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Conditions Treated

We provide treatments for any and every condition of the lower extremity, but here are some examples.

Achilles Tendon Disorders

What Is the Achilles Tendon?

 

 

 

The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the “heel cord,” the Achilles tendon facilitates walking by helping to raise the heel off the ground. It is the largest tendon in the body transmitting and pro-pulsing your entire body weight during walking/climbing stairs and 2-3x your total body weight in running.  

 

 

 

Achilles Tendonitis and Achilles Tendonosis  Achilles tendonITIS is an inflammation of the Achilles tendon. This inflammation is typically short-lived. Over time, if not resolved, the condition may progress to a degeneration of the tendon (Achilles tendonOSIS), in which the tendon loses its organized structure and is likely to develop microscopic tears.  Over time, these microscopic tears evolve into chronic degeneration (with or without pain) which may finally result in partial or complete rupture of the tendon.

 

 

 

Causes

 

 

 

As “overuse” disorders, Achilles tendonitis and tendonosis are usually caused by a sudden increase of a repetitive activity involving the Achilles tendon. Such activity puts too much stress on the tendon too quickly, leading to micro-injury of the tendon fibers. Due to this ongoing stress on the tendon, the body is unable to repair the injured tissue. The structure of the tendon is then altered, resulting in continued pain. Athletes are at high risk for developing disorders of the Achilles tendon. Achilles tendonitis and tendonosis are also common in individuals whose work puts stress on their ankles and feet, such as laborers, as well as in “weekend warriors”—those who are less conditioned and participate in athletics only on weekends or rather infrequently. In addition, people with excessive pronation (flattening of the arch) have a tendency to develop Achilles tendonitis and tendonosis due to the greater demands placed on the tendon when walking. If these individuals wear shoes without adequate stability, their over-pronation could further aggravate the Achilles tendon.

 

 

 

Symptoms

 

 

 

The symptoms associated with Achilles tendonitis and tendonosis include:

 

 

 

 

        • Pain—aching, stiffness, soreness, or tenderness—within the tendon. This may occur anywhere along the tendon’s path, beginning with the tendon’s attachment directly above the heel upward to the region just below the calf muscle. Often pain appears upon arising in the morning or after periods of rest, then improves somewhat with motion but later worsens with activity.

 

 

 

 

 

        • Tenderness, or intense pain, when the sides of the tendon are squeezed.

 

 

 

 

 

        • When the disorder progresses to degeneration, the tendon may become enlarged and develop nodules in the area where the tissue is damaged.

 

 

 

 

Diagnosis

 

 

 

In diagnosing Achilles tendonitis or tendonosis, the surgeon will examine the patient’s foot and ankle and evaluate the range of motion and condition of the tendon. The extent of the condition can be further assessed with x-rays or other imaging modalities.

 

 

 

Treatment

 

 

 

Treatment approaches for Achilles tendonitis or tendonosis are selected on the basis of how long the injury has been present and the degree of damage to the tendon. In the early stage, when there is sudden (acute) inflammation, one or more of the following options may be recommended:

 

 

 

 

        • Immobilization

 

 

 

 

 

        • Ice

 

 

 

 

 

        • Medications

 

 

 

 

 

        • Orthotics

 

 

 

 

 

        • Night splints

 

 

 

 

 

        • Physical therapy

 

 

 

 

 
When is Surgery Needed?

 

 

 

If non-surgical approaches fail to restore the tendon to its normal condition, surgery may be necessary. The foot and ankle surgeon will select the best procedure to repair the tendon, based upon the extent of the injury, the patient’s age and activity level, and other factors.

 

 

 

Prevention

 

 

 

To prevent Achilles tendonitis or tendonosis from recurring after surgical or non-surgical treatment, the foot and ankle surgeon may recommend strengthening and stretching of the calf muscles through daily exercises. Wearing proper shoes for the foot type and activity is also important in preventing recurrence of the condition.

