Orthopedic surgeons specifically manage issues related to your musculoskeletal system—the system that provides form, support, stability, and movement for your body.  While the main components—muscle and bones—are fairly obvious, this system also includes cartilage, tendons, ligaments, joints, and connective tissue.

Your visit to an orthopedic surgeon might be for a chronic issue like carpal tunnel syndrome or for an acute injury like a torn meniscus, the thin fibrous cartilage in the knee.  Like most office visits, your initial visit with your orthopedic surgeon involves diagnosis and the development of a treatment plan. And it can set the stage for a life-changing procedure.

Edward Yang, MD

“I went into medicine and specialized in orthopedics because of my love of fixing things with my hands,” says Edward Yang, MD, a board certified orthopedic surgeon and Chief of Orthopedic Surgery at Mount Sinai Queens. “This combined with my passion for helping people led me to surgery and the specialty of Orthopedics. The surgery we do can truly change our patient’s life.”

And the right surgeon can make a big difference. “I provide my patients with a written diagnosis, and treatment plan. In addition, I often video a short exercise program for them to do at home. If my diagnosis and your symptoms are severe enough to warrant surgery, I provide written pamphlets on the surgery that is being planned,” he says. “Make sure your surgeon also discusses the risks, benefits, and alternatives to treatment when discussing surgery. “

In this Q&A, Dr. Yang offers some suggestions for how you can prepare for a visit with an orthopedic surgeon and for orthopedic surgery.

Prepare for the visit: Communication and planning in advance for the visit are key. Research shows the more involved you are in your care, the better the results.   The first steps are the same as for any doctor visit:  compile the information you need to give your orthopedic surgeon a good medical history, including any other conditions or past surgeries, and all of the medications you are taking.

Write it down: Write down the reason for your visit; this one step provides tremendous clarity for both you and your doctor.  It is important to focus, as much as possible, on the reason for your visit: When did the pain start? Where is the pain? What makes it hurt?  What helps? Have you had this problem before?  What is the quality of the pain?  Try not to volunteer unnecessary information. Be prepared with a written list of questions, and plan to take notes during the visit.

Bring your images: A great tip for saving time and money is to bring copies of any scans or X-rays related to the reason for your visit. Most images are available in digital format and are easily transported to your doctor’s office on a disk or USB flash drive. Don’t forget the accompanying report from the radiologist.

The physical exam: Dress comfortably in clothes that are easy to change into and out of. This is the time to ask your questions and be clear about next steps. The next steps often utilize the diagnostic tools in the orthopedic surgeon’s toolbox.

Healing from an injury or chronic orthopedic condition can be challenging, and many patients are unsure about their options for recovery. For example, will your condition require physical therapy or surgery, and when is it necessary to see a specialist?

Melissa Leber, MD

In this Q&A, Melissa Leber, MD, Associate Professor Orthopedics, and Emergency Medicine at the Icahn School of Medicine at Mount Sinai, explains the different options patients have to relieve their pain. Dr. Leber is also Director of Player Medical Services at the US Open and Director, Division of Emergency Medicine Sports Medicine.

If I have a chronic orthopedic condition or injury, when should I see a specialist?

If you’re developing pain, whether it’s your knee or shoulder or another body part, you can try a course of anti-inflammatories, rest, and activity modification. If your pain is really debilitating—for example, if it’s greater than a three or four out of 10 on a pain scale, or it’s starting to affect your everyday life and the things you love to do—that’s when you should see a specialist.

When is physical therapy the best option, and when is surgery called for?

After evaluating the patient, we decide on whether to recommend surgery or non-operative treatments. Most of the time, we can present the patient with various options and decide on what is best for that particular patient. It depends on age, medical history, and their goals. Occasionally, surgery is 100 percent necessary to get you back to your normal function, but most of the time, surgery is elective. It’s not a black and white answer on whether you have to do surgery or have to do physical therapy. It may depend on whether you’re an athlete, how quickly you want to return to normal activity, whether you’re okay functioning at 80 percent versus 100 percent, and some of that is a personal discussion between you and your physician.

Are my age and general health important factors in choosing surgery versus physical therapy?

Your age and general health definitely affect whether we might recommend non-operative treatments versus surgery. Some of that depends on what your goals are for return to activity, and on what other conditions you may have: diabetes, high blood pressure, heart conditions, etc., Some medical problems may make you less fit for surgery. Sometimes it’s not really a choice, because, in the case of a hip fracture, for example, you may never be able to walk again without surgery. It depends on the condition.

If my orthopedist recommends surgery, what questions should I ask?

