Hip, knee, ankle, and foot: common injuries, prevention, and treatment options

**Peter Attia** (0:11)
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My guest this week is Dr. Adam Cohen. Adam is board certified in both orthopedic surgery and sports medicine and has extensive training and expertise in various sports medicine injuries. He's the director of sports medicine at Ortho Manhattan and serves as the team physician for Horace Mann Athletics. He also holds academic appointments at the NYU Langone Health System and the Mount Sinai Health System. Adam previously served as the assistant team physician for the New York Yankees and served as a consultant for the US Open Tennis Championship, as well as provided orthopedic coverage for the New York City Ballet. This episode is in some ways a follow-up to the episode I did with Dr. Alton Barron, which focused on the upper extremity. In this episode with Adam, we're gonna focus on everything you need to know about the lower extremities. This includes of course the hip, knee, ankle and foot.
For each of these, we walk through the anatomy, what can go wrong, what causes injuries, as well as what surgical and non-surgical management of these things looks like. We then end the conversation looking at how someone can go and find a good surgeon if they need any of these issues addressed as we discuss them today.
In addition to our conversation where Adam of course uses these images and models, he also runs me through the typical exams that he will do for each part of his assessment. These exams will make a lot more sense if you can see them rather than hear them. So for the audio portion of this podcast, we will not include any of the exam content. It simply won't make any sense. So if you choose to listen to this in audio, you may still wanna go and check out our YouTube page to look for the exams. Of course, you may just choose to watch the entire thing on YouTube so that you can see his images. So without further delay, please enjoy my conversation with Dr. Adam Cohen.
Hey, Adam, thank you so much for coming from New York to Austin. Very excited to do this, and of course this needs to be done in person. We're gonna do today what I did with your colleague, Dr. Baron, a little while ago on the upper extremity, which is everything you need to know about the lower extremity and its orthopedic injuries. So for each of the major issues, the hip, the knee, the foot, we're gonna talk about the anatomy, talk about what goes wrong. We'll talk about the surgical and non-surgical management for those things. So thanks very much for joining.

**Adam Cohen** (3:20)
Sure, great. Thanks for having me. Appreciate it.

**Peter Attia** (3:22)
Wanna start with the hip?

**Adam Cohen** (3:23)
Yeah, let's jump right in. So let's talk about the anatomy of the hip. The hip joint is a ball and socket joint. I have a model here. Unlike the shoulder, it's a very contained, concentric joint and much more stable under normal circumstances than the shoulder. It's a deep socket. The socket is called the acetabulum. This is the femoral head, and the femoral head is covered with cartilage.
We'll place this down for a moment.
If we just focus on the proximal femur, we have the head, as I mentioned. The neck, and this is the subtrochanteric region, and this is the trochanteric region.
The acetabulum is formed in utero. It starts about fourth week in utero, and then by the 30th week, it starts to develop. And I think that's a good starting spot because a lot of the problems that we see, or a number of the problems we see in the hip really start that early. There is a condition called developmental dysplasia of the hip. It used to be referred to as congenital dysplasia of the hip, but we felt that there are more factors involved than any congenital ones in particular. Basically, what happens is if the hip is not concentrically reduced as either late in stages of pregnancy or in early childhood, the first several months of life, in fact, the acetabulum will not form properly. So, for example, if the ball is shifted out of the socket, let's say due to positioning in utero where it's not completely in, the acetabulum will not form correctly. What that means is that after birth, if it's sitting outward, this deep socket will not form and it'll be quite shallow.