Achilles Tendon Rupture

What is it? An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping.  A rupture may also be the result of chronic disorder or degeneration of the Achilles tendon (“the straw that broke the camel’s back”). Achilles tendon ruptures are most often seen in “weekend warriors” – typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.   Signs and Symptoms  A person with a ruptured Achilles tendon may experience one or more of the following:

 

 

 

 

 

 

 

 

        • Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf – often subsiding into a dull ache

 

 

 

 

 

 

 

 

 

        • A popping or snapping sensation

 

 

 

 

 

 

 

 

 

        • Swelling on the back of the leg between the heel and the calf

 

 

 

 

 

 

 

 

 

        • Difficulty walking (esp. upstairs or uphill) and difficulty rising up on the toes

 

 

 

 

 

 

 

 

These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the “R.I.C.E.” method should be used. (‘Complete’ Rest, Ice, Compression, and Elevation) Diagnosis The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes. The diagnosis of an Achilles tendon rupture is typically clinical and straightforward and can be made through this type of examination.  In some cases, however, the surgeon may order an MRI or Ultrasound  to help evaluate the extent of the damage or for surgical planning. Treatment  Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches. The decision of whether to proceed with surgery or non-surgical treatment is based on the severity of the rupture and the patient’s health status and activity level. Non-Surgical Treatment  Non-surgical treatment, which is associated with a higher rate of re-rupture, is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. Non-surgical treatment involves use of a cast, walking boot, or brace to restrict motion and allow the torn tendon to heal. Surgery Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient’s push-off strength and improves muscle function and movement of the ankle. Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient.   Physical Therapy  Whether an Achilles tendon rupture is treated surgically or non-surgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve the range of motion of the foot and ankle.

Ankle Sprain

What is Ankle Sprain?

 

 

 

An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue – like rubber bands – that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement. Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.

 

 

 

Causes

 

 

 

Sprained ankles often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position. Ankle sprains commonly occur while participating in sports, wearing inappropriate shoes, or walking or running on an uneven surface. Sometimes ankle sprains occur because of a person is born with weak ankles. Previous ankle or foot injuries can also weaken the ankle and lead to sprains.  

 

 

 

Symptoms

 

 

 

The symptoms of ankle sprains may include:

 

 

 

 

 

 

 

 

        • Pain or soreness

 

 

 

 

 

 

 

 

 

        • Swelling

 

 

 

 

 

 

 

 

 

        • Bruising

 

 

 

 

 

 

 

 

 

        • Difficulty walking

 

 

 

 

 

 

 

 

 

        • Stiffness in the joint

 

 

 

 

 

 

 

 

These symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people with previous ankle sprains. Instead, they may simply feel the ankle is wobbly and unsteady when they walk. Even if there is no pain or swelling with a sprained ankle, treatment is crucial. Any ankle sprain – whether it’s your first or your fifth – requires prompt medical attention.

 

 

 

Why Prompt Medical Attention Is Needed?

 

 

 

There are four key reasons why an ankle sprain should be promptly evaluated and treated by a foot and ankle surgeon:

 

 

 

 

 

 

 

 

        • An untreated ankle sprain may lead to chronic ankle instability, a condition marked by persistent discomfort and a “giving way” of the ankle. Weakness in the leg may also develop.

 

 

 

 

 

 

 

 

 

        • A more severe ankle injury may have occurred along with the sprain. This might include a serious bone fracture that, if left untreated, could lead to troubling complications.

 

 

 

 

 

 

 

 

 

        • An ankle sprain may be accompanied by a foot injury that causes discomfort but has gone unnoticed thus far.

 

 

 

 

 

 

 

 

 

        • Rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.

 

 

 

 

 

 

 

 

Diagnosis

 

 

 

In evaluating your injury, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. X-rays or other advanced imaging studies may be ordered to help determine the severity of the injury.

 

 

 

Non-surgical Treatment

 

 

 

When you have an ankle sprain, rehabilitation is crucial—and it starts the moment your treatment begins. Your foot and ankle surgeon may recommend one or more of the following treatment options:

 

 

 

 

 

 

 

 

        • Rest

 

 

 

 

 

 

 

 

 

        • Icing of the affected area

 

 

 

 

 

 

 

 

 

        • Compression

 

 

 

 

 

 

 

 

 

        • Elevation

 

 

 

 

 

 

 

 

 

        • Early physical therapy.

 

 

 

 

 

 

 

 

 

        • Medications

 

 

 

 

 

 

 

 

 When Is Surgery Needed?