• What will the recovery time look like?
• Should I expect to be in any kind of a brace or a sling after the surgery?
• How much physical therapy will I need to return to normal?
• When should I expect to be at 80 percent functioning versus 100 percent functioning after the surgery?
• What is the success rate of this surgery? Is it a 100 percent success rate, 80 percent success rate?
• What are the risks of this surgery?
• Is it possible that I may come out of the surgery having continued pain?
• What would you do or recommend if I were your sibling or parent?

You will weigh the pros and cons of the surgery based on how much discomfort you’re in now and how much it’s affecting your everyday life. For example, a patient with knee pain may have knee arthritis as well as meniscus tearing, and we have to choose which patients we recommend for surgery, in which case we might say, “Okay, let’s focus on the non-operative treatments for now.” If you’re not doing well, we might recommend you consider surgery later. Some of that depends on how much arthritis is in the knee, and that’s a much more in-depth conversation.

What are some of the common misconceptions patients have about orthopedic surgery?

One of the biggest misconceptions we hear from patients is that they prefer not to see an orthopedic surgeon because they automatically think they’ll be recommended to have surgery, and that’s not true. Most of the time, the orthopedic surgeon will try non-operative treatments or conservative treatments rather than jumping straight into surgery. It really is a case-by-case situation. In general, you shouldn’t be afraid to go to see the specialist, because they may have great advice and ideas regarding the non-operative treatments that may help you—interventions such as injections and even platelet rich plasma and other things that we can offer.

What else should people know about physical therapy and surgery?

Going into physical therapy takes time and patience, but in general, you can work on functional correction using strength training, balance, stretching, and all the modalities that physical therapy can offer. Most of the time, physical therapy can work wonders. If you’re willing to put the time and effort in, you really can do great things with physical therapy and rehab. Try to find a therapist who you trust and connect with as physical therapy will go better. You can always switch to a different physical therapy clinic if you don’t love the place you are going. Ask your doctor for recommendations on which physical therapist or physical therapy location would be best for you.

Should I try taking medications at home?

Many patients come to see us having not tried taking any over-the-counter medications at home. Taking a few doses of anti-inflammatories known as NSAIDs—non-steroidal anti-inflammatories—can help considerably. Naprosyn or ibuprofen are different types of NSAIDs that can help a lot, even just two or three doses. Of course, check with your primary care doctor if you aren’t sure whether it is safe to take NSAIDs given your other medical problems and medications.

If my doctor tells me I need to rest, does that mean I can’t do anything?

When a doctor recommends rest after you’ve had an injury or an area of pain, it doesn’t mean complete rest. It just means sometimes doing more low impact exercise or trying to avoid over stressing that area of pain or that joint. If you have an injury or an area of pain, ask what exercises you can do, because many times there are a lot that you’re able to do to stay active. As you get older, if you stop exercising completely, you get deconditioned quite quickly, and that can hurt your recovery and your performance. I recommend trying to stick with activity but alter that activity to do something slightly different so you’re not injuring that area further.

How much strength training versus cardio should I do?

Patients shouldn’t focus on cardio 100 percent of the time. I often see patients coming in with knee or hip pain, and they walk 10,000 to 20,000 steps a day, or they run three to five miles every day. Sometimes it’s actually best to focus on resistance and strength training more than cardio. As patients get older, strength training becomes more and more important. When someone is 20 years old, they could do 80 percent cardio, 20 percent strength training. When they’re 80 years old, it should be the opposite, where they do 80 percent strength training and 20 percent cardio. If you have the capability, getting a personal trainer can be extremely helpful towards maintaining a healthy and pain-free life. They can watch your technique and help avoid injury while also making you stronger.

In this Q & A, Meghan Kelly, MD, Assistant Professor of Orthopedics at the Icahn School of Medicine at Mount Sinai, provides at-home stretching tips that treat heel pain in more than 90 percent of plantar fasciitis patients and advises on how to prevent developing the painful condition.

How do I make my heel stop hurting?

To immediately deal with the pain associated with plantar fasciitis, you can use ibuprofen (ex. Advil) or naproxen (Aleve).  In addition, rolling a frozen water bottle under the arch of your foot can also relieve the pain.

What can I do to treat plantar fasciitis?

The way to treat about 95 percent of plantar fasciitis cases is by stretching. There are two main stretches which, if done well every day, should make the condition go away in about a month. This method worked for me and every one of my patients.

On the left, Dr. Kelly shows how patients can stretch their plantar fascia and, on the right, she demonstrates an Achilles tendon stretch.

Attend to your plantar fascia.

Plantar fasciitis is an inflammation of the plantar fascia—a thick band of tissue at the bottom of the foot. You can address this inflammation by stretching that tissue. Do this by putting your leg in a “figure four” position with the ankle over the opposite knee. Then, grab your toes and pull them toward your shin and massage the plantar fascia for 5 minutes. You should do this stretch two or three times a day.

