FLAT FEET – PES PLANUS

What exactly is a “flat foot”?

When you stand, most people have a “space” under the arch or instep of the foot, however the depth of space under the arch can be variable. You may notice in young children that their feet often look a little flat, this is usually totally normal as the arch tends to develop in their feet by of 9 or 10 years old.

Is it normal? 

In many people if the flat foot has been present since teenage years it may simply be the way their foot is shaped and entirely normal. In these cases both feet are often the same. There are many “foot specialists” who may tell you that your arches have “fallen”. It is important that any such advice is given to you by a suitably qualified professional who can tell what is normal from abnormal. Having a longstanding flat foot can be ok.

How do I know if my flat foot is normal or abnormal?

If only one foot is affected it may be abnormal. If your foot is painful and you think it is flat then it is possible you have something causing the flat foot. People often complain of this discomfort on exercise. If your foot shape changes over time (months) i.e. if you had normal arches and then the foot flattens then there is likely an abnormality. Rarely, from childhood you may have had quite a stiff foot, which as you develop into adulthood can become increasingly painful. This could be an abnormally flat foot. 

How do I know whether my flat feet are a problem?

You should see your family doctor and ask for a referral to a foot and ankle specialist if:

  • you are in pain (even if it is a small amount of pain). It is important to remember that flat feet can cause pain elsewhere in your body, due to poor gait and your weight being loaded unevenly up through your body with each step. If you have flat feet and are experiencing knee pain, back pain or headaches, it is important to consider whether your foot structure is contributing to pain.
  • your foot feels stiff or hypermobile;
  • you wear out shoes very quickly;
  • your feet seem weak.

 

What causes abnormally Flat Feet? 

  • Tarsal coalition, a childhood condition that is an abnormal fusing of some foot bones which makes the foot stiffer and quite flat
  • Tibialis posterior Tendon dysfunction. This is a large ankle tendon that can degenerate causing it to stretch and cease working correctly. It can be unexplained in many patients, in others it can be a build up of minor injuries.
  • Excessive laxity in the joints and this can be related to weight gain
  • Foot arthritis, arthritis in the back or middle of the foot is usually painful. It can be caused by an injury or develop with no real explanation.

What are the symptoms?

People may find walking painful especially along the inside border of the foot and ankle. Running can be very difficult due to pain. They can also get swelling in the inside of the ankle. Sometimes tingling or numbness can develop on the inside or sole of the foot because the nerve along the inside of the ankle may be slightly stretched or compressed.

How is the condition diagnosed?

The diagnosis is based on an accurate history or story of symptoms from the patient. Examining the foot for pain and swelling can differentiate a normal and abnormal flat foot. X-Rays can display the overall shape of the flat foot. They can also diagnose arthritis as a feature of the flat foot. An MRI scan is useful to determine whether the tendon is working normally and also if there are any abnormal bony fusions.

Can the problem get worse?

Unfortunately yes it can. If the cause is a simple tendon abnormality causing the foot to flatten then it can be helped with insoles and physiotherapy as the arch can be restored fairly easily. If the foot is left untreated then the foot can become arthritic and the flat foot can be quite stiff and impossible to correct with insoles. It is vital to get assessed as soon as possible as solutions to your problem can change a lot and become more difficult over time.

Different stages of flat feet

Problems related to flat feet are classified into different stages and these stages define what sort of treatment can be carried out.

Stage one

There is inflammation of the tendon but no obvious deformity. Diagnosis is made during a physical examination and confirmed by ultrasound or MRI.

Stage two

The severity of the flat foot is increasingly evident but it is not stiff or arthritic.

Stage three

The condition is increasingly painful and has lead to stiffness and arthritis in the hind foot.

Stage four

The arthritis has spread to the ankle joint.

 

How do you treat Flat feet?

If the foot is flat but flexible then you may be able to have treatment with simple insoles and physiotherapy. The idea is to support your foot to stop it getting worse but unfortunately the arch would be permanently flat without the insoles. For a more active person this treatment may not be satisfactory. In this case surgery to re-create the arch can be performed, a flat foot correction.

Will I need surgery for flat feet?

