Dr. Chris Kestner Speaks about Ankle Injury & Recovery

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Toree: Hey, I’m Toree McGee and this is The Rapid Recovery Report, sponsored by ROMTech, the more modern technology of rehabilitation. We’ll be doing this weekly series, and if you’ve watched us before, you know the drill, but for those of you who are new, let’s get into it a little bit. 

We talk to different guests, surgeons patients, insiders here at ROMTech, and we talk about all things wellness and health, and we’ll also touch on ROMTech’s PortableConnect. If you’re new to ROMTech, this device right here is the PortableConnect. Ain’t she pretty? It’s a high-tech recovery device that’s geared to get patients moving and on to recovering faster from injuries and surgeries and just getting back to their lives. If you’re interested to learn a little bit more, you can visit us at www.romtech.com and follow us at the social handles listed in the description below. 

Today we’ve got a really fun guest, so let’s get right into it. 

Foot & Ankle Surgeon, Dr. Chris Kestner

Intro: There’s an old saying, put your best foot forward, but did you know that there’s a large percentage of people who neglect their foot and ankle care and end up with real problems? Don’t believe me? Ask Dr. Christopher Kestner, a graduate of the Sydney Kimmel Medical College at Thomas Jefferson University in 2006. Dr. Kestner has worked with elite athletes and everyone in between with the belief that his patients deserve one-on-one top-notch care, and Dr. Kestner delivers just that to his patients every day. Why walk around in pain? Call Dr. Kestner today. Oh, and he might drop some mad baseball knowledge on you too. He was a star athlete in college, just saying. Dr. Kestner, we salute you. 

Toree: Hey Dr. Kestner, great to have you here. 

Dr. Kestner: Hello, great to be here. 

Toree: We’re excited. Let’s get into our questions here. Tell us where you’re from and where do you currently practice? 

Dr. Kestner: Sure. I’m from uh Wilmington, Delaware originally, and then moved to Charleston South Carolina about 10 years ago. I’ve been working with a kind of a sport-centric practice down here ever since I moved here. Lucky enough to take care of some of the local college athletes, semi-pro, and minor league athletes in the area. 

Toree: Awesome, okay. What got you into medicine in the first place? 

Dr. Kestner: Sure. My dad was actually a physician, so growing up was exposed to it a little bit, and then was lucky enough in college to spend some time with a local surgeon in a small town in Vermont and to see someone there who really kind of had to deal with everything because there aren’t many many docs in different areas up there. so really got exposed to quite a variety. I guess that’s probably what really spurred all the interest. 

Toree: Okay, so your dad, your family, did they play a big part in your decision to go to medical school? 

Dr. Kestner: Honestly, he really didn’t kind of push either way. He said, “If it’s something you’re interested in, let me know, but make sure you know what it all involves.” They were supportive but didn’t really push in any specific direction. 

Toree: Okay, well, that’s good. And I’m sure it’s really helpful to kind of know what you’re getting into before you get into it. As long as he was very honest about how tough it is. 

Dr. Kestner: That’s probably true with just about anything. 

Toree: Yeah, definitely. During your residency, you performed all types of orthopedic surgeries

Dr. Kestner: Correct. 

Toree: What drew you then ultimately to foot and ankle?

Dr. Kestner: Yeah, great question. Really it’s probably just a variety. There are multiple types of surgeries, both with bone corrections, bone cuts, but then also a lot of soft tissue type surgeries involving tendons and ligaments. The patients are all different ages. Kind of a nice combination of traumatic injuries but then also wear-and-tear type injuries. Every patient’s totally different. Every case is totally different. It’s a very complex sequence of joints, a lot of complex motions. That was kind of just interesting as far as just the challenge of what all that would entail. 

Toree: Okay. I mean there’s a lot of really small bones in the foot, so are a lot of the surgeries really intricate? 

Dr. Kestner: They can be. 

Toree: Did you play with Legos a lot as a kid? 

Dr. Kestner: Absolutely. 

Toree: Putting stuff back together, perfect. 

Dr. Kestner: Absolutely.

How Common are Foot & Ankle Injuries?

Toree: If you were to compare the number of foot and ankle injuries with the number of like knee injuries in general, would you say that there are more foot and ankle injuries or less than there are knee? 

Dr. Kestner: Historically, there are actually way more foot and ankle injuries. The most common cause for any emergency room visit from an orthopedic standpoint is a sprained ankle, and a lot of those can be misdiagnosed. They can have small breaks in either the foot or an ankle bone itself, but ankle injuries are certainly the most common. 

Toree: Yeah. I mean, I feel like everyone I know has had a sprained ankle at some point in their lives. 

Dr. Kestner: Exactly. Who doesn’t twist their ankle at some point? 

Toree: Yeah. Do patients sometimes put off seeing a doctor about a foot-and-ankle treatment because a thing like a sprained ankle is so common? 

Dr. Kestner: Certainly, all the time, particularly when it happens on the weekend. Nobody wants to ruin their weekend sitting in an emergency room or anything like that. A lot of the time, just putting some ice on it and taking some Advil and giving it a day or two, kind of let it declare itself. Mondays tend to be very very busy because we get the calls from everyone who got hurt over the weekend, and they say, “Well, it’s not any better, I better come in.” 