 

 

 

In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments and/or repairing of damaged cartilage or soft tissues within the ankle joint, as commonly occurs with chronic ankle injuries. The foot and ankle surgeon will select the surgical procedure best suited for your case based on the type and severity of your injury as well as your activity level.  After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome. Be sure to continue to see your foot and ankle surgeon during this period to ensure that your ankle heals properly and function is restored.

Athlete's Foot (Tinea Pedis)

What is it?

 

 

 

Athlete’s foot, also known as tinea pedis, is caused by several types of fungal organisms. People often have an itching sensation and cracking, peeling or scaly skin. Athlete’s foot commonly presents in the space between the toes but can be more widespread and even cause blistering.

 

 

 

Cause

 

 

 

Athlete’s foot is caused by fungi.  These organisms thrive in a moist and warm environment including certain parts of the body as well as the shoes and socks.

 

 

 

Treatment

 

 

 

Diagnosis is typically made based on history, symptoms and visual exam.  Scrapings of the involved area may need to be obtained for pathology analysis. Prescription antifungal medications are the most effective way to treat tinea pedis. Often, topical medications are only needed but severe cases require oral medications. The treatment of Athlete’s foot depends on reducing skin moisture. Shoes should be rotated, and socks should be changed frequently. Feet should be thoroughly dried. Sprays and powders can be helpful.  Chronic Athlete’s foot can also result in Dermatitis, requiring additional treatment.

 

 

 

For additional information: http://www.apma.org/learn/FootHealth.cfm?ItemNumber=978

Brachymetatarsia

Brachymetatarsia is a condition in which one of the bones in the front of the foot is significantly shorter than the others. Although it may affect any of the five metatarsals, it most commonly affects the fourth metatarsal. Looking at the foot, it might appear that the fourth toe itself is shorter than the adjacent toes. Sometimes it may even appear as if the fourth toe is raised up, with the third and fifth toes touching each other below it. The condition occurs when the affected metatarsal bone fails to develop fully, or its growth plate closes prematurely.

 

 

 

It is easily diagnosed with an x-ray. Beyond concerns about the toe’s appearance, the shortened metatarsal may not contact the ground properly or carry its share of the person’s body weight, resulting in pain and discomfort. It may also change the appearance and contour of the ball of the foot, making shoe selection difficult. In some cases brachymetatarsia causes no pain or discomfort, and may be treated with careful shoe selection. In others, surgical treatment may be required which can restore the affected digit to be in line with the surrounding ones as well as elongate the metatarsal to a more anatomically satisfactory alignment.

Bunion (Hallux Abductovalgus)

What is it?

 

 

 

Most people describe a bunion as a bump on the side of the big toe, but it is more complex. The bump may be the only visible change, but the bones in the forefoot are misaligned. The big toe leans toward the second toe, or even move all the way under it. The skin on the bottom of your foot may become thick and painful. Bunions are progressive. They begin with shifting of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump. Symptoms usually appear at later stages of the deformity.

 

 

 

Causes

 

 

 

Bunions are most often inherited. Specifically, the type of foot that makes a person prone to developing a bunion is hereditary. Poorly fitting shoes can contribute to making the deformity worse, often leading to symptoms appearing at a young age.

 

 

 

Treatments

 

 

 

Conservative treatment includes shoe modifications, splinting and padding, oral medications, injection therapy and orthotic therapy. If conservative measures fail to relieve symptoms, surgery might be necessary. Usually, surgery is done on an outpatient basis and the patient can walk immediately without use of crutches. The procedure your doctor selects will depend on your particular case, taking into consideration the extent of the deformity, age, activity level, and other factors. Bunions in children and adolescents are often more complex, resulting from numerous factors affecting the foot and ankle. Please see the section on Pediatrics (need link to another section on website)

 

 

 

For additional information: http://www.foothealthfacts.org/footankleinfo/bunions.htm

Chronic Ankle Instability

What Is Chronic Ankle Instability?