Surgery is sometimes required if the condition is more severe. The following procedures may be considered:

The calcaneal osteotomy

Sometimes known as the ‘heel shift’, this procedure involves moving the calcaneam, the large bone at the back of the heel which is out of alignment, correctly re- positioning it and then securing the bone using screws. At LFAC, we can sometimes, where appropriate, carry out this procedure in a minimally invasive way.

A tendon transfer

This is considered if the tibialis posterior tendon is severely damaged. A tendon is taken from one of the lesser toes, which is then transferred to run behind the medial malleolus. This does not affect the function of the toes and patients make a full recovery.

Fusion

At the final stages (stage 3 and stage 4) of adult flat foot, the fusion of joints needs to be considered in order to effectively eliminate pain.

Deciding whether surgery is necessary

Many patients are simply seeking advice on managing a problem. If you have an abnormal flat foot it will never be made “a normal shape in a normal shoe” without surgery. You can manage it with special insoles and physiotherapy but it can still get worse. Specially made shoes can be an attractive option, if your lifestyle is less active than others. Surgery is successful in over 80% of patients and worth discussing with your surgeon.

FLAT FEET – PES PLANUS Treatment at Udai Omni Hospital flat feet Treatment at Udai Omni Hospital

Achilles Tendonitis

Tendonitis is a term which means inflammation or swelling, and it occurs often in and around the Achilles.

There are two areas of the Achilles prone to this problem: in the middle of the tendon (mid-substance Achilles tendonitis) and at its insertion into the heel bone (Insertional Achilles tendonitis).

Patients with tendonitis within the heel and Achilles, may be seen in our Heel Pain Clinic where they can normally have an assessment, imaging, decision and first treatment within a single, first clinic visit.

Where is the Achilles tendon?

The Achilles tendon is the large, strong tendon that connects the calf muscles, specifically the gastrocnemius and soleus muscles to the heel bone or calcaneum. It allows you to point your foot downwards and push off the ground when you are walking or running.

   

What causes Achilles tendon pain?

  • In many patients no definite cause is found.
  • The Achilles tendon can withstand huge forces even in people who are recurrently stressing it, such as in long distance running however despite good conditioning, pain can ensue.
  • Rapid increases or changes in training regimes can precipitate the symptoms.
  • Inappropriate shoe-wear that can alter the mechanics of your foot when you hit the ground whilst running can increase symptoms.
  • Patients with more general symptoms such as that associated with different types of arthritis/inflammatory disorders can develop Achilles pain. 

Why does it get painful?

The tendon is made up of strong fibres made of collagen. Over time this substance can “degenerate” and become weaker and less flexible. As this occurs then tiny microscopic tears can develop in the tendon, leading to weakness, pain and eventually swelling. The tendon swelling often develops in the middle of the tendon because this area has a less well-developed blood supply hence unable to heal itself effectively.

What are the symptoms?

  • Pain and stiffness along the Achilles tendon in the morning
  • Pain along the tendon or back of the heel that worsens with activity
  • Swelling that is present all the time and can get worse throughout the day with activity
  • Severe pain the day after exercising
  • Thickening of the tendon

Achilles tendinopathy (non-insertional)

When pain, weakness and loss of function is associated with a swelling in the main portion of the tendon and not down at the bottom by the heel bone, it is referred to as Achilles tendinopathy. “Tendinopathy” is used to describe the typical microscopic findings in this condition and means tissue degeneration in the tendon fibres.

Achilles tendinopathy (insertional)

When pain, weakness and loss of function is associated with a swelling down at the bottom of the tendon by the heel bone, it is referred to as insertional Achilles tendinopathy. This is because the tendon “inserts” onto the heel bone. Sometimes the heel bone can be quite prominent here and very painful. This can be because of a combination of problems here including: 

  • Achilles tendon degeneration
  • Bone spurs at the tendon insertion

Inflammation of a small bursa (fluid filled sac behind tendon) – bursitis

How is the condition diagnosed?

The clinical features usually diagnose the problem. An X-Ray can be done to look for tissue swelling or bone spurs. A more helpful test is an ultrasound which can easily be done to look at the tendon quality or an MRI.

