The first toe MTP joint

First Metatarsophalangeal  (MTP) Joint Arthritis
(http://www.drchiodo.com/Pages/disorders/halluxrigidus.php)

Arthritis of the 1^st toe metatarsophalangeal (MTP) joint is the second most common pathology of this joint following hallux valgus, or bunion deformity.   First MTP joint arthritis is a progressive degenerative condition, which results in decreased motion of the joint. The exact cause of 1^st MTP joint arthritis is unknown; predisposing factors that precipitate this condition include acute injury, such as forced plantarflexion or dorsiflexion (turf toe), stubbing the toe, repetitive microtrauma, fractures into the joint or a crush injury. Congenital deformities of the first MTP joint may also predispose an individual to develop arthritis; these include a short or long first metatarsal, flattened first metatarsal head or an elevated first metatarsal.

Onset of symptoms is usually insidious, but may occur after an acute injury. Stiffness of the first MTP joint, as well as pain and swelling of this joint are common presenting symptoms. Pain is often increased with activity. Positions such as squatting, which cause the joint to hyperextend, will also cause pain. For women, high-heeled shoes often cause increase discomfort due to hyperextension and increased jamming of the joint. Pain is often relieved with rest.  Patients’ may also complain of pain on the lateral aspect of their foot as they may compensate and weight bear more laterally to decrease the stress on the first MTP joint.

After taking an accurate history from the patient, physical examination of the patient’s feet is the next step to make a correct diagnosis. In mild cases of arthritis, physical exam may only reveal tenderness or synovial thickening of the joint space. The joint may appear erythematous (red) due to inflammation.  Bony hypertrophy and osteophyte formation is often palpable if not visible on exam. There is often limited or no motion of the joint. Patients often experience increased pain with passive range of motion of the joint; this may be due to inflammation of the synovial tissue, the capsule surrounding the joint, stretching of tendons crossing the joint or impingement of soft tissue between osteophytes. Patients may also complain of tingling or increased sensitivity as a result of nerve compression due to the osteophytes. With the patient standing, it may be noted that the patient weight bears on the lateral aspect of their foot to decrease the stress on the first MTP joint.

An accurate history and physical examination can lead to the correct diagnosis the majority of the time. X-rays of the foot are taken to confirm the diagnosis and rule out any other causes of the patient’s pain. Findings on x-ray may include narrowing of the joint space, flattened/widening of the first metatarsal head, bone spur formation, cyst formation in the bone or an osteochondritis dessican lesion.

Conservative treatment of arthritis of the 1^st MTP joint is aimed at slowing the progression of the disease and relieving pain. Anti-inflammatories, such as Motrin or Ibuprofen, are used to decrease the inflammation of the joint. A steroid injection into the joint is another option to decrease the inflammation; although this may only temporarily relieve the pain. Complications of steroid injections include further degeneration of the joint cartilage, infection and nerve damage that can result in numbness/tingling. Orthotics (custom molded inserts) and stiff soled shoes are used to decrease the stress on the joint. With bone spurs located on the dorsal/top aspect of the joint, shoes with an increased depth in the toe box will decrease the pressure placed on the top of the joint. Shoe wear with lower heels will also decrease the stress of the joint.

Surgical treatment options are dependent upon the severity of the arthritis, patient age and activity level.  Surgery options include debridement/cheilectomy, joint replacement (arthroplasty) and joint fusion (arthrodesis).  Debridement of the first MTP joint involves removal of the bone spurs and bony formation that is causing pain and restricting motion of the joint. Debridement preserves joint motion. Patients are able to walk on their foot the day of surgery in a rigid postoperative shoe, but are asked to limit their activities. When the patient returns to the office for their first postoperative appointment, he/she is taught how to perform range of motion exercises of the joint to prevent recurrent stiffness. Joint replacement, or arthroplasty, may also preserve motion of the joint. In this procedure a portion of the first metatarsal and/or proximal phalanx are resected to allow implantation of the joint replacement. Although the joint is salvaged with arthroplasty, there are many inevitable complications associated. Patients lose push off ability of their first toe while walking, as tendon attachments need to be resected in order to place the implant. Patients often get pain in other parts of their foot, which could lead to fractures, as the weight bearing stresses are altered, and often patients develop great toe deformities. Arthrodesis is reserved for end-stage arthritis of the joint or revision of previous failed procedures.  With joint fusion, the first metatarsal and proximal phalanx of the first toe are fused together, which inhibits movement of this joint.  The joint is fused together using plates and screws in a position for walking. Post-operatively patients are in a cast for three months. Weight bearing on the operative foot is usually allowed at one month. Three months after surgery the patient usually goes to physical therapy and may progress to regular activity as tolerated. Casting may be extended if healing is slow. Fusion allows for normal push off with the great toe , which is needed for normal walking.  With first metatarsophalangeal joint fusions, running is limited and heels greater than one inch cannot be worn.

