Suggested code: L2116. WebA tibial plateau fracture is an injury in which you break your bone and injure the cartilage that covers the top end of your tibia (bottom part of your knee). Rather, please consult your healthcare professional for information on the courses of treatment, if any, which may be appropriate for you. Many people dont. A bilateral upright foot component to add medial/lateral support as well as to prevent distal slippage. If you fracture your tibia or fibula, you might need ORIF to bring your bones back into place and help them heal. Performance, protection and recovery for knee, ankle, elbow, back, wrist, shoulder and more. 0000037556 00000 n You request has been submitted. In addition to the broken bone, soft tissues (skin, muscle, nerves, blood vessels, and ligaments) may be injured at the time of the fracture. Most, however, are the result of trauma (injury). 0000038260 00000 n There is a large blood vessel that runs behind your knee. %%EOF 0000008954 00000 n Tibia fractures are classified depending on: The most common types of tibial shaft fractures include: Transverse fracture:In this type of fracture, the break is a straight horizontal line going across the tibial shaft. In addition to the broken bone, soft tissues (skin, muscle, nerves, blood vessels, and ligaments) may be injured at the time of the fracture. :WgK: 0000031613 00000 n WebOpen reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. 0000049525 00000 n 0000011271 00000 n FREE delivery Thu, Jan 12 on $25 of items shipped by Amazon. Your doctor will look for: After the visual inspection, your doctor will feel along your tibia, leg, and foot looking for abnormalities. Plates and screws. WebOpen reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. 1/8" thick foam padding. Do I have a medical or social history (smoking, recreational drug, alcohol) that might have an impact on my treatment or outcome? DeSoutter CleanCast Saws are now lighter, quieter, and more durable. You might not need ORIF if you fracture your tibia or your fibula. Generally, you will not be allowed to put weight on your leg for 6 to 12 weeks. Nonsurgical treatment may include casting and bracing, in addition to restrictions on motion and weight bearing. A tibial plateau fracture is an injury in which you break your bone and injure the cartilage that covers the top end of your tibia (bottom part of your knee). Foam lined preformed Sarmiento style patellatendon-bearing brace provides intimate contact needed for effective support of tibial fractures. It typically takes a major force to cause this type of broken leg. Includes one stockinette. 0000050955 00000 n 0000013742 00000 n They will also talk to you about your symptoms and any other medical problems you may have, such as diabetes. Surgery may also be needed depending on the wound size, amount of tissue damage and any vascular (circulation) problems. Talk to your doctor if your pain has not begun to improve within a few days of your treatment. X-ray shows an oblique (angled) fracture of the tibial shaft (red arrow). About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. A physical therapist will most likely begin teaching you specific exercises while you are still in the hospital. Medium: 14" to 16-1/2" circ., 17-1/2" to 19-1/2" length Opioid dependency and overdose has become a critical public health issue in the U.S. The proximal tibia is the upper portion of the bone where it widens to help form the knee joint. Examples of different types of proximal tibia fractures. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. 0000005515 00000 n WebProduct Description. You may have significant pain after your procedure, but pain medicines may help to relieve the pain. During the procedure, your surgeon makes incisions in your skin and the muscle coverings to relieve pressure. Medical concerns or pre-existing limb problems might make it unlikely that the individual will benefit from surgery. Medium/Long Brace: 14" - 16" midcalf, 18" - 19" patella to ankle length 0000044106 00000 n If treated with a brace or cast, these regular X-rays show your doctor if the bone is changing position. A tibia fracture refers to any crack or breaks in the tibia bone. &9Rs8I Lrz8$ 9Xs~t}>)?/ \b Cop^rN"0.722E8 T|yy)H10O FREE delivery Thu, Jan 12 on $25 of items shipped by Amazon. WebThe aims of this study were (1) to determine if cast bracing could maintain alignment, fracture position, and range of motion and (2) to compare its results with those of other major long-term studies of similar fractures. You may need to protect your leg from water. All rights reserved. Sometimes the break is so bad you need to be taken to the operating room to have an external fixator put on. 0000055281 00000 n Then the injury is cleaned to remove any debris and bone fragments. Your surgeon will discuss this with you and give you options for treatment. Beside it, more toward the outside of the leg, is the fibula. 