Toree: Yeah. Do you think that foot-and-ankle injuries are kind of the ones that tend to get put off the most rather than other orthopedic injuries

Dr. Kestner: I think it kind of depends. If you’re able to walk on something and kind of get by, I think people are willing to give it a day or so and see what happens. It can be a little bit harder if you hurt your foot to a point you can’t really walk, then you might be more apt to seek some treatment or some care. 

Toree: Yeah. I mean it seems really acute. If you have something wrong in the foot or the ankle, it’s going to hurt a whole heck of a lot, whereas people needing knee replacements will tough it out, rather than kind of walking around on it, or rather than going in and getting surgery and being down and out for a while. 

Dr. Kestner: Certainly, and that probably comes into play too. Is it a new injury or if it’s something you’ve been dealing with for quite some time. They might say, “Alright, another week or so may not hurt too much more,” so they might deal with it.

Using the PortableConnect for Foot & Ankle Recovery

Toree: You’ve started using the PortableConnect in some of your patients’ rehab, is that right? 

Dr. Kestner: Absolutely. 

Toree: Okay. How does it currently work for foot and ankle? We talked to a lot of folks that do knees. Well, that’s pretty self-explanatory, but tell us a little bit about it. 

Dr. Kestner: I think it’s fantastic for foot and ankle because a lot of the times, depending on what the injury may be, they may not be able to put weight through their foot. We call it non-weight-bearing. Say they had a broken bone, if you put too much pressure on it, the bone could shift or move, and that could certainly compromise the repair, whereas the PortableConnect is a good way to get some motion going on but that can kind of limit the force through the foot or the ankle.

Toree: Sure. 

Dr. Kestner: Using the motorized mechanism allows them to get the motion, start working on some strengthening, but it really limits the amount of force going through whatever the repair may have been. 

Toree: Right. For those of you that have never really seen the PortableConnect in person, there’s a motor built inside, so it’s kind of able to move your feet along for you. Dr. Kestner’s patients that are non-weight-bearing can sort of just rest their foot on the pedals and have it do the motion for them, where they’re able to move and kind of keep that ability to be limber, I guess, up a little bit. 

Dr. Kestner: Exactly, right, and then as they can start to put some weight through it, the motor can kind of assist them where they’re not putting their full weight but starting to put some, and then as their weight bearing increases, they actually end up getting some resistance, and that can work more on strengthening. You can really dial in exactly how much resistance you want based on what you’re trying to get to heal, whether it’s an Achilles rupture or a ligament issue, or a broken bone. 

Toree: Okay. Do you have patients that are on the device in braces or something, or maybe they’re not supposed to be moving their ankle so much but they’re still able to use it? 

Dr. Kestner: Yeah, you certainly can. The braces will just kind of limit the motion to some degree but that way they can still get motion through their knee or their hip, absolutely. 

Toree: Perfect, okay, awesome. We just never talked to foot-and-ankle people so this is really interesting. 

Dr. Kestner: It’s been a great addition to our practice, honestly. 

The Growing Popularity of Ankle Replacements

Toree: Great. We’re glad to hear it. Now, a complete ankle replacement is a thing when I feel like it didn’t really used to be. How long has that been available to patients? 

Dr. Kestner: Sure. They’ve been available just in some aspect for a few decades now, maybe 20 years or so, but the early devices, it’s a much more complex joint, and the early devices were not as reproducible and predictable, and so the long-term results just were somewhat questionable. The newer designs have become much better, a lot more predictable, and so starting to see more patients becoming good candidates for them. 

Toree: How does an ankle replacement work? We’ve seen things with the knee joints and it moves basically just like this, not side to side or anything. You can move your foot all the way around. 

Dr. Kestner: Right, and that’s one of the reasons why it’s much more complex joint to replace is because you have all these degrees of motion you have to account for, and that can cause increased wear in the joint. With any joint replacement, the theory is more or less the same. The natural cartilage in the joint has been worn out. What you basically do is cut bone down to good healthy bone, and then put a metal covering on each of the bone, and then typically a piece of plastic in the middle. Now, instead of having bone touching bone, you have basically metal with a plastic intermediary to allow that motion to occur. 

Toree: Okay, that’s very cool. I mean it’s so neat. What is the lifespan then of like a total ankle replacement? I know they say knees have certain amounts of years that are typical for it. What about ankle? 

Dr. Kestner: Yeah it’s variable, depending on how active people are. The newer results are showing that over 90% are still in after 10 years, so that’s pretty successful that in 10 years you have a 90 chance of still having the ankle replacement in. It’s not quite as good as a knee or hip but it’s getting much better. 

Toree: I mean, I would assume that it’s much harder on the ankle when you do an ankle replacement than it would be on a knee because knee replacements, you’re still bearing the bulk of a patient’s weight. It’s not the full weight. Like an ankle is the absolute full weight of the patient, and you have all of that complex movement in there. 

Dr. Kestner: Correct. Research has shown it’s approximately 10 times the amount of weight that you experience through a knee or a hip, and through a much smaller surface area, so it gets concentrated pretty significantly. 