 

 

 

Chronic ankle instability is a condition characterized by a recurring “giving way” of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Usually the “giving way” occurs while walking or doing other activities, but it can also happen when you’re just standing. Many athletes, as well as others, suffer from chronic ankle instability. People with chronic ankle instability often complain of:

 

 

 

 

 

 

 

 

        • A repeated turning of the ankle, especially on uneven surfaces or when participating in sports

 

 

 

 

 

 

 

 

 

        • Persistent (chronic) discomfort and swelling

 

 

 

 

 

 

 

 

 

        • Pain or tenderness

 

 

 

 

 

 

 

 

 

        • The ankle feeling wobbly or unstable

 

 

 

 

 

 

 

 

Causes

 

 

 

Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn.  Proper rehabilitation is needed to strengthen the muscles around the ankle and “retrain” the tissues within the ankle that affect balance. Failure to do so may result in repeated ankle sprains.  Repeated ankle sprains often cause – and perpetuate – chronic ankle instability. Each subsequent sprain leads to further weakening (or stretching) of the ligaments, resulting in greater instability and the likelihood of developing additional problems in the ankle.

 

 

 

Diagnosis

 

 

 

In evaluating and diagnosing your condition, the foot and ankle surgeon will ask you about any previous ankle injuries and instability. Then he or she will examine your ankle to check for tender areas, signs of swelling, and instability of your ankle as shown in the illustration. X-rays or other imaging studies may be helpful in further evaluating the ankle.

 

 

 

Non-Surgical Treatment

 

 

 

Treatment for chronic ankle instability is based on the results of the examination and tests, as well as on the patient’s level of activity. Non-surgical treatment may include:

 

 

 

 

 

 

 

 

        • Physical therapy

 

 

 

 

 

 

 

 

 

        • Bracing

 

 

 

 

 

 

 

 

 

        • Medications

 

 

 

 

 

 

 

 

When Is Surgery Needed?

 

 

 

In some cases, the foot and ankle surgeon will recommend surgery based on the degree of instability or lack of response to non-surgical approaches. Surgery usually involves repair or reconstruction of the damaged ligament(s). The surgeon will select the surgical procedure best suited for your case based on the severity of the instability and your activity level. The length of the recovery period will vary, depending on the procedure or procedures performed.

Diabetic Pedal Complications And Amputation Prevention

People with diabetes are prone to having foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor circulation. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation. Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection.  Having diabetes increases the risk of developing a wide range of foot problems such as that small foot problems can turn into very serious complications.  

 

 

 

Diabetes-related Foot and Leg Problems

 

 

 

 

 

 

 

 

        • Infections and ulcers (sores) that don’t heal. An ulcer is a sore in the skin that may go all the way to the bone. Because of poor circulation and neuropathy in the feet, cuts or blisters can easily turn into ulcers that become infected and won’t heal. This is a common – and serious – complication of diabetes and can lead to a loss of your foot, your leg, or your life.

 

 

 

 

 

 

 

 

 

        • Corns and calluses. When neuropathy is present, you can’t tell if your shoes are causing pressure and producing corns or calluses. Corns and calluses must be properly treated or they can develop into ulcers.

 

 

 

 

 

 

 

 

 

        • Dry, cracked skin. Poor circulation and neuropathy can make your skin dry. This may seem harmless, but dry skin can result in cracks that may become sores and can lead to infection.

 

 

 

 

 

 

 

 

 

        • Nail disorders. Ingrown toenails (which curve into the skin on the sides of the nail) and fungal infections can go unnoticed because of loss of feeling. If they are not properly treated, they can lead to infection.

 

 

 

 

 

 

 

 

 

        • Hammertoes and bunions. Nerve damage affecting muscles can cause muscle weakness and loss of tone in the feet, resulting in hammertoes and bunions. If left untreated, these deformities can cause ulcers.

 

 

 

 

 

 

 

 

 

        • Charcot foot. This is a complex foot deformity. It develops as a result of loss of sensation and an undetected broken bone that leads to destruction of the soft tissue of the foot. Because of neuropathy, the pain of the fracture goes unnoticed and the patient continues to walk on the broken bone, making it worse. This disabling complication is so severe that surgery, and occasionally amputation, may become necessary.

 

 

 

 

 

 

 

 

 

        • Poor blood flow. In diabetes, the blood vessels below the knee often become narrow and restrict blood flow. This prevents wounds from healing and may cause tissue death.