Some complications of surgery include infection, incisions not healing, bones not healing, pain in other areas of the foot and numbness/tingling and deep venous thrombosis(blood clot). Swelling after any procedure to the foot may last up to 6 months post-operatively.

Jessica Parezo, MS, RPA-C

David J. Pochatko, MD

Coughlin, M. J., & Mann, R.A. (1999). Surgery of the foot and ankle, 7th edition, volume 1. St. Louis: Mosby, Inc.

One of the most commonly injured parts of the knee; the meniscus is a wedge-like rubbery cushion where the major bones of your leg connect. Meniscal cartilage curves like the letter “C” at the inside and outside of each knee. A strong stabilizing tissue, the meniscus helps the knee joint carry weight, glide and turn in many directions. It also keeps your femur (thighbone) and tibia (shinbone) from grinding against each other.

Football players and others in contact sports may tear the meniscus by twisting the knee, pivoting, cutting or decelerating. In athletes, meniscal tears often happen in combination with other injuries such as a torn ACL (anterior cruciate ligament). Older people can injure the meniscus without any trauma as the cartilage weakens and wears thin over time, setting the stage for a degenerative tear.

Without treatment, a fragment of the meniscus may loosen and drift into the joint, causing it to slip, pop or lock – your knee gets stuck, often at a 45-degree angle, until you manually move or otherwise manipulate it. If you think you have a meniscal tear, see your physician right away for diagnosis and individualized treatment.

How Do You Tear a Meniscus?

Menisci tear in a number of different ways:

• Young athletes often get longitudinal or “bucket handle” tears if the femur and tibia trap the meniscus when the knee turns.
• Less commonly, young athletes get a combination of tears called radial or “parrot beak” in which the meniscus splits in two directions due to repetitive stress activities such as running.
• In older people, cartilage degeneration that starts at the inner edge causes a horizontal tear as it works its way back.

What are the Signs and Symptoms of a Meniscus Tear?

You might experience a “popping” sensation when you tear the meniscus. Most people can still walk on the injured knee and many athletes keep playing. When symptoms of inflammation set in, your knee feels painful and tight. For several days you have:

• stiffness and swelling.
• tenderness in the joint line
• collection of fluid (“water on the knee”)

Treatment Options For Meniscal Tears

Nonoperative Approach

Initial treatment of a meniscal tear follows the basic RICE formula: rest, ice, compression and elevation, combined with nonsteroidal anti-inflammatory medications for pain. If your knee is stable and does not lock, this conservative treatment may be all you need. Blood vessels feed the outer edges of the meniscus, giving that part the potential to heal on its own. Small tears on the outer edges often heal themselves with rest.

Surgical Repair

If your meniscal tear does not heal on its own and your knee becomes painful, stiff or locked, you may need surgical repair. Depending upon the type of tear, whether you also have an injured ACL, your age and other factors, your surgeon may recommend surgery with use an arthroscope to either place sutures to repair the meniscus or to use small instruments to trim off damaged pieces of cartilage.

Surgical Techniques

Dr. Gambacorta has spent many years developing highly specialized arthroscopic techniques to treat tears in the meniscus. This experience has enabled us to repair not only small “simple” tears, but also complex multi-component tears.

In some cases, the torn part of the meniscus is either so small it would be impractical to repair, or so damaged that the repair would have a high likelihood of failure. In these cases, this tissue is simply trimmed out to leave a stable rim of meniscus and to minimize further damage within the knee.

Risks of Surgery

Risks of surgery include bleeding, infection (around 1%), nerve or vessel injury (most commonly an area of numbness on the skin adjacent to the incision), retear of the meniscus, knee stiffness (5 to 25%) and need for further procedures. Rare risks include bleeding from acute injury to the popliteal artery (overall incidence is 0.01 %), weakness or paralysis of the leg or foot, and a blood clot in the veins of the calf (0.12%). The goal of meniscal surgery is to obtain a stable, smooth rim of meniscal tissue that does not rub abnormally on the cartilage surfaces of the knee. Patients may still have an increased risk of arthritis in the knee after a meniscal tear, even if surgery is performed.