Your Achilles tendon is tight. Loosen it.

Almost everyone has a tight Achilles—it’s just the way we’re built—and a tight Achilles tendon can affect the plantar fascia. There are a couple of stretches that can help. The one I like, and that I show my patients, involves standing on a stair or curb with both heels facing out. Hold onto the railing, then move the heel that is painful off the edge of the stair or curb and let it drop. Allow your other foot to relax. Hold this position for five minutes. I know that’s a really long time, but the Achilles tendon is a very large tendon and it takes time to stretch it. Do this twice a day. It doesn’t always feel great at the time, but it really does help.

The hardest part about treating this condition is being diligent about doing these stretches twice a day, every single day. I often recommend taping a reminder on your refrigerator, or some place you can’t avoid seeing.  If your heel hurts after you stretch, that’s normal. That’s when you can ice it and/or take a painkiller.

Should I try to stay off my feet? Do I need to wear special shoes in the house or outside?

You can walk as much as you want with plantar fasciitis. If it starts to hurt, you can stop—but you aren’t damaging anything if you keep walking.

In terms of footwear, the best shoes for plantar fasciitis are ones that fit correctly—both in length and width—and provide arch support. You can also use removable inserts (called orthotics) to “fix” a pair of shoes that does not have the support you need. I recommend trying over-the-counter orthotics first, to see if they help as custom-made ones can be very expensive. If you have really flat feet or very high arches, you can get over-the-counter orthotics that are designed to help with that.

I don’t routinely recommend wearing shoes inside—I’m a big fan of bare feet—but, if you’re having pain from plantar fasciitis, wearing supportive shoes in the house can sometimes help. Try it and see if it works for you.

Should I use a foot brace or splint, or a boot?

There are splints available at your local pharmacy that hold your foot at a right angle while you sleep. This will keep your plantar fascia stretched out overnight, and then, when you get up in the morning, you won’t have heel pain as you step out of bed. Some people swear by this method. The majority, however, tell me that they tried an overnight splint but woke up in the middle of the night to take it off because it was uncomfortable. If you want to try using a splint, that’s fine; it won’t do any damage. But, there are no research studies that prove its effectiveness.

Occasionally, I prescribe a walking boot for plantar fasciitis patients as it can take some pressure off the heel. But that can backfire. If you’re wearing the boot all the time and not doing the stretching exercises, your calf muscles may weaken. That won’t help with the pain. Sometimes, I give patients a walking boot for about a week, just to get them walking until the pain becomes bearable. During that time, I urge them to continue doing their stretches and, as soon as they can, I encourage them to stop using the boot altogether.

All in all, the best—and most effective—treatment for plantar fasciitis is stretching.

What if I’ve tried all this and am still having pain?

If none of this works, you might try formal physical therapy. A physical therapist may be able to help you do your stretches more effectively. Sometimes they have equipment in the physical therapy suite that you don’t have at home and can be beneficial.

If none of that works, there are also some procedures available. Extracorporeal shock wave therapy is a noninvasive method of stretching the plantar fascia that involves applying waves of electricity to the tissue. Another option is the Tenex FAST procedure. With this approach, we poke tiny holes in the plantar fascia with a needle. perform these procedures and those who do will likely only try them if everything else has failed.

How can I prevent plantar fasciitis?

The best way to prevent the condition is to avoid unsupportive shoes and to stretch before and after you exercise. But sometimes you do everything right and still end up with plantar fasciitis. That’s why it’s good to know what stretches can treat it.

Each year, approximately two million patients in the United States are treated for an irritating heel pain caused by a condition with a difficult-to-pronounce name. Plantar fasciitis (pronounced PLAN-taar-fa-shee-AY-tus) is an inflammation of the plantar fascia—a thick band of tissue at the bottom of the foot—which connects your heel bone to your toes and helps support your arch.

This very common condition is the most frequent cause of heel pain and can affect just about anyone, though it’s pretty rare among kids. If left untreated, the pain can last for weeks, months, or even years.

Meghan Kelly, MD, Assistant Professor of Orthopedics at the Icahn School of Medicine at Mount Sinai, explains why we experience this condition and when you should see a doctor.

What does it feel like to have plantar fasciitis?

You will probably feel pain in your heel, though it may also spread to your arch and along the bottom of your foot, all the way across to where your toes begin. Sometimes you’ll experience a slow burn, sometimes it really fires up. It’s usually most tender on the inside of the heel.

The pain usually starts first thing in the morning. You get out of bed, put your foot on the floor, and you feel pain on the bottom of the foot when you try to put your heel down. You may find you want to tiptoe around a little bit until things start to settle. Once your plantar fascia stretches out, it becomes more tolerable to walk on your whole foot.