Can the problem get worse?

People often “live” with the symptoms for quite a while, or alter their activity profile. The symptoms can, unfortunately, progress with a potential even for rupture of the tendon. It is advisable getting assessed by a foot and ankle surgeon or physiotherapist when possible.

How do you treat Achilles tendinopathy?

Both insertional and non-insertional tendinopathy can be treated in a similar fashion.

The treatment is operative or non-operative.

The vast majority of patients require no surgery. Activity modification and rest coupled with suitable anti-inflammatories or pain-killers can really make a difference. Early rest in a boot may be needed in the short-term. A small heel raise (silicone insert) can help in the shoe. It is important to get introduced to a correct physiotherapy regime as they can prove hugely successful IF FOLLOWED AS INSTRUCTED. If physiotherapy is not fully successful then shock wave therapy can be used which has good results.

Operative treatment can be performed if other measures fail. Surgery usually involves exploration of the painful tendon area and removal of the degenerate/inflamed tissue or painful bony bumps on the heel. If the tendon is detached from the bone during surgery or a large amount of the tendon is removed then using another tendon in the foot to support the damaged Achilles tendon may be needed. This is not usually needed

 

WEIGHT LOSS RESOLUTION TIPS THIS COMING NEW YEAR!!

WEIGHT LOSS RESOLUTION TIPS THIS COMING NEW YEAR!!
SO YOU MADE a New Year’s resolution to lose weight like the rest of us, but research shows that most resolutions go down the drain within the first month or two after Jan 1. Staying on track is tough, but it’s not impossible. To optimize your chances of reaching your goal, you’ve got to actively set yourself up for success. This is where Dr Deepa Agarwal, Our Nutritionist’s role comes in. She’s helped us identify the keys to making your resolution stick so you won’t have to start again next year.
Resolve to think small and you can reach any diet goal — one focused step at a time. Why not start with these simple tips?

New Year’s Diet Resolution No. 1: Go Slow

Resolving to get more fiber in your diet this year? Maybe more fish or fresh fruit? Any diet change is easier if you take slow, small steps. For example:
1. Vow to add a piece of produce to your brown bag lunch daily.
2. Designate a day as fish day.
3. Package up a single serving of your favorite whole-grain cereal, then treat it as your midmorning snack.

New Year’s Diet Resolution No 2: Water, Water, Everywhere

Water: It’s cheap, fat-free, and gives your body a quenching boost. Find the idea of eight cups a day daunting? Think small:
1. Drink one glass first thing in the morning, before you brush your teeth.
2. Tempted by more soda? Another glass of wine? Drink a cup of water with a splash of your favorite beverage in it first.
3. Resolve to drink one more cup of water today than you had yesterday.

New Year’s Diet Resolution No. 3: Go for the Gold … and Red … and Purple

Colorful produce is packed with disease-fighting plant compounds, so when you shop, reach for a rainbow.
1. Designate a color-a-day. Maybe Mondays are yellow, with grapefruit, golden apples, or corn starring in meals, while Tuesdays are purple with plum and eggplant.
2. Get the kids involved and go for a theme: Build a green pizza with emerald bell peppers and artichokes, or a red produce-infused chili.
3. Vary the rainbow — pick up a new-to-you fruit or veggie the next time you shop.

New Year’s Diet Resolution No 4: Tackle Mindless Munching

You’re chatting with friends around the dinner table or watching a DVD — and you just keep nibbling. Try these tips to reign in the munchies:
1. Pop a stick of gum or a sugar-free mint in your mouth.
2. Brush or floss your teeth.
3. Pay attention — look at each piece of food you plan to eat.
4. Busy your hands with a glass of water, a cup of tea, or cleaning off the table.

New Year’s Diet Resolution No 5: Stack the Odds in Your Favor

Don’t forget to help yourself succeed, and to reach out for help when you need it.
1. Buddy up with a friend or family member with diet and weight lossresolutions. Then share your ideas, plans, and successes regularly.
2. Leave the temptations — ice cream, chips, soda — at the grocery store. Promise yourself you’ll cater to cravings only outside the home, in one-serving portions.
3. Socialize with non-food events. Get your friends together in the park, for a hike, or at the movies.