Alternatives to Surgery

Surgical treatment is usually advised for patients with symptoms of unstable meniscal tears, including pain, locking, giving way or catching in the knee. However, deciding against surgery is reasonable for select patients.

Nonoperative management of isolated meniscal tears is likely to be successful or may be indicated in patients:

• with small, stable tears located in the outer third of the meniscus
• with low demand lifestyles
• with no effusion or swelling of the knee and no symptoms of locking or catching in the knee.

You must complete a course of rehabilitation exercises before gradually resuming your activity.

Pre operative care

If you decide to have arthroscopic surgery to treat your meniscal tear, you may be asked to have a complete physical with your family physician before surgery to assess your health and to rule out any conditions that could interfere with your surgery.

Prior to surgery tell your doctor about any medications that you are taking. You will be informed which medications you should stop taking before surgery. This typically includes aspirin and anti-inflammatory medications such as Advil®, ibuprofen, Motrin®, Naprosyn® or Aleve®, all of which should be stopped 10 days before surgery. Tylenol® can be taken in the week preceding your surgery, but be sure not to exceed the recommended daily dose.

Tests, such as blood samples or a cardiogram, may be ordered by your doctor to help prepare for your procedure.

Postoperative care

After surgery you will be given written instruction sheets, pictures of your surgery, a prescription for therapy, and a copy of rehabilitation guidelines. This information will answer most of the questions you may have during your recovery.

You will be going to physical therapy (PT) after your surgery. At the initial evaluation you will meet with the physical therapist or athletic trainer (ATC) who will be responsible for your rehabilitation. During this visit, you will be instructed in exercises, wound care and how much weight you should place on your operated leg. In addition, your therapist will ask you to help set your goals for rehabilitation. If you have a mensical repair, you will be partial weight bearing with crutches for four to six weeks.

The entire rehabilitation process will take 2 to 6 months. During the early phase of your rehabilitation you will be closely monitored. As you progress, you will be able to do more exercises on your own. If you have any questions concerning your rehabilitation process, they should be directed to your rehabilitation team.

This information is intended for education of the reader about medical conditions and current treatments. It is not a substitute for examination, diagnosis, and care provided by your physician or a licensed healthcare provider. If you believe that you, your child, or someone you know has the condition described herein, please see your healthcare provider. Do not attempt to treat yourself or anyone else without proper medical attention

What is a Bunion?

A bunion is a bump found on the inside of the foot at the base of the great toe. The deformity usually involves the first metatarsophalangeal joint (MTP). This joint is made up of the phalanx bone inside the toe and the metatarsal bone in the forefoot. If you bend your toes up you can feel the ends of the metatarsals on the bottom of the foot. This is called the ball of the foot.

The deformity occurs because the end of the metatarsal bone(head) becomes prominent. This is secondary to the bone growing in this area or the great toe deforming toward the second toe. The most common cause of this deformity is related to shoe wear that presses on the great toe or first metatarsal head. One can also be born with this deformity. An injury can cause the deformity to occur, but it is uncommon.

What are the Symptoms of a Bunion?

Patients usually present to the doctor with symptoms of pain caused by shoe wear rubbing on the bunion. If the great toe deforms significantly, it can push on the second toe causing it to hurt or deform into a hammertoe which can also rub on the shoe and cause pain. Sometimes the patient’s bunion won’t hurt, but the second toe pain/deformity will bring them to the doctor.

Upon evaluation, we need to determine what is causing the bunion deformity. Besides taking a patient’s history, we will need to examine the foot and get x-rays. Upon examination we will be determining what is causing the bump/deformity. We will see if it is passively correctible. We will check range of motion of the toe. We check for arthritis of the joints as well as instability.

We will have the patient stand to determine arch alignment and how the bunion deformity looks upon using the foot. We also want to see the influence of the great toe on the other toes to see if any deformity in the other toes exists. We also check to see if the foot has adequate blood supply. X-rays are taken standing so that we see how bad the deformity is and what is causing it. We can evaluate the arch, the other toes, and see if any arthritis is involved in this deformity.

What are the Treatment options for Bunions?

