The Achilles’ tendon is the largest tendon in the body and as a result is prone to injury. .
A sudden eccentric load on the Achilles can cause it to rupture. For example getting ready to sprint or jump or even missing a step getting up on a kerb. Often patients describe a sensation of being kicked from behind or feeling a bang. .
Unfortunately sometimes patients present to A&E complaining of “an ankle injury” or “I sprained my ankle”. Patients are examined while on a couch, an ankle fracture is excluded and x-rays are normal. This is when an injury can be missed and I see several of these a year. .
A missed chronic Achilles’ tendon rupture can be a catastrophic injury. .
I always examine the patient on a couch in the prone position. Inspect for obvious swelling, loss of definition of the tendon, extensive bruising, tenderness, palpable gap in the tendon, loss of normal resting equinus posture of the foot and a positive squeeze test (Thompson’s or Simmonds test). .
I get an US scan not to confirm the diagnosis but to help with my treatment plan. If the tear is at the musculotendinous junction I would treat non operatively. If the gap in equinus is also less than a 1cm I would offer non operative management. .
So take home message - get your patient prone on the couch and you will never miss an injury 👍🏼🙏🏼
I would like to thank my patient for giving me permission to use this video.
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“They didn’t even get my good side” #barbiehand
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**WARNING VIEWER DISCRETION** Patient X presented with left foot/ankle pain after sustaining an ankle sprain over a year ago.
After a thorough physical/radiographic exam was done, it was revealed that there was a Non-Union of the anterior process of the calcaneus. This is often missed in the setting of an ankle sprain.
Treatment of choice here was excision of the non healing fragment. One can appreciate how open her CC joint is after excision.
Hyaluronic acid injections ( JUVEDERM) have been shown to lead to an increase in collagen production.
Replacing lost volume with injected hyaluronic acid can also minimize the appearance of pores by re-inflating the skin.
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Board Certified Plastic Surgeon, Dr. Leilie Javan.
Today feels like a Sunday as I’m finally enjoying a day off post back-to-back weekend night shifts following weekday shifts. I have to admit to feeling like a zombie as my circadian rhythm takes hit during this transition.
A few tips I have found useful to transition from night to day routine :
1️⃣ Taking a nap (2 hours max) at the end of my night shift.
2️⃣ Planning a day outside to get lots of sunlight exposure.
3️⃣ Working out in the evening so that I get tired enough to crash and sleep at night.
4️⃣ Avoiding caffeine!
Do you have any special tips to transition from night to day shifts?
Swipe to see my favorite way to brew tea!
This tea maker is so much fun to watch. Each morning it automatically brews my tea for me at the proper temperature and for the perfect time based on the specific tea I’m brewing. 🍁
Check out the link in my profile to find this on my Amazon list.
EMPEZANDO A TRABAJAR CON ÁNIMO LUEGO DE "LA VACACIÓN"... AGRADECIDO CON DIOS POR EL TRABAJO Y LAS BENDICIONES RECIBIDAS #surgeonlife
“I am still learning.”
Today I’m at a meeting in Switzerland learning new and novel techniques to treat osteochondral lesions around the ankle. .
The older I get and more experienced, the more I realise I don’t know. The human body is a miraculous machine and sadly our knowledge is severely lacking. As clinicians we are only scratching the surface. As soon as we discover one thing, it opens up another 10 questions. .
All doctors need to attend regular meetings and conferences and demonstrate that they are keeping their knowledge and skills up to date. This is a GMC and appraisal requirement. But I love learning anyway, especially when it involves travelling to beautiful places and eating nice food!
The day I stop learning I’ll hang up my boots. Until then I will continue learning from my experience, from my peers, my allied healthcare colleagues and of course from my patients!
Wondering if you’re a candidate for LASIK? 🤓 Well look no further- check out our LASIK self-test (link in bio) and schedule a consult 👀 #Pennyapproved
Crisp air, pretty leaves,
sweaters & boots,
and coffee ☕️. I ❤️ FALL 🍂🍁😉
Skin staple removal
Many of you asked me how do we remove the skin staple after the wound is healed.
So here’s how to remove them, using a special device for staple removal. It’s totally pain free, the patient will only feel a little jolt during the removal.
#rudimansurgeryvideo #woundcare #ilovemyjob #surgeonlife