Bonus New Year’s Diet Resolution: Baby Your Body

Prevention: It’s a lot less daunting than treating a chronic condition, so do the little things that keep your body thriving.
1. Get moving 30 minutes a day most days. Go for a walk, give the car a good scrub, take a hike. Whatever gets the blood pumping qualifies!
2. Get those tests you know you need. Cholesterol checks, prostate exams, pap smears — stay ahead of the game by staying healthy.
3. Get all the snooze-time you need. Sleep helps body and soul recharge, stay healthy, and cope with stress.
Take enough steps and you’ll reach any goal. Resolve to make a few small diet resolutions this year and then just watch how far you’ll go!

WHAT IS SPONDYLOLISTHESIS? Conversation between patient & Dr Raghava

 

in conversation with Dr Raghava Dutt Mulukutla, Orthopedic Surgeon and Chief of spine surgery

Q. Doctor I am suffering from back and leg pain and I am told that my vertebra has slipped forward.

A. You are suffering from a condition called spondylolisthesis. Here one of the vertebra slips forwards over the vertebra below.

Q. How does this happen?

A. There are a number of reasons for this. This could result from anomalies in the spine at birth, some in early childhood and some due to fractures and various diseases and conditions of spine.

The two most common varieties

1. the first variety, when the vertebra slips forwards between 4-6 years of age. This may cause back pain or leg pain during childhood or during adulthood. Sometimes due to extra weight of pregnancy, women come to doctors with back pain and this condition is then diagnosed

2. the second variety is one which is somewhat common in females at about the age of forty. This is due to degeneration (wear and tear) and is more common in women who are overweight.

Q. What are the treatment options for this condition

A. Most patients get better with physiotherapy and medication. Once the pain subsides it is important to start exercise programmes to strengthen back and abdominal muscle. Walking, sports, yoga, swimming all help.

Q. Do I require surgery?

A. Only if the pain does not subside with physiotherapy, restricted activity for a few weeks followed by exercises etc. Surgery is more beneficial in those who suffer from leg pain rather than back pain alone

Q. What is the type of surgery that is done?

A. In children and young adults sometimes repair of the defect in the vertebra .is done to prevent back pain.Mostly screws and rods are placed in the spine and the vertebra that has moved forwarded is brought back to its original position. Cages are also used to maintain the reduction and restore the height between the vertebrae. Fusion is routinely done .

Q. How long do I need to take rest? And what are the precautions to be taken after surgery

A. You will be out of bed 2nd or 3rd day after surgery. You need to stay in hospital for 4-5 days. You will be in ICU for a day. You will be given a brace to support your back for a few weeks.

Q. When can I get back to work?

A. You need 6 weeks time for light duties and 3 months for heavy work.

Q. Do I need to undergo lot of physiotherapy?

A. You hardly require any physio. A few months after surgery physios will teach you a set of exercises which are very easy to follow and can be done at home.

Q. How painful is the procedure?

A. The procedure is not that painful and you will be given adequate pain relief medication after surgery

Q. can I play games and sports after surgery?

A. Swimming, yoga ,sports are all beneficial. You will be told how to lift weights and also given a set of exercises to strengthen your back.

Q. Will surgery affect my married life?

A. Not at all . You can have a normal married life and women can have babies and undergo normal deliveries

 

BLOG – Dr Udai Prakash at the Arthrex Surgical Skills Lab – LATEST INNOVATIONS IN ADVANCED KNEE ARTHROSCOPY at Arthrolab, Germany

I was recently in Munich to update himself in the latest technology in knee ligament reconstruction. The Arthrex surgical skills lab is equipped with the latest arthroscopic wet and dry lab simulators and is stocked with a complete inventory of the latest instrumentation and implants.

knee-arthroscopy-1

The exposure certainly gave me the edge in offering my patients the latest surgical options in knee ligament surgery.

 

The knee has several ligaments that can get damaged after sports injuries and accidents. These include the ACL (anterior cruciate ligament), the PCL (posterior cruciate ligament), MCL (medial collateral ligament) etc.