 

 

 

 

 

 

 

 

What Your Foot and Ankle Surgeon Can Do?

 

 

 

Your foot and ankle surgeon can help wounds heal, preventing amputation. There are many new surgical techniques available to save feet and legs, including joint reconstruction and wound healing technologies. Getting regular foot checkups and seeking immediate help when you notice something can keep small problems from worsening. Your foot and ankle surgeon works together with other health care providers to prevent and treat complications from diabetes.

 

 

 

Your Proactive Measures

 

 

 

You play a vital role in reducing complications. Follow these guidelines and contact your foot and ankle surgeon if you notice any problems:

 

 

 

 

 

 

 

 

        • Inspect your feet daily. If your eyesight is poor, have someone else do it for you. Inspect for:

                • Skin or nail problems: Look for cuts, scrapes, redness, drainage, swelling, bad odor, rash, discoloration, loss of hair on toes, injuries, or nail changes (deformed, striped, yellowed or discolored, thickened, or not growing).

                • Signs of fracture: If your foot is swollen, red, hot, or has changed in size, shape, or direction, see your foot and ankle surgeon immediately.

 

 

 

 

 

 

 

 

 

        • Don’t ignore leg pain

 

 

 

 

 

 

 

 

 

        • Nail cutting

 

 

 

 

 

 

 

 

 

        • No “bathroom surgery.”

 

 

 

 

 

 

 

 

 

        • Keep floors free of sharp objects.

 

 

 

 

 

 

 

 

 

        • Don’t go barefoot (WEARING SOCKS IS ALSO “BAREFOOT”).

 

 

 

 

 

 

 

 

 

        • Check shoes and socks.

 

 

 

 

 

 

 

 

 

        • Have your circulation and sense of feeling tested.

 

 

 

 

 

 

 

 

 When Amputations and Debridements are Necessary?

 

 

 

Even with preventative care and prompt treatment of infection and complications, there are instances when amputation and/or debridement is necessary to remove infected tissue, save a limb, or even save a life. This is an unfortunate but medically necessary undertaking in certain cases.

Flat Feet (Adult)

What is it?

 

 

 

A painful flat foot, or adult acquired flatfoot deformity, is a progressive collapsing of the arch of the foot that occurs as the posterior tibial tendon becomes insufficient due to various factors.  Early stages may present with only pain along the posterior tibial tendon whereas advanced deformity usually results in arthritis and rigidity of the rearfoot and ankle.

 

 

 

Cause

 

 

 

Posterior tibial tendon dysfunction is the most common cause of acquired adult flatfoot. Sometimes this can be a result of specific trauma, but usually the tendon becomes injured from wear and tear over time. This is more prevalent in individuals with an inherited flat foot but excessive weight, age, and level of activity are also contributing factors.

 

 

 

Treatment

 

 

 

Depending on the stage of the deformity and patient’s functional goals, various treatment options are available. Some patients improve with conservative care which includes rest and immobilization, shoe modifications, orthoses and bracing, or physical therapy. Surgery might be warranted for advanced stages of the condition.  Often a combination of procedures including tendon and muscle augmentation, tendon transfers, realigning of bones or fusion of certain joints might be necessary in more advanced cases.  Your doctor will evaluate and recommend an individualized plan of care with your specific needs in mind.

Flat Feet (Pediatric)

What is it?

 

 

 

Flat foot is a partial or total collapse of the arch and can be classified as symptomatic or asymptomatic. Although usually painless in young children, flatfeet in older children can be painful. Sometimes pain occurs during or after sports and other physical activities and is easily noticed.  However, children often exhibit more subtle signs such as changes in walking, difficulty with shoes, reduced energy or withdrawal from physical activities.

 

 

 

Diagnosis

 

 

 

In addition to a thorough foot and ankle examination, your doctor will provide a gait analysis.  The child’s walking pattern and range of motions of the foot as well as the knee and hip need to be examined.

 

 

 

Treatment

 

 

 

If the child has no symptoms, immediate treatment is often not required or orthotic devices may be considered. The child will be observed and re-evaluated periodically by your doctor. When the child has symptoms, treatment is required. This can include temporary changes in activity, shoe modifications, use of custom orthoses and bracing, physical therapy or medications. For some cases, surgery is necessary. The procedure(s) necessary for your child will be recommended by your doctor on an individual basis.