Plantar fasciitis pain usually comes and goes throughout the day. It might feel better after walking a bit, then painful again if you’ve been sitting then stand up to walk, or if you’ve been on your feet for an extended period. That’s the unusual part about plantar fasciitis. While other conditions, like arthritis and Achilles tendonitis, get progressively worse throughout the day, the pain with plantar fasciitis waxes and wanes.

What causes plantar fasciitis?

This condition can occur for a variety of reasons, but is usually due to a change in the way your foot hits the ground. It can also stem from tightness in your foot and ankle muscles.

Often, people experience plantar fasciitis after a change in activity. Personally, I had that experience a few years ago, when I started wearing a pair of shoes with a really hard insole. Plantar fasciitis can also affect athletes when they change up their exercise routine. Occasionally we don’t know what caused the pain.

I saw a lot of plantar fasciitis as the world began opening back up after the COVID-19 lockdowns of 2020. All of a sudden, people traded in their flip flops and sneakers for hard-bottomed shoes and heels. They started going back to the gym, commuting to the office, and walking around the city after having not done so for more than a year. And, their feet were not happy about it.

How is the condition diagnosed? Is it chronic?

Most of the time, plantar fasciitis is diagnosed by taking a patient’s medical history, going over a list of their symptoms, and pressing on the “magic spot” that really hurts. Typically, for plantar fasciitis patients, that spot is on the bottom of the heel, close to the instep. Sometimes doctors take X-rays to rule out other issues, such as bone spurs or a foot shape that might make you more prone to problems.

Thankfully, if treated completely, plantar fasciitis goes away and does not come back. If it does come back, that means you never really got a hold of the condition the first time around.

Do I need to see a doctor?

There’s a good chance you can address plantar fasciitis on your own. But, if you find the condition is affecting your daily activities, you should consider going to the orthopedist. A doctor can make sure you do have plantar fasciitis, not something else, and can give you some simple stretches to treat it.

As many continue to work from home due to the COVID-19 pandemic, physicians are seeing a rise in orthopedic complaints associated with home offices. Anyone who has worked for extended periods at home knows these can include pain in your shoulder, hip, and lower back, among other nagging complaints.

“The shift of our work spaces from the office to our home introduces the challenge of finding a good working space. This can be especially difficult when also caring for our loved ones while working,” says Shawn G. Anthony, MD, MBA, Assistant Professor of Orthopedics at the Icahn School of Medicine at Mount Sinai.

Many of these pains are preventable with a few simple changes to the home office environment. To optimize your in-home work space and avoid irritating aches, Dr. Anthony provides these four tips.

Find a dedicated home office space

A dedicated space can be a challenge if you live in a New York City apartment or are rooming with others. So, while the ideal home office does not need to be a separate room, it should have basic components like adequate lighting—lighting that is bright white and non-glare producing—, an adjustable chair, and a flat table surface. Most importantly, avoid working in bed or on the couch, as working for extended periods with poor posture causes the most number of injuries.

Create a comfortable work space

Try to position your laptop or desktop monitor at or slightly below eye level—this is where an adjustable chair is helpful—so that your wrists are kept level and your feet are supported or kept flat on the floor. Patients often ask whether a standing desk is better than sitting. If possible, it’s best to combine both throughout the workday as each can cause issues after prolonged periods of time.

Maintain good posture while working

It’s easy to forget good posture and slouch in a chair. When seated, remember to keep your ears positioned over your shoulders and your shoulders positioned over your hips. This will keep your spine in good alignment while sitting for long periods. Your hips and knees should be bent at approximately 90 degrees, and a cushion can be added for lower lumbar support. Try to keep frequently used objects, such as a telephone or computer mouse within reach, as repeatedly stretching to reach for items can cause overuse injuries.

Take breaks and exercise

If you don’t already, introduce 10 minutes of morning and evening stretches to maintain flexibility. Tight muscles from prolonged sitting are the most frequent cause of joint pain due to increased stress across joints. A foam roller is especially helpful to maintain flexibility and to combat tightness in the quads, hamstrings, or iliotibial band—a thick band of tissue that extends laterally from the pelvis to the knee.

Throughout the day, stay hydrated and eat healthy snacks. Be sure to take breaks from sitting in front of your computer by walking around the room during phone calls and setting timers for stand up reminders. Though gyms may be closed, you can stay active by introducing body weight exercises such as wall squats, which are great for your core and quads. Jumping jacks and running in place are good cardio exercises that can be done indoors.

Introducing these simple tips will help stave off injuries and make for a more comfortable work space that does not hamper productivity. If you have any questions or if you are experiencing joint pain, schedule an in-office or virtual visit with a Mount Sinai orthopedist.