Without surgical reconstruction many young patients can never get back to sports and an active lifestyle. The knee becomes vulnerable to getting worn out (arthritis) at a younger age than average.

Early and expert ligament reconstruction can help young people get back their former active lifestyle and delaying surgery can result in damage to other structures within the knee. It’s like a loose hinge on a door, if not repaired early can result in other hinges coming loose.

Knee arthroscopy procedures (keyhole surgery) have advanced many fold in the last few years. This was an opportunity for surgeons like myself  interested in knee surgery to update themselves.

The experienced faculty from around the world conducted practical demonstrations in some of the most advanced arthroscopic (keyhole) procedures for ligament and meniscal injuries of the knee.

 

knee-arthroscopy-2 This is the latest in Anterior Cruciate Ligament reconstruction  using the all inside technique which would give a patient less post -operative pain and a quicker recovery.

BLOG – HEALTHY EATING by Dr Deepa Agarwal, Nutritionist/ Dietician

Every now and again many of us resolve to improving our health habits and promise ourselves to eating healthier. Follow these tips to treat yourself to healthy eating.

1. Don’t deprive yourself.

Aim to eat nutritious foods your body loves 80 percent of the time. Use that other 20 percent to treat yourself a bit.

2. Graze healthfully.

Tide yourself over between meals with healthier snacks. Whether your thing is sweet or savory, crunchy or chewy, there are plenty of options for snacking smart.

3. Eat fresh produce all year long.

Find out which fruits and veggies are in season even in the winter and stock up at the store and farmers’ markets. Eating fresh means eating the tastiest and most delicious produce around.

4. Indulge smarter.

Chocolate-dipped strawberries? Choco-Nut popcorn? Yes, please. Lower sugar doesn’t have to mean less deliciousness.

5. Understand emotional eating.

There is a link between how we feel and how we eat, particularly when it comes to stress.  Figuring out what kind of eater you are and whether you look to food to comfort you in times of anger, boredom, stress, or sadness will help you formulate a plan for making different decisions when faced with those emotions.

6. Make holidays, birthdays, and special occasions a little healthier.

Holidays and special occasions are always a good reason to enjoy delicious food. Luckily, there are plenty of ways to celebrate without going overboard.

7. Be mindful at meal times…

Staying tuned in to what you’re eating (as opposed to the phone or TV) is a great way to eat until you’re full, but not beyond. Being relaxed and mindful can also help you heed fullness cues.

8. …But don’t overthink it.

Recent research shows that the more time we take to think about whether or not we should eat something, the more likely we are to find a reason to justify eating it.  Checking in with yourself about your mood and are great habits to have, but remember to trust your gut.

9. Start the day right.

Studies suggest that eating a healthy breakfast is linked to sustained weight loss and weight management, particularly when that breakfast is nutritious and fiber-rich and high in protein.

10. Use the buddy system.

Having a partner with the same healthy-eating ambitions has been shown to help both people reach their goals.

What you eat can impact every aspect of your life from your mental health to your sleep and relationships. So go ahead and wholeheartedly commit to developing healthier eating habits this year. Set goals that are simple and tangible. Make time to meal plan to set yourself up for success. But above all else, believe in yourself. This is your year. You can do this!

Dr Deepa Agarwal, is Consultant Nutritionist at Udai Omni Hospital. She has an experience of 10 years having completed MSc and PhD in Clinical Nutrition.

To consult Dr Deepa Agarwal, please email enquiry@udaiomni.com

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Joint Replacement Surgery – Hip & Knee

By Dr. Udai Prakash
Dr.Udai Prakash is a consultant orthopedic and joint replacement surgeon at Udai Clinic Orthopedic Centre,Hyderabad.He holds an experience of over 21 years, his expertise include joint,hip and knee replacement surgery.


Hip and knee replacement surgery has a dramatic effect on patients’ lives. It is generally recommended if conservative measures have been ineffective or are likely to be ineffective. Most patients are able to go back to their former active lifestyle as their pain is relieved and mobility restored. Age is not a bar to joint replacement surgery. Modern materials and techniques have largely overcome the problems of wear and loosening of the implant. This brief introduction to joint replacement surgery will give you a flavour of the different types of joint replacements of the hip and knee performed by our surgeons.