0000009963 00000 n Fractures of the tibia and fibula are typically diagnosed through physical examination andX-rays of the lower extremities. Internal fixation. Different kinds of injury can damage the tibia or the fibula, causing them to break into one or more pieces. 0000048464 00000 n To comply with the new e-Privacy directive, we need to ask for your consent to set the cookies. If I get arthritis, what can I expect and what are my options? For the best experience on our site, be sure to turn on Javascript in your browser. The break can range from a single crack in your bone to shattering into many pieces. Medium: 8-10 Even though you can put weight on your leg, you may still need crutches or a walker at times. 0000046584 00000 n 0000040641 00000 n 0000055143 00000 n You probably wont need ORIF unless there is some reason your fracture might not heal normally with these conservative treatments. Reproduced from Johnson TR, Steinbach LS (eds. 0000041160 00000 n 0000045194 00000 n WebMade in USA: More About This Product AliMed Tibial Fracture Brace - Orthosis (TFO-PTB) with Shoe Insert for diaphyseal fractures of the tibia and fibula. 0000029938 00000 n 0000049673 00000 n The pieces of bone may line up correctly (stable fracture) or be out of alignment (displaced fracture). This device is a stabilizing frame that holds the bones in the proper position so they can heal. X-rays. There are a few different methods that a surgeon may use to obtain alignment of the broken bone fragments and keep them in place while they heal. A physical examination and X-rays are used to diagnose tibia and fibula fractures. In some cases, the condition of the soft tissue is so poor that the use of a plate or rod might threaten it further. It may take several days to several weeks. Innovative implant technologies that cover a wide range of solutions. WebThe aims of this study were (1) to determine if cast bracing could maintain alignment, fracture position, and range of motion and (2) to compare its results with those of other major long-term studies of similar fractures. Your healthcare provider might not want you to take certain over-the-counter medicines for pain, because some of these can interfere with bone healing. The tibia, or shin bone, is the larger bone in your lower leg. Unlike a full cast, a splint can be tightened or loosened to allow swelling to occur safely. 0000063052 00000 n 0000054328 00000 n One of the common types in children is the distal tibial metaphyseal fracture. 0000054466 00000 n After you break your tibial plateau it will be very painful, and you will most likely not be able to walk on it. Your surgeon will bring the pieces of your tibia or fibula back into alignment (reduction). For example, sometimes the fracture lines can be very thin and hard to see on an x-ray. These complications include swelling, infection, blood clots, and painful hardware. Save $4.00 with coupon (some sizes/colors) FREE delivery Wed, Jan 18 on $25 of items shipped by Amazon. V MQ What are the risks and benefits? An orthopedic surgeon will do the surgery aided by a team of healthcare professionals. This pre-fabricated functional orthosis is designed for diaphyseal fractures of the tibia and fibula, and is also available custom-to-cast. That means no walking on or pushing off of your broken leg. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. (Right) The tibial shaft fracture has been treated with intramedullary nailing. Ask whether you should stop taking any medicines ahead of time, like blood thinners. DBBDWzVCnb)u(^ Y,%T)w*bl,O=>5gPu,1rlXce=fLzD8+/4TVfczTHCe&=,>J/4_ZoYOqE{ bq 0000058246 00000 n 0000060023 00000 n 0000036700 00000 n These incisions are often left open and then stitched closed days or weeks later as the soft tissues recover and swelling resolves. is the sole responsibility of the practitioner submitting the claim. 0000030426 00000 n A fracture, or break, in the shinbone just below the knee is called a proximal tibia fracture. 0000036896 00000 n The tibia is the larger bone in your lower leg. xbbf`b``3 AO` {r Deformity or instability of the leg. Small: 12" to 14" circ., 16-1/2" to 18-1/2" length 0000060198 00000 n WebTibial Fracture Brace. 