Peter Attia· MD
so it's there's stages so there's early stage where you can treat it in a boot sometimes we just go in and and uh address the tendon itself more advanced stages you start to see changes in the ankle joints so you would never how is this occurring I mean why isn't this a problem that is fixed with foot exercises and and PT and like what why would we let a person get to the point where they're Arch completely collapses and the musculature becomes so compromised because some people have anatomy of their foot they're pronated flat feet that is not easily correctable even with exercise it's just mechanically different and that tendon itself once it becomes so stretched and and these aren't people who would benefit I mean I'm not a huge fan of of orthotic arches but wouldn't these people benefit from that yes and they are prescribed that but it doesn't it doesn't mean the disease process won't progress a lot of this is mechanical we've talked about that and a lot of this is biologic too and so there we have we have decent ways of helping people if they don't have a biologic problem we have decent ways of helping people with mechanical problems but it's all of this all of these factors uh play into whether someone would benefit from EXC excise right but so there are things that can be done nonetheless so you can give people rigid shoes to help with their feet and allow them to exercise other parts right so just because one area is deficient you can fuse the ankle so the pain goes away and still go get on a plan to maintain the health of the rest of you but if your foot kills with everything you do you can't help any of the rest of it so when people talk about an ankle Fusion normally they're talking about tibia to Tais that's the normal Fusion now that was traditionally what's used now again this is not my field but there's also ankle Replacements now too which are becoming more popular because again the technology is improved but that's not the same patient necessarily what are the other injuries to the ankle and foot that require surgical intervention so there are there fractures of the fifth metatarsal so this is the fifth metatarsal and you can have fractures of the proximal fifth metatarsal where there's a tendon attached here called the paranas tendon which um pulls off that piece and that rarely requires surgery and that tends to heal if you fracture it right here less than a centimeter higher up that fracture is in an area where the blood supply is pretty deficient call it a water water shed Zone and that often won't heal so sometimes we'll make those people so you break it here oh don't worry about it you could wear whatever shoes you like as long as it doesn't hurt you break it here oh you need to be in a cast or a boot for six weeks non weight bearing or surgery to put a screw in there wow right so there are certain types based on the blood supply to the Bone certainly navicular stress fractures are another one of those fractures that are serious that typically in a runner yes correct correct what about the other metatarsals you have stress fractures tend to heal the you know we we see it commonly second and third metatarsal stress fractur do they have Watershed zones as well no they heal it's just the fifth one but you know a lot of people have I worry about the stress fractures because often times you'll see somebody they have foot pain they're Runner and then you find out they had three other stress fractures