Toree: Yeah, I mean you think about it that way, and 10 years is really impressive. Now, we see a lot of arthritis is really really common. Do you see high levels of arthritis in patients as far as ankles go? 

Dr. Kestner: Yeah. Fortunately, not as much in ankles as knees or hips. It’s only about 10% as common as it is in knees or hips. It’s a remarkable joint. The thickness of the cartilage is substantially less than the knee or hip. It feels so much more forced, and yet for some reason, the joint is much more resilient to developing arthritis. More typically the arthritis in the ankle from post-traumatic causes, either old breaks, or someone’s been in a car accident, or rheumatoid arthritis which can affect any joint, but just your typical run-of-the-mill osteoarthritis which is typically your wear and tear isn’t nearly as common in the ankle as it is in the knee or hip. 

Toree: That’s magical to me. 

Dr. Kestner: It’s very interesting. We have no way to explain that. We talk about it all the time. 

Toree: Yeah, it doesn’t make any sense in theory. 

Dr. Kestner: We’re learning more and more, but some things are still a mystery. 

Preventing Foot & Ankle Injuries

Toree: Yeah, what a trip. Do you see more injuries for foot-and-ankle patients related to weight? Are heavier patients kind of more prone to foot and ankle problems? 

Dr. Kestner: Certainly. It’s an aspect of physics, basically. When I talk to patients, I kind of equate it to a car. If you had a big van on very very small tires, you’re going to put a lot more force through those tires. At the end of the day, our body is a machine, and so more weight or more force, let it be running or impact activity is going to cause more wear and tear. I certainly see more Achilles tendinitis, more arthritis in people that might be carrying a few extra pounds. 

Toree: Okay. Is diet and exercise a big thing that you pitch just being foot and ankle as well? 

Dr. Kestner: Absolutely. I generally tell people diet is about 80% of it, exercise is about 20%, but exercise is extremely important, and then the type of exercise is also very important. Running is fantastic, but it is more wear and tear. There are other things such as a pedal device where you can still burn as many calories and get as much use out of it but it won’t cause nearly as much wear and tear on the body. 

Toree: Yeah. How do you feel about walking? I’m a big person, like I have a standing desk and a treadmill under my desk where I try to walk all the time. 

Dr. Kestner: Sure. Walking is great. I tell patients that elliptical machine is a little bit better but there’s something to be said for being outside and being in the fresh air. It’s extremely therapeutic. I have patients ask all the time. They say, “Well, how do I not get arthritis?” I say, “Well, honestly, sit on the couch and don’t do anything, but then you’re going to end up with a whole host of other problems that are honestly much worse.” 

Toree: Yeah, definitely. 

Dr. Kestner: That’s really our job as physicians is to keep people as active as possible. 

Toree: I mean, that’s a common theme that we hear across pretty much any specialty or any practice is a body in motion station stays in motion, so just keep moving. 

Dr. Kestner: Exactly right.

What to do When Experiencing Foot or Ankle Pain

Toree: Great. I’ve got just one more question for you. Thank you so much again for hanging out with us. What advice do you have for someone who’s watching this who might be experiencing foot or ankle pain, like do’s and don’ts? 

Dr. Kestner: The first thing I would say is don’t be afraid to get an evaluation, to call, make an appointment, check an x-ray, and kind of see where you stand is always the first place to start. Frequently, there are a lot of things we can do to help prolong any wear and tear, prolong any issues before they become more severe. If you hold off too long, you lose some of those options, and then you’re looking at either living with it or a more substantial surgery, but there’s very little downside into at least checking an X-ray, getting an evaluation, very very few people would push anyone into a surgery if it’s not 100% necessary but it’s just very nice to get an expert’s opinion, an honest opinion, see what’s going on, and what can be done, and what we can do to make you feel better, and kind of keep you doing the things you want to do. 

Toree: Perfect. See, so don’t be afraid of the doctor. You have really good ones like Dr. Kestner out here looking forward to helping you. 

Dr. Kestner: That’s right. Yeah, we’re not just there to operate, I promise. 

Toree: All right. Well, thank you again, Dr. Kestner, for taking the time. It was really exciting and fun for me personally to have a foot-and-ankle specialist on here. It’s a little different than our run-of-the-mill total knee and hip orthopedist

Dr. Kestner: Good to mix it up a little bit. 

Toree: Absolutely. We appreciate it. Folks, be sure to check Dr. Kestner out at www.scsportsmedicine.com. They’re also on Facebook at SC Sports Med, and you can find all of that contact info below in the description.  Don’t forget to follow us as well on Facebook, Instagram, and LinkedIn, and subscribe to our YouTube channel. That info is also in the description.  

Hey, if you’re interested in being a guest on our show reach out to us by emailing [email protected]. Until next time, stay well and keep moving.

Thanks again, Dr. Kestner. We had a great time. 

Dr. Kestner: Anytime. Have a great afternoon.

Toree: You too.

Disclaimer: The content discussed on this program is often medical in nature and is used for informational purposes only. No content discussed should be taken as medical advice. Please consult your healthcare professional for any medical questions.

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