Treatment can be surgical or non-surgical. Non-surgical treatment will not correct the bunion deformity or any lesser toe deformities that have occurred secondarily to the bunion deformity. Non-surgical treatment is an attempt to make the patient comfortable. Wider and deeper shoes are available that can take pressure off the bunion and/or toe deformities. Soft leather is helpful in that it can be stretched where the bump(s) are. A toe spacer can be used in between the first and second toes to keep them apart. A Budin splint or taping can be used to help the second toe lay flatter/straighter. Corn pads or cushion over the bump/deformity doesn’t usually help unless the shoe is bigger. Orthotics or arch supports are rarely helpful by themselves. They often make you wear a bigger shoe, though, and it is the bigger shoe that relieves the pain, not the orthotic. The orthotic may help someone with a significantly flattened arch by not allowing the foot to roll onto the bunion deformity when walking, thus lessening the stress/pain in this area.

Bunion Surgery

The indications for surgery are pain despite trying shoe wear that is wider/bigger, worsening of the deformity with or without pain, second toe deformity caused by the great toe pushing on it, pain in the bunion area when using the foot without shoe wear on.

There are many procedures to correct the bunion deformity. The procedure selected will be based on the result of your examination and standing x-rays. Bunion surgery can involve removing the bone bump, releasing and tightening ligaments, lengthening tendons, cutting the bone and putting it back together in correct alignment and/or fusing joints together, thus, making that joint not move any longer. Fusion is used for extremely severe deformities, recurrent deformity, hallux varus or for significantly arthritic joints.

Some of the complications that can occur are an infection, stiffening of the metatarsophalangeal joint, recurrence of the bunion deformity, hallux varus(the great toe deforming away from the second toe), numbness/tingling secondary to moving nerves aside to perform the operation, pain in other areas of the foot secondary to altered pressure on that part of the foot by realigning the bones or by abnormally walking on the foot after the operation, swelling, loss of correction or blood clot (DVT).

Postoperatively, a cast or special shoe is worn. The repaired ligaments, tendon, cut bone(s) need time to heal. Crutches/walker is commonly used to keep pressure off the foot until healing is enough to allow weight bearing. Weight bearing on the foot is usually allowed at four weeks after the operation. Weight bearing for exercise usually starts at eight weeks post-op. At twelve weeks post-op, usually there is no restriction on activity. If you walk or weight bear on your foot too soon, you can damage your operation.

Range-of-motion(ROM) exercises of the first MTP joint are commonly started 7-10 days post-op. These have to be done to prevent stiffness of the joint. We will instruct you on how to do this. Physical therapy is seldom needed. When we do use it, it is to help those that can’t get back their ROM of the first MTP joint themselves.

Swelling will occur. The amount of swelling is dependent on the extent of your surgery and how much you keep your foot elevated above your heart prior to your first post-op visit. Swelling lasts six months.

Wearing a post-op shoe with the foot wrapped properly is important to getting and keeping a good bunion correction. We will change the flexibility of your post-op shoe during your recovery period. We will advise you on how to wrap your foot.

When a fusion is needed, you will wear a cast for three months. Walking usually is allowed after one month post-op. Range-of-motion exercises are not usually needed.. After three months, you may need physical therapy. Casting causes an increased risk of developing a blood clot in your leg or a deep venous thrombosis (DVT).

While the bunion correction usually allows the foot to be placed in many different types of shoes without pain, it is important not to wear the shoe wear that causes the deformity. Loafer shoe wear is more prone to causing the deformity than tie-up shoes. Also, shoe wear that narrows in the toe area, i.e. comes to a point will usually cause recurrence of the bunion deformity.

Dr. David J. Pochatko, MD, is a fellowship trained Foot and Ankle Orthopedic Surgeon for Northtowns Orthopedics. With the help of his physician assistants, he specializes in the surgical and non-surgical treatment of the foot and ankle problems, injuries, and deformities. He also sees many people who have had failed previous surgery and need revision of that surgery.

Northtowns Orthopedics – where your first surgery is your best chance to get better.

What Is Planatar Fascitis?

Plantar fasciitis is one of the most common foot ailments that patients come to see us for at Northtowns Orthopedics. The plantar fascia is one of the mechanisms that support the arch. It originates at the bottom of the heel and inserts into multiple areas from the ball of the foot out to the toes. This can become inflamed and partially tear. The causes for these microscopic tears can be many. Usually it is caused by overacting or suddenly increasing your activity on your feet. Some believe it is due to heel spurs; however, they are only present in about 50% of cases. Others attribute it to inflammation caused by a systemic disease like rheumatoid arthritis. Whatever the cause proper evaluation and treatment are necessary.