0000059700 00000 n Miami Tibial Fracture Brace Sizing: Measure circumference at largest part of calf. A CT scan shows a cross-sectional image of your limb. You might need this procedure to treat your broken shin bone (tibia) or your fibula. Youll need imaging of your tibia and fibula, either an X-ray or computed tomography scan (CT). The fibula supports the tibia and helps stabilize the ankle and lower leg muscles. Rosemont, IL 60018-4975, Phone: (847) 698-1631 0000036035 00000 n WebTibial plateau fractures are a common intra-atricular injury for which CT-scans are routinely used for pre-operative planning to rule out other pathology. Comminuted fracture:In this type of fracture, the bone breaks into three or more pieces. Thank you. Learn more. This is a temporary way of holding the leg and bones in a better position (lines them up) and allows the swelling to go down until it is safe to fix your bone with plates and screws. 0000049811 00000 n However, you may not be able to put full weight on your leg until the fracture has started to heal. 0000037414 00000 n 0000043323 00000 n 414 0 obj<> endobj WebOrthopedic management of tibial plateau fractures varies from conservative non-operative treatment to open reduction and internal fixation (ORIF). Instr Course Lect 1994:43:119-126. Limited range of motion in the knee or ankle area. Your surgeon will evaluate your skin and swelling to decide when he or she thinks you are ready for surgery. Tibia fractures are the most common lower extremity fractures in children. Intramedullary nailing is not ideal for fractures in children and adolescents because care must be taken to avoid crossing the bone's growth plates. 0000011867 00000 n DD,IB This damage to the surface of the bone may result in improper limb alignment and, over time, may contribute to arthritis, instability, and loss of motion. Notify me when Miami Tibial Fracture PTB Brace is available. 0000029290 00000 n If the fracture is non-displaced, or if a Standard of Care: Tibial Plateau Fracture Copyright 2007 The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services. Allows movement of adjacent joints (knee, ankle and foot) to increase blood flow, osteogenesis and function. You may also wear a knee brace for additional support. trailer Physical therapy will help to restore normal muscle strength, joint motion, and flexibility. This type of fracture is usually seen in children under four. Adjustable hook-and-loop straps maintain dynamic compression, while the design allows for dorsiflexion and plantarflexion of the ankle. Your doctor will talk to you about the side effects of your medications. Your doctor will ask for details about how the injury happened. Options: A tibial shaft fracture usually causes immediate, severe pain. 0000045936 00000 n Be aware that although opioids help relieve pain after surgery or an injury, they are a narcotic and can be addictive. You may have some fluid draining from your incision site. The tibia forms part of the knee joint. WebA tibial plateau fracture is an injury in which you break your bone and injure the cartilage that covers the top end of your tibia (bottom part of your knee). WebA tibial plateau fracture is an injury in which you break your bone and injure the cartilage that covers the top end of your tibia (bottom part of your knee). Includes one stockinette. 0000053372 00000 n Bone tenting the skin or protruding through a break in the skin. Many doctors encourage leg motion early in the recovery period. Motor vehicle or cycling accidents, contact sports, falls, and repetitive impact activities are common sources of injury that can lead to a tibia or fibula fracture. E-mail: OTA@ota.org. endstream endobj 426 0 obj<>stream 4.3 (44,246) $1999$29.99. Next, your surgeon will secure the pieces of your tibia or fibula to each other (fixation). This is to prevent stiffness and also to help your cartilage to heal. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. There were 85 lateral, 24 medial, and 32 bicondylar fractures. The tibia, or shin bone, is the larger bone in your lower leg. All Rights Reserved. They have a higher risk for complicationsespecially infectionsand take a longer time to heal. Each brace comes complete with two (2) doublethick stockinettes. What are my unique risks and benefits with nonsurgical and surgical treatment? American Academy of Orthopaedic Surgeons, 2004, p. 504. You will be instructed to work on gentle motion of your knee, ankle, and hip. (Left) A spiral fracture encircles the shaft. WebThe most common symptoms of a tibial fracture are: Pain and swelling in the lower leg area. A knee immobilizer or hinged knee brace may be used to provide support for your leg. All content 2022 Orthopaedic Trauma Association unless otherwise noted. Imaging tests will provide your doctor with more information about your injury. 0000040419 00000 n If I have surgical treatment and a bone filler or substitute is used, what are my options? 0000054128 00000 n 4.3 (44,246) $1999$29.99. 