Orthopedic Q&A: ACL Recovery, Hip Pain, and Foot Problems | OEP375

We tackle three common orthopedic questions submitted through YouTube, Facebook, and podcast emails. From diagnostic challenges to treatment options, these Q&As provide practical guidance for patients experiencing hip, foot, and knee conditions.

• Young adults with hip pain that mimics arthritis might actually have labral tears or femoral acetabular impingement requiring MR arthrogram for diagnosis
• Morton's neuroma and metatarsalgia can coexist because they share common causes like calf tightness and forefoot pressure
• Metatarsalgia encompasses several diagnoses including sesamoiditis, capsulitis, and plantar plate tears
• Morton's neuroma typically causes paresthesia in the third/fourth toes with sharp, shocking pain
• Treatment for foot conditions includes orthotics, stretching, metatarsal pads and intrinsic strengthening
• ACL tears won't heal themselves, but some patients can function well without surgical repair
• Secondary restraints (menisci, capsule, muscles) significantly influence knee stability after ACL injury
• Non-athletes and those avoiding cutting/pivoting sports are better candidates for non-surgical ACL management

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Chapters

• 0:00 Welcome and Sponsor Introductions
• 1:37 22-Year-Old with Hip Pain
• 4:03 Morton's Neuroma vs Metatarsalgia
• 7:24 ACL Recovery Without Surgery

Transcript

Speaker 1: 0:00

Hello everyone and welcome to episode 275 of the OrthoDal Pal podcast. I'm your host, paul Markey. Today we're going to go through it for the PDQ&A, where we talk about medical benefits, our social and moral needs, and then we're also going to be talking about recovering after ACL injury. And before we get started, I just want to mention that our sponsors, first of all hosting course options are available Visit glasschainingandeducationcom and use discount code BFR50 to receive $50 off your course purchase.

Speaker 1: 0:28

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Speaker 2: 0:34

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Speaker 2: 3:57

All right, there's question number one. Number two Can I have both a Morton's neuroma and a metatarsalgia? And I get this question more often than any other question, I believe, on my YouTube channel, and the answer to that is yes, you could definitely have both. Why? Because they can both be irritated the same way. A tight calf can cause overpressure in the forefoot, you can have splaying of the forefoot, you could lose that transverse metatarsal arch, which all can contribute to this Cumulative trauma. Starting to increase walking or running mileage, maybe uneven surfaces, maybe climbing hills a lot Anything that puts a lot of pressure on the forefoot can cause both of these to happen. Some people just more susceptible to getting one than the other.

Speaker 2: 4:51

Now I need to talk a little bit about metatarsalgia because it's kind of a junk term. It encompasses a lot of other diagnoses such as sesamoiditis, capsulitis of the metatarsophalangeal joint. You could have a plantar plate tear predislocation syndrome. Any of these more specific diagnoses fall under the realm of metatarsalgia and actually Morton's neuroma has been categorized under metatarsalgia in the past also, so you can have a little bit of both. For sure, your Morton's neuroma is going to cause more of a paresthesia into the third and fourth toes most typically, but it can happen in a second also. Issues under metatarsalgia can happen from one through five, so that's more common but not typically cause any paresthesia. Usually your Morton's neuroma will give you like a sharp, shocking type of discomfort also. So that's how you differentiate, you know, between the two of them.

Speaker 2: 5:50

I treat them very similarly. I usually use an orthotic. I like to do gastroctolius, stretching on all of these folks. No off of a two by four, or maybe the bar in a gym, you know, like the base of a squat rack or something like that. I don't like to hang off of that forefoot because it just aggravates all of those tissues quite a bit, especially early on. Orthotics, metatarsal relief pads and reestablishment of that transverse metatarsal arch can be super helpful than ultimately trying to rebuild the ability to flex the intrinsics in the foot. So that's how I would answer that question. And yes, many people do have both. You don't see it very often, but a fair number of folks do get it All right.

Speaker 1: 6:44

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Speaker 2: 7:23

Is there any chance of recovery from an ACL injury without surgery? And so this really depends on what you mean by recover from, okay. So the ACL itself will, if cut in half or if torn, will not heal itself back up. It's very, very unlikely that will happen, okay. The other thing we need to remember is that what are the secondary restraints looking like?

Speaker 2: 7:57

So a couple of weeks ago I had a patient come in. He had a skiing injury. I assessed his knee and it was very clear that he had a grade three anterior instability. I could grab a hold of that tibia, translate it anteriorly. It was super loose, there was no end point. And come to find out when he had surgery. We definitely suspected a meniscus tear. But when he had surgery it was not. The meniscus was not repairable, it was shredded. So you know, not having that meniscus tear will cause some extra instability in the knee. So we know that the secondary structures like the menisci, like the capsule, like the conformity of the femur on the tibia, all of these things can help support the knee. Also, the dynamic structures, you know your hamstrings, your quads, popliteus all of these structures help to dynamically and statically support the leg.

Speaker 2: 8:55

So if you tear your ACL and you're not a very active person. You don't do a lot of high speed cutting and pivoting type activities We've seen people do well without an ACL. Now it is, you know, likely they're going to develop early arthritis in the future, but you know. But can an athlete get back to playing sports without an ACL? We have seen people do it, people with good secondary structures, and they've not damaged any other structure but the ACL. If they can build enough strength, proprioception and maintain good stability, they can get out there and play sports.

Speaker 2: 9:33

Not many will, okay, but some can. So the people who will be able to get away without having the ACL repaired will be your non-athletes. People doing slower activities, more in a straight plane Runners will do better than people who play cutting sports okay. So it really depends. When you say recovering from um, most people will recover from it, but they won't regrow that ACL on their own. So, uh, there we have it, folks. Three orthopedic questions and answers. Um, again, these are answers from Paul and from my experience, and so if you have any questions or comments you'd like to add, I hope you have a great day, be kind to each other and take care.