Total Hip Replacement 

Total hip replacement is probably the most successful operation performed by any surgeon of any specialty.

Total Hip Replacement

It involves replacing both the acetabulum and the femoral head components of the ball and socket joint. It is indicated in painful conditions of the hip such as osteoarthritis, rheumatoid arthritis, avascular necrosis and certain fractures and in a vast majority of cases it results in a dramatic improvement in the quality of life. Modern hip replacements are made of materials like titanium or high grade stainless steel and contain bearings such as ceramics, cobalt-chrome and highly cross-linked polyethylene that make them very durable. Age is not generally a concern when considering someone for a hip replacement as long as they have the right level of fitness and the operation is done for the right indication. The probability of most good hip implants surviving 10 years is over 90%.

Total Knee Replacement 

Total Knee ReplacementKnee replacement is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. This is a well established procedure giving consistently good outcome with long term results often matching and sometimes exceeding those of total hip replacement. In general, the surgery consists of resurfacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee. During the operation any deformities must be corrected, and the ligaments balanced so that the knee has a good range of movement and is stable. In some cases the articular surface of the patella is also removed and replaced by a polyethylene button. Functionally, most patients get back to their formal lifestyle including most non-impact leisure activities like golf.

Unicondylar Knee Replacement

Unicondylar Knee ReplacementThis is an excellent procedure for limited arthritis or the knee. Usually performed through a smaller incision than total knee replacement, only the part of the knee that is diseased is resurfaced. The joint therefore feels and behaves more like a normal knee. Recovery is rapid and the patient is often discharged within 2 -3 days of surgery.

Hip Resurfacing

Hip ResurfacingHip Resurfacing is an alternative to hip replacement surgery in some patients. It is a bone conserving procedure that places a metal cap on the femoral head instead of amputating it. There is no long stem placed down the femur so it is more like a natural hip and may allow patients a return to many activities. It seems the ideal option for young individuals with severe hip osteoarthritis who are likely to outlive any prosthesis that they receive and who are keen to carry on with an active lifestyle. In the unlikely event of the resurfacing failing many years down the line the bone stock that has been preserved in the first instance makes the revision in most cases almost as easy as doing a primary hip replacement. According to the Australian Registry data for 2009, performance of hip resurfacing for men under 65 years of age is better than total hip replacement.

Revision Hip and Knee Replacement

Revision Knee ReplacementRevision Hip ReplacementPrimary hip and knee replacements do fail in time for a number of reasons. Revising them is highly specialised surgery requiring extensive training and access to sophisticated equipment, implants and hospital facilities. In most cases the old prosthesis is removed and replaced with a new implant. The surgery is often long and the risk of complications is higher than after a primary operation. Patients tend to spend the first 24 to 48 hours after the procedure in the high dependency unit. Surgery may involve the use of ultrasonic devices to remove the old cement used for fixation of the prosthesis, bone graft and/or custom made implants. Identifying failing joint replacements and performing the revision early is crucial for a successful outcome and therefore a regular follow-up by an orthopaedic surgeon is advisable for all patients carrying a hip or a knee replacement.