Evaluation of plantar fasciitis includes taking an accurate history of the symptoms, physical examination, as well as x-rays. Plantar fasciitis pain is pain on the bottom of the heel usually worse with the first step of the morning or after sitting for an extended period of time, proceeds to get better with walking, and then is aggravated again with prolonged activity. The pain is not present at rest, and there is no swelling or bruising associated. The physical exam will reveal pain at the origin of the plantar fascia on the bottom of the heel. X-rays are obtained to look at the overall alignment of the foot and its mechanics, and to rule out a fracture or other causes for the heel pain.

When we evaluate someone for plantar fasciitis we take into consideration other causes of plantar heel pain. Other causes include atrophy of the fat pad on the bottom of the heel. This causes pain secondary to lack of cushion on the bottom of the heel. More possible causes include a systemic arthritic condition, nerve impingement/entrapment, stress fracture, or low back disc herniation.

Treatment for Plantar Fascitis

Conservative treatment of plantar fasciitis is 95% successful within 6-12 months of commencing treatment. The protocol for treatment includes such things as good shock absorptive shoe wear (sneakers), heel cushions, orthotics (inserts with arch support and heel cushion), night splints, stretching of the Achilles tendon, and an anti-inflammatory to decrease the pain. Avoidance of impact loading exercises is also advised.

The heel cushions or orthotics allow for shock absorption to the heel when you are active on your feet. Less stress on the heel helps.

 David J. Pochatko, M.D.

The ACL (anterior cruciate ligament) is a major ligament in the knee that helps stabilize the knee. It is a strong ligament inside your knee that allows you to turn, cut, twist and pivot. There are four ligaments that connect the knee joint. The best known of these ligaments is the ACL. The ACL connects the tibia, a bone of the lower leg to the femur, the bone of the upper leg. It prevents the tibia from sliding (translating) too far forward from the femur. The ACL is especially crucial in sports where it provides stability during stop/go/pivot motions.

 How do ACL Injuries Occur?

 There are two common mechanisms in which an ACL gets torn: Contact and Non-contact.  Contact ACL injuries involve a direct blow to the knee.  Usually the foot is planted and the shin bone (tibia) is hyperextended.  We see this injury pattern in collision sports and motor vehicle accidents.    Most injuries to the ACL occur with a non-contact mechanism. Non-contact ACL injuries can are caused by a pivot, which is a sudden cut or turn and the foot stays planted on the ground or take place when landing improperly from a jump. It is estimated that 70% of ACL injuries are non-contact.

What are the Symptoms of ACL Injuries?

• Immediate swelling
• Pain
• A “pop” is often heard
• Pain is noticed with walking and bending the knee
• Feeling unstable

ACL Treatment Options:

Non Surgical ACL Treatment

Complete tears of the ACL do not heal back together. In other areas of your body where you get a cut, your body has the ability to heal it with a scab or scar. Inside of your knee joint there is joint fluid. The joint fluid inhibits this healing process and does not allow the ACL to heal back together.  A non-surgical treatment may be elected if the patient is not very active and does not participate in sports.

ACL Surgery

Your physician may recommend an ACL reconstruction after sustaining an injury.  The reconstruction involves replacing the torn ACL with a new ACL graft. Since a repair (or suturing together) of torn ACL fibers is not effective, another piece of tissue (graft) is chosen by you and your doctor to place within your knee using the arthroscope. Autograft means your own tissue. These choices include two of your hamstring tendons or less commonly part of your patellar (the tendon from your kneecap to the bottom leg bone). Allograft tissues come from a donor. These tissues include either a patellar tendon or other soft tissue including most commonly the tibialis anterior and Achilles tendons.  Reconstructing the ACL reestablishes the stability and can serve to protect the knee from future injuries.

Surgical Techniques in Patients with Open Growth Plates

ACL injuries often occur in younger children with open growth plates.  The growth plates also called the physis, are the areas of the bone that allow it to grow in length. Treating this injury in children is challenging.  Using adult surgical techniques to reconstruct the ACL in a child can cause damage to the growth plates and may lead to a shortened or an angled leg. To avoid damage to the growth plate, Dr. Gambacorta may recommend the use of a special surgical technique called physeal sparing ACL reconstruction.  This is an accepted method for reconstructing the ACL in young children that minimizes the risk to the growth plate.

ACL Surgery Recovery:

 After surgery you will be given written instruction sheets, pictures of your surgery, a prescription for therapy, and a copy of rehabilitation guidelines. This information will answer most of the questions you may have during your recovery.