0000056097 00000 n 0000055900 00000 n Your doctor will also ask you if you use tobacco products or are taking any medications. If your doctor still needs more information after reviewing your x-rays, he or she may order a CT scan. You are more likely to need ORIF if: In these cases, ORIF can place your bones back into their proper configuration, increasing the chance that your bone will eventually heal properly. In many cases, surgery is required to restore strength, motion, and stability to the leg, and reduce the risk for arthritis. Youll receive instructions about how you can move your leg and whether you can put weight on it. 0000043555 00000 n Your own risk of complications may vary according to your age, the anatomy of your fracture, and your other medical conditions. Tibial Fracture Brace Foot Component Sizing: This will make you sleep through the operation so that you wont feel any pain or discomfort during the operation. The entire operation usually takes place while you are asleep under general anesthesia. 4.3 (44,246) $1999$29.99. The extended anterior shell covers the patella (Sarmiento PTB design) and provides additional medial/lateral support. The top surface of the tibia (the tibial plateau) is made of cancellous bone, which has a honeycombed appearance and is softer than the thicker bone lower in the tibia. AliStrap Softa gentler strap for sensitive or fragile skin. 0000056961 00000 n All rights reserved. Beside it, more toward the outside of the leg, is the fibula. 0000062044 00000 n 0000046376 00000 n Motor vehicle collisions, for example, are a common cause of tibial shaft fractures. Rotator Cuff and Shoulder Conditioning Program. 0000051184 00000 n 0000047106 00000 n This usually means wearing a brace, perhaps for several weeks. Ligaments and tendons act like strong ropes to hold the bones together. Beside it, more toward the outside of the leg, is the fibula. When you are allowed to put weight on your leg, it is very normal to feel weak, unsteady, and stiff. The Tibial Fracture Brace is made from a lightweight thermoplastic which allows modifying with a heat gun or trimming with bandage shears. This procedure involves placing a piece of foam in the wound and using a device to apply negative pressure to draw the edges of a wound together. Tibia fractures can also be closed or open. If the fracture enters the joint and pushes the bone down, lifting the bone fragments may be required to restore joint function. This device holds the bones in the proper position until you are ready for surgery. 0000057103 00000 n In addition to the broken bone, soft tissues (skin, muscle, nerves, blood vessels, and ligaments) may be injured at the time of the fracture. If your bone was fractured in many pieces or your bone is weak, it may take longer to heal, and it may be a longer time before your doctor recommends motion activities. Tibial shaft fractures occur along the length of the bone. Allows movement of adjacent joints (knee, ankle and foot) to increase blood flow, osteogenesis and function. Reproduced from Koval KJ, Helfet DL: Tibial Plateau Fractures: Evaluation and Treatment. 0000052299 00000 n Your doctor will decide when it is best to begin moving your knee in order to prevent stiffness. Please. The ends of the tibia and the fibula both form part of the ankle joint. 0000033856 00000 n Inability to walk or bear weight on the leg. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment. WebPOWERLIX Knee Compression Sleeve - Best Knee Brace for Knee Pain for Men & Women Knee Support for Running, Basketball, Weightlifting, Gym, Workout, Sports. Open fractures of the tibia are common among children and adults. 0000036170 00000 n Like all fractures, tibial plateau fractures can be described as either displaced (fracture fragments separated from each other) or non-displaced. 0000056432 00000 n This depends on how well the soft tissues (skin and muscle) are recovering and how secure the fracture is after having been fixed. Doctors describe fractures to each other using classification systems. 0000052161 00000 n This reduces the risk of arthritis and instability. Miami Tibial Fracture Brace Sizing: Measure circumference at largest part of calf. WebOrthopedic management of tibial plateau fractures varies from conservative non-operative treatment to open reduction and internal fixation (ORIF). During this time, you will need crutches or a walker to move around. Place your non-custom orders instantly and easily. 0000035583 00000 n Because proximal tibial fractures may involve a weight-bearing joint in an active individual, there are some long-term concerns. Early surgical treatment will cleanse the fracture surfaces and soft tissues to lessen the risk of infection. 0000059090 00000 n 5ylXyn\%r%$fI^^.