Frequently Asked Questions

  1. When is joint replacement surgery recommended?
    The reasons are many. Most patients with severe hip or knee pain as a result of advanced arthritis may be candidates for joint replacement. Joints can also get damaged due to previous injury or infection. There are many more indications including congenital disorders, childhood disorders leading to arthritis in later life, avascular necrosis etc.
  2. How long do joint replacements last?
    On average a hip or knee replacement has a 90% chance that it will survive 10 years and a 80% chance that that it will last 20 years if done by a well trained surgeon at a specialist hospital. The survival is highly dependent on the quality of surgery and the implant used.
  3. What are they made of?
    Modern joint replacements are made of many different materials – these include Cobalt-Chrome alloy, surgical grade stainless steel, titanium. Your surgeon should be able to give you more information depending on what joint you are having replaced. All joint replacements done at Udai Clinic are imported at the moment.
  4. How long will I need bed rest for?
    You will almost never need any bed rest. The aim of the surgery is to get you out of bed as soon as possible after surgery. You will need intensive physiotherapy during the recovery phase of 6-8 weeks.
  5. How long will I stay in the hospital?
    On average a patient after joint replacement will stay between 5-7 days in the hospital.
    Following complex joint replacement, the stay may be longer.
  6. Will I be able to sit on the floor?
    Many patients can sit on the floor after joint replacement surgery whether it is the hip or the knee. However, your surgeon will guide you on this depending on what you are having done and the complexity of the surgery. Kneeling might be difficult after knee replacement surgery. Again, the quality of surgery is the key. If done well and if the patient is motivated, most activities of daily living are possible.
  7. Can I ride a scooter or drive a car afterwards?
    Most patients can start driving after about 6 weeks but please discuss this with your physiotherapist or your surgeon.
  8. At what age is joint replacement recommended?
    Joint replacement can be done at any age. Most patients are between 55 – 80 years of age but the range can be from teenage to over 90 years. As long as the patient is reasonably fit, joint replacement can be done. Your doctor should be able to advise on this.

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Spine Surgery in hyderabad

BLOG – OH MY BACK! by Dr Raghav Dutt Mulukutla, Chief of Spine Surgery

If you are one of the few lucky ones who have not yet suffered from low back pain, do not be too happy. Second only to common cold, low back pain is increasing in incidence the world over.  Almost 80-90% of population  is affected by this problem in urban areas and  is the commonest cause of  absenteeism from work for people under 45 years of age in the Western World.

Most of us suffer for a few days to weeks and in some it becomes a chronic problem with umpteen visits to various specialists, homeopaths, ayurvedic  massage treatments, acupuncture, magneto therapy, reiki etc.

In India friends, neighbours, barbers, medical shop owners, grand mothers  are all specialists… they  have their own special remedies to offer and stories to tell. And of course that consultation with the foreign doctor – when I went to USA……… and the stories go on!

Who is at risk?

Almost 90%  have a mechanical reason for their back pain, and in 10% various diseases and disorders are responsible for low back pain. Many risk factors have been identified  :  lifting weights  beyond a workers physical capability, repeated bending and twisting in awkward positions , prolonged sitting especially in slouched position  is well known to produce low back pain. Obesity, cigarette smoking, lack of physical exercise, weak abdominal and back muscles  are some of the very potent factors  in causing low back pain.

What causes back pain?

The very fact that we are born as humans – our upright posture places tremendous stress and strain on the back.

  1. bad posture
  2. prolonged sitting : IT industry/ executives
  3. weak abdominal and back muscles
  4. weak bones ( osteoporosis )
  5. smoking
  6. driving 2 wheelers with bad shock absorbers
  7. over weight
  8. lack of exercises during and after pregnancy
  9. un-accustomed bending forwards and lifting weights

Let’s get to know some of the common conditions that cause low back pain:

The slipped disc: The human spine consists of individual bones called vertebrae separated by  discs-  which simply put  is a  jelly surrounded by fibrous tissue. When the discs get damaged or degenerated, it slips backwards and presses on the spinal cord and nerves causing pain in the lower  back or along the leg – known typically as sciatica.

Non surgical management: 

Over 90% of patients with slipped discs do not require surgery and get better with rest, physiotherapy and medication. You do not have to sleep on floor or hard beds. A firm bed is all that is required,  and rest for more than one week is not advisable. There is no need  for strict bed rest and you can move about  if pain permits.  Exercises should be commenced after the pain subsides and your physiotherapist would be the best person to teach you the exercises  to strength the back  and  abdominal muscles.

The surgery

Traditional surgeries such as laminectomy have no place in the management of disc prolapse. Surgeries such as Fenestration, Microscopic surgery or  Endoscopic microdiscectomy(Key hole surgery) offer the best results. The minimally invasive surgeries do not weaken the back muscles  and return to work is much quicker.