You will be going to physical therapy (PT) the day after your surgery. At the initial evaluation you will meet with the physical therapist or athletic trainer (ATC) who will be responsible for your rehabilitation. During this visit, you will be instructed in Phase 1 exercises, wound care and how much weight you should place on your operated leg. In addition, your therapist will ask you to help set your goals for rehabilitation. If you have an ACL reconstruction with no meniscal repair, you will be partial weight bearing when you are able to feel your leg again after surgery. If you have a meniscal repair along with your ACL reconstruction, you will be on crutches from 4 to 6 weeks.

The entire rehabilitation process will take 5 to 6 months. During the early phase of your rehabilitation you will be closely monitored. As you progress, you will be able to do more exercises on your own. If you have any questions concerning your rehabilitation process, they should be directed to your rehabilitation team.

If you are unsure what type of pain you are experiencing and would like to schedule a consultation appointment with     

Dr. Gambacorta,

contact us at (716) 636-1470.

For more information on this and other injuries see our website at www.northtownsorthopedics.com.

This information is intended for education of the reader about medical conditions and current treatments. It is not a substitute for examination, diagnosis, and care provided by your physician or a licensed healthcare provider. If you believe that you, your child, or someone you know has the condition described herein, please see your healthcare provider. Do not attempt to treat yourself or anyone else without proper medical attention.

Our Ski Season hours of operation are:

• Monday: 9:00 am – 4:30 pm
• Tuesday: 8:00 am – 1:00 pm
• Wednesday: Closed
• Thursday: 12:00 pm – 8:00 pm
• Friday: 2:00 pm – 10:00 pm
• Saturday: 12:00 pm – 10:00 pm
• Sunday: 12:00 pm – 6:00 pm

Northtowns Orthopedics Ellicottville Office:

 6133 Jefferson Street, U.S. Route 219

Suite 1001

Ellicottville, New York 14731

The Child Athlete is Not a Little Adult Athlete

The sports medicine clinic at Women & Children’s Hospital of Buffalo is the first orthopedic clinic in Western New York primarily focused on the pediatric athlete. Young athletes are at risk for specific injuries and often require age appropriate treatments. In the Department of Sports Medicine, Dr. Gambacorta understands this difference and the use of advanced surgical and non-surgical techniques when treating your patients.

Common pediatric sports related injuries treated in our clinic include:

•   Knee: Major ligament injuries, including ACL tears in children with open growth plates, Meniscal Tears and Discoid Meniscus, Osteochondral Fractures, Osteochondritis Dissecans (OCD), Patella Dislocations and Fractures, Knee Pain.
•   Shoulder: Traumatic Dislocations, Multidirectional Instability, SLAP Tears, Labral injuries, AC Separations, Little Leaguer’s Shoulder and Fractures, Rotator cuff Tears, Shoulder Pain.
•   Elbow: Little Leaguers Elbow, Osteochondritis Dissecans, Ulnar Collateral Injuries, Apophyseal Injuries, Dislocations and Fractures, Elbow Pain.
•   Hip: Femoroacetabular Impingement, Labral Tears, Snapping Hip, Avulsion Injuries, Dislocations and Fractures, Hip and Groin Pain.
•   Lower Leg: Exertional Compartment Syndrome, Stress fractures, Osteochondritis Dissecans (OCD), Achilles and Peroneal Tendon Injuries, Os Trigonium, Ankle Sprains, Ankle Instability, Fractures and Dislocations, Ankle Pain.

According to the Centers for Disease Control, more than half of all sports related injuries are preventable. We are committed to keeping your kids in the game for life. Call us at (716) 878-7563 to schedule an appointment with Dr. Gambacorta at WCHOB or (716) 636-1470 to schedule an appointment at another location.

Most of these injuries are due to falls or collisions. Common skiing injuries may occur in many areas of the body, like ACL tears, shoulder dislocations, leg fractures, wrist fractures and concussions.

Many of these injuries can be prevented by using proper equipment, being physically prepared and using some common sense.

REDUCE THE RISK:

• Stay in Control.
• Observe warning signs and stay off closed trails.
• Use appropriate equipment.
• Check that ski’s and binding’s are adjusted correctly.
• Use of a helmet can help prevent serious and even fatal injuries.
• Wrist guards and knee pads can help especially in terrain parks.
• Take ski / snowboarding lessons to learn proper technique.
• Take breaks for hydration and rest.

We at Northtowns Orthopedics hope you are able to enjoy and be safe while skiing and snowboarding this winter.  Should an accident occur, Northtowns Orthopedics has an office in Ellicottville, NY conveniently located at the base of the mountain at Holiday Valley. During the ski season a physician can be found at the office during day and evening hours to assist with care and treatment or you may schedule an appointment at one of our 7 other locations across western New York.