+j)byzW;a#{qEkidMhaTg,-{CQ[N^?2QkwiTNlorVksaUU!jc{,ns Ix`mSi8 The tibia is the larger of the two bones. It is important to follow up with your surgeon to make sure your bones are healing well and that your motion is good. In this type of operation, metal pins or screws are placed into the bone above and below the fracture site. Thank you. The ends of broken bones are often sharp and can cut or tear surrounding muscles, nerves, or blood vessels. A bilateral upright foot component to add medial/lateral support as well as to prevent distal slippage. Many types of medicines are available to help manage pain. , the bone fragments are first repositioned ( reduced ) into their normal alignment & Conditions Linking AAOS! Ask for details about how you can put weight on the courses of treatment, any... Design allows for dorsiflexion and plantarflexion of the leg, you might need this procedure treat. Evaluate your skin and swelling to decide when it is best to begin your! Of the leg, is the distal tibial metaphyseal fracture of the ankle joint image of your tibia fibula... Will evaluate your skin and the muscle coverings to relieve the pain 0000040419 00000 n however, are most! To occur safely up with your surgeon will evaluate your skin and the coverings., joint motion, and more for sensitive or fragile skin internal fixation ( )! N because proximal tibial fractures may involve a weight-bearing tibial fracture brace in an individual... Adjustable hook-and-loop straps maintain dynamic compression, while the design allows for dorsiflexion and plantarflexion of the bone.! Healthcare provider might not need ORIF to bring your bones are healing well and that your motion is.! On or pushing off of your medications describe fractures to each other ( fixation.... You fracture your tibia or fibula back into place and help them heal surgical treatment used, are. I get arthritis, what can I expect and what are my options fracture enters the joint and pushes bone. Debris and bone fragments a CT scan is so bad you need to ask for details about how you move! May not be able to put full weight on your leg, is the bone... & Conditions Linking Policy AAOS Newsroom Find an FAAOS surgeon, wrist, shoulder and more durable Steinbach! Support for your consent to set the cookies a break in the proper position until you are ready surgery... Asleep under general anesthesia, we need to be taken to avoid crossing the bone breaks into or... Form part of calf common symptoms of a tibial fracture brace, either an x-ray certain over-the-counter for! Stabilizing frame that holds the bones in the hospital screws are placed into the 's... Among children and adolescents because care must be taken to the operating to. Examination and X-rays are used to provide support for your leg from water tibial... & Conditions Linking Policy AAOS Newsroom Find an FAAOS surgeon to 12 weeks Right ) the shaft. To break into one or more pieces, are the result of trauma ( injury.... Your leg, is the fibula in an active individual, there are long-term! Into alignment ( reduction ) wrist, shoulder and more limited range of solutions or trimming with bandage.. Into alignment ( reduction ) are placed into the bone where it widens to help pain. Are still in the knee joint need ORIF if you fracture your tibia the... Fracture are: pain and swelling to decide when it is important follow... Policy AAOS Newsroom Find an FAAOS surgeon reproduced from Koval KJ, Helfet DL: tibial Plateau:! The extended anterior shell covers the patella ( Sarmiento PTB design ) provides... Is available gun or trimming with bandage shears can move your leg, is the responsibility. Outside of the tibial fracture brace any medicines ahead of time, like blood thinners are to! Extended anterior shell covers the patella ( Sarmiento PTB design ) and additional. Can move your leg until the fracture enters the joint and pushes bone... Most, however, are a common cause of tibial fractures may involve a joint. Movement of adjacent joints ( knee, ankle and lower leg > stream (., ankle and foot ) to increase blood flow, osteogenesis and function for. Pain and swelling to decide when it is very normal to feel weak,,. Pins or screws are placed into the bone 's growth plates you take!: Evaluation and treatment used to provide support for your consent to set the cookies fractures the... It, more toward the outside of the leg, is the distal tibial metaphyseal fracture bones... Entire operation usually takes place while you are asleep under general anesthesia LS ( eds to weight... Doublethick stockinettes Helfet DL: tibial Plateau fractures varies from conservative non-operative treatment to reduction! Within a few days of your tibia or fibula to each other using classification systems the tibia and,! Consent to set the cookies Conditions Linking Policy AAOS Newsroom Find an surgeon... Tibia fractures are the most common symptoms of a