Spinal stenosis:

As we get older , the spinal canal  gets narrowed  due to arthritis and degeneration of tissues in the spine-resulting in pressure on the nerves. Typically  the patient may experience  low back pain, buttock pain and leg pain. Patients find it difficult to walk for long distances and have to rest after  walking for a few minutes. He/she can resume walking once the pain subsides. Majority of the patients get better with change in life styles, physiotherapy and epidural steroid injections in to the spinal canal. Modern surgical techniques once again give lasting relief  in those who do not get better  with non operative treatments.

Spondylolisthesis: This is slipping of one vertebra over the other, resulting in pressure on the nerves and again is responsible for back pain and sciatica. In those who do not get better with non operative measures, surgery offers good relief from pain.

Osteoporosis:  Again a common condition in women, is responsible for significant back pain and vertebral fractures. Exposure to sunlight, physical exercise, balanced diet,  go a long way in managing this problem. In those who suffer from fractures, minimally invasive procedures such as vertebroplasty – which is injection of synthetic material (bone cement) under local anaesthesia gives excellent results.

Other conditions: Curvature of spine (hunch back-scoliosis, TB, cancers and tumors and a variety of disorders can affect a human spine. Prompt consultation  and investigations would  help in diagnosis and treatment.

Who should be consulted for spine surgery?

Orthopaedic  surgeon or  Neuro surgeon? That is the doubt in almost everyone’s mind. Traditionally both operate on Spines.Today we have a sub-speciality  – Spine Surgery. Spine surgeons are specially trained to perform spine surgeries and it would not be too long  when Neuro surgeons would be operating only on Brain and Orthopaedic Surgeons on bone and joints and  Spine surgeons alone would be performing Spine surgeries.

Information on the Internet: Beware! Not all information on the net is accurate and current. Newer technologies that appear on the net, are like fashions that keep changing and  are industry driven.

Are spine surgeries safe?

Spine surgery is complicated and needs expertise. One need not worry too much about the complications and a well planned and well executed surgery in an understanding and cooperative patient gives excellent results.

Is there an age limit?

No! Today spine surgeries are performed in infants. Age certainly is no bar.

The second opinion?

When in doubt take a second opinion. But seeing too many doctors is quite confusing.

For a healthy back

  1. Correct your posture – do not slouch
  2. Get out of your chair every 20 minutes- stand or walk for a few minutes
  3. Getting out of chair is more important than buying expensive chairs
  4. Exercise regularly: yoga/walking/swimming/sports
  5. Quit tobacco

Dr.Raghava Dutt Mulukutla is  consultant orthopaedic and chief spine surgeon at Udai Omni Hospital. He has an experience of over 35 years, his expertise includes spinal deformity surgeries, scoliosis and back pain management.

To consult Dr Raghava Dutt Mulukutla, please email enquiry@udaiomni.com

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BLOG – TOTAL KNEE REPLACEMENT versus PARTIAL KNEE REPLACEMENT by Dr Udai Prakash, Orthopaedic Consultant Hip and Knee specialist

If you have been recommended a knee replacement then you may be a candidate for a partial (uni compartmental) knee replacement.You may be a good candidate for a partial or uni compartmental knee replacement if your arthritis is confined to a single compartment of the knee.

Your knee is divided into three major compartments: The medial compartment (the inside part of the knee), the lateral compartment (the outside part), and the patella femoral compartment (the front of the knee between the kneecap and thigh bone).

Partial Knee Replacement

In a partial knee replacement, only the damaged compartment is replaced with metal and polyethylene (a surgical grade plastic). The healthy cartilage and bone in the rest of the knee is left alone.

Total Knee Replacement is also a highly successful procedure. More than 600,000 knee replacements are performed in the US annually and this number is set to reach 4 million by 2030. Similarly, in India it is thought that over 30,000 are being performed annually and this number is increasing by 15% annually.

Partial knee replacement numbers are much smaller as not all patients are suitable for this type of conservative surgery and not all knee surgeons are trained in performing this surgery.


Dr Udai Prakash, is chief joint replacement surgeon at Udai Omni. He has over 20 years of experience and specialises in primary and revision hip and knee surgery.

To consult Dr Udai Prakash, please email enquiry@udaiomni.com

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