Fractures Of The Calcaneus (Heel Bone)

What is the Calcaneus? 

 

 

 

The calcaneus, also called the heel bone, is a large bone that forms the foundation of the rear part of the foot. The calcaneus connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the subtalar joint. This joint is VERY important for normal foot function. Calcaneal1 The calcaneus is often compared to a hard boiled egg, because it has a thin, hard shell on the outside and softer, spongy bone on the inside. When the outer shell is broken, the bone tends to collapse and become fragmented. For this reason, calcaneal fractures are severe injuries. Furthermore, if the fracture involves the joints, there is the potential for long-term consequences such as arthritis and chronic pain.

 

 

 

How do Calcaneal Fractures Occur?

 

 

 

Most calcaneal fractures are the result of a traumatic event—most commonly, falling from a height, such as a ladder, or being in an automobile accident where the heel is crushed against the floorboard. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone.

 

 

 

Types of Calcaneal Fractures

 

 

 

Fractures of the calcaneus may or may not involve the subtalar and surrounding joints.  Fractures involving the joints (intra-articular fractures) are the most severe calcaneal fractures, and include damage to the cartilage (the connective tissue between two bones). The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury.  Fractures that do not involve the joints (extra-articular fractures) often have a better prognosis, and seldom require surgical intervention.

 

 

 

Signs and Symptoms 

 

 

 

The signs and symptoms of traumatic fractures may include:

 

 

 

 

 

 

 

 

        • Sudden pain in the heel and inability to bear weight on that foot

 

 

 

 

 

 

 

 

 

        • Swelling in the heel area

 

 

 

 

 

 

 

 

 

        • Bruising of the heel and ankle (and even the forefoot)

 

 

 

 

 

 

 

 

Diagnosis 

 

 

 

To diagnose and evaluate a calcaneal fracture, the foot and ankle surgeon will ask questions about how the injury occurred, examine the affected foot and ankle, and order x-rays, and also advanced imaging tests are commonly required such as CT scan or MRI to evaluate fracture patterns and surgical planning if indicated.

 

 

 

Treatment 

 

 

 

Treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. The foot and ankle surgeon will discuss with the patient the best treatment—whether surgical or non-surgical—for the fracture. For some fractures, non-surgical treatments may be used. These include:

 

 

 

 

 

 

 

 

        • Rest, ice, compression, and elevation (R.I.C.E.)

 

 

 

 

 

 

 

 

 

        • Immobilization

 

 

 

 

 

 

 

 

For traumatic fractures, treatment often involves surgery to reconstruct the joint, or in severe cases, to fuse the joint.

 

 

 

Rehabilitation 

 

 

 

Whether the treatment for a calcaneal fracture has been surgical or non-surgical, physical therapy plays a key role in regaining strength and restoring function.

 

 

 

Long-term Complications of Calcaneal Fractures 

 

 

 

Calcaneal fractures can be serious injuries that may produce lifelong problems. Arthritis, stiffness, and pain in the joint frequently develop. Sometimes the fractured bone fails to heal in the proper position. Other possible long-term consequences ofcalcaneal fractures are decreased ankle motion and walking with a limp due to collapse of the heel bone and loss of length in the leg. Patients often require additional surgery and/or long term or permanent use of a brace or an orthotic device (arch support) to help manage these complications.

Gout

What is it?

 

 

 

Gout is a disorder that results from the build-up of uric acid in the tissues or a joint. It most often affects the joint of the big toe, but can happen almost anywhere in the lower extremities (most common), as in the upper extremities (less common).

 

 

 

Causes

 

 

 

Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of purines, chemicals that are found naturally in our bodies (DNA) and in food. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid (i.e. – “under excreters” & “over producers”). Gout occurs most commonly in the big toe or the forefoot because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since this area is the part of the body that is farthest from the heart, it’s also the coolest part of the body – and, thus, the most likely target of gout. However, gout can affect any joint or area in the body. The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. For example, the body’s ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medications (“water pills”), and the vitamin niacin (also called nicotinic acid). While gout is more common in men aged 40 to 60 years, it can occur in younger men as well as in women. Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat.  

 

 

 

Symptoms

 

 

 

An attack of gout can be marked by the following symptoms:

 

 

 

 

 

 

 

 

        • Intense pain that comes on suddenly – often in the middle of the night or upon arising (typical scenario is a bed sheet that causes intense pain just by touching the foot lightly).

 

 

 

 

 

 

 

 

 

        • Signs of inflammation such as redness, swelling, and warmth over the joint.

 

 

 

 

 

 

 

 

 Diagnosis

 

 

 

To diagnose gout, the foot and ankle surgeon will ask questions about your personal and family medical history, followed by an examination of the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.

 

 

 

Treatment

 

 

 

Initial treatment of an attack of gout typically includes the following:

 

 

 

 

 

 

 

 

        • Medications

 

 

 

 

 

 

 

 

 

        • Dietary restrictions

 

 

 

 

 

 

 

 

 

        • Fluids

 

 

 

 

 

 

 

 

 

        • Immobilize and elevate the foot

 

 

 

 

 

 

 

 

 The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment, and they may or may not be chronic for the patient. A thorough examination and follow up is often necessary to manage patients prone to gout attacks.

Haglund's Deformity

What is it? Haglund

 

 

 

Haglund’s deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes.  This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).

 

 

 

Causes

 

 

 

Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, any shoes with a rigid back, such as ice skates, men’s dress shoes, or women’s pumps, can cause this irritation. To some extent, heredity plays a role in Haglund’s deformity. Inherited foot structures that can make one prone to developing this condition include:

 

 

 

 

 

 

 

 

        • A high-arched foot

 

 

 

 

 

 

 

 

 

        • A tight Achilles tendon

 

 

 

 

 

 

 

 

 

        • A tendency to walk on the outside of the heel.

 

 

 

 

 

 

 

 

Symptoms

 

 

 

Haglund’s deformity can occur in one or both feet. The symptoms include:

 

 

 

 

 

 

 

 

        • A noticeable bump on the back of the heel

 

 

 

 

 

 

 

 

 

        • Pain in the area where the Achilles tendon attaches to the heel

 

 

 

 

 

 

 

 

 

        • Swelling in the back of the heel

 

 

 

 

 

 

 

 

 

        • Redness near the inflamed tissue

 

 

 

 

 

 

 

 

Diagnosis

 

 

 

After evaluating the patient’s symptoms, the foot and ankle surgeon will examine the foot. In addition, x-rays will be ordered to help the surgeon evaluate the structure of the heel bone.  MRI evaluation may help to diagnose Achilles tendon disorders as they are sometimes common with this condition in late stages.

 

 

 

Non-Surgical Treatment

 

 

 

Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Non-surgical treatment can include one or more of the following:

 

 

 

 

 

 

 

 

        • Medication

 

 

 

 

 

 

 

 

 

        • Ice

 

 

 

 

 

 

 

 

 

        • Exercises

 

 

 

 

 

 

 

 

 

        • Heel lifts

 

 

 

 

 

 

 

 

 

        • Heel pads

 

 

 

 

 

 

 

 

 

        • Shoe modification

 

 

 

 

 

 

 

 

 

        • Physical therapy

 

 

 

 

 

 

 

 

 

        • Orthotic devices

 

 

 

 

 

 

 

 

 

        • Immobilization

 

 

 

 

 

 

 

 

 

 

 

 

When Is Surgery Needed?

 

 

 

If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. The foot and ankle surgeon will determine the procedure that is best suited to your case.

Hallux Rigidus (Degenerative Joint Disease Of The Great Toe Joint)

What is it?

 

 

 

Hallux rigidus is a very common disorder of the great toe joint. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe.    This condition is also known as degenerative osteoarthritis. Because hallux rigidus is a progressive condition, the toe’s motion decreases as time goes on. In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called “hallux limitus.” But as the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of “rigidus,” in which the big toe becomes stiff, or what is sometimes called a “frozen joint.”

 

 

 

Causes

 

 

 

Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis – the kind that results from “wear and tear” – often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation, familial anatomic tendencies, overuse from work or activity, inflammatory diseases such as gout or rheumatoid arthritis are susceptible to developing hallux rigidus. Your foot and