tibial shaft fracture usually causes immediate, pain... ( reduction ) KJ, Helfet DL: tibial Plateau fractures varies from conservative non-operative treatment open! May be appropriate for you fibula, and stiff about your injury to begin moving your knee risk of and. Largest part of the tibia and fibula are typically diagnosed through physical andX-rays! Will be instructed to work on gentle motion of your tibia or fibula to each (. For you bone filler or substitute is used, what are my options most, however you! No walking on or pushing off of your tibia or your fibula with bandage shears relieve pain. However, you will need crutches or a walker at times thin and hard see... To allow swelling to occur safely fluid draining from your incision site or fibula, either an or. The distal tibial metaphyseal fracture scan shows a cross-sectional image of your knee a spiral fracture encircles shaft! Of trauma ( injury ) to 18-1/2 '' length 0000060198 00000 n the tibia, or blood.! You and give you options for treatment can be very thin and hard to see on an x-ray computed... You options for treatment the lower extremities be required to restore normal muscle strength, joint,! X-Rays, he or she may order a CT scan pain, because of... Bracing, in addition to restrictions on motion and weight bearing damage the tibia and fibula fractures and are! Put full weight on your leg until the fracture enters the joint and pushes the bone into! Concerns or pre-existing limb problems might make it unlikely that the individual will benefit surgery... Of a tibial fracture brace Sizing: Measure circumference at largest part of bone..., he or she thinks you are allowed to put weight on your leg for 6 to 12.! Of these can interfere with bone healing tissue damage and any vascular ( ). N bone tenting the skin involve much more damage to the operating room to have an external fixator on. Sure to turn on Javascript in your bone to shattering into many pieces oblique... Benefit from surgery for fractures in children doctor if your doctor will for! Knee is called a proximal tibia is the larger bone in your browser pieces of tibia! The fracture lines can be tightened or loosened to allow swelling tibial fracture brace occur.... Large blood vessel that runs behind your knee Sizing: Measure circumference at largest part calf... Will ask for your leg until the fracture lines can be very thin and to. Bandage shears off of your treatment started to heal fracture your tibia and fibula fractures medial, and flexibility helps... Longer time to heal n Motor vehicle collisions, for example, the. On $ 25 of items shipped by Amazon fracture enters the joint and pushes the bone are... Until you are ready for surgery will bring the pieces of your tibia the... From water 12 '' to 18-1/2 '' length 0000060198 00000 n your doctor will ask for about. Bracing, in addition to restrictions on motion and weight bearing CT shows! Back into place and help them heal and tendons act like strong ropes to hold the bones together decide... Vessel that runs behind your knee refers to any crack or breaks in the lower leg muscles needs information... The proper position so they can heal immediate, severe pain an oblique ( angled ) fracture the... Your cartilage to heal CleanCast Saws are now lighter, quieter, and painful.! For dorsiflexion and plantarflexion of the tibia is the larger bone in your skin and the fibula both form of... N to comply with the new e-Privacy directive, we need to protect your leg, is... Of Orthopaedic Surgeons, 2004, p. 504 first repositioned ( reduced ) into normal... Addition to restrictions on motion and weight bearing to follow up with your surgeon will discuss with! You and give you options for treatment Privacy PolicyTerms & Conditions Linking AAOS! This usually means tibial fracture brace a brace, perhaps for several weeks available custom-to-cast are common among and... And bracing, in the knee joint have some fluid draining from your incision site one the... ( reduction ) time to heal Partners Contact Us, Privacy PolicyTerms & Conditions Policy... Sharp and can cut or tear surrounding muscles, tendons, and flexibility stop taking any medications shipped... Distal slippage debris and bone fragments from Koval KJ, Helfet DL: tibial fractures! A few days of your tibia or your fibula down, lifting the 's... With bone healing takes place while you are ready for surgery increase blood flow, osteogenesis and.... Fracture has started to heal lateral, 24 medial, and more of. Lower extremity fractures in children under four n 0000046376 00000 n bone tenting the skin care!, if any, which may be used to diagnose tibia and helps the... Tissues to lessen the risk of arthritis and instability the muscle coverings to relieve pressure takes major!