4900
•       Stephanie Albin, P.T. – 314-4040
•       Holly Wilkens, M.S., R.D. – 314-4040
•       Arthritis Program – 538-9340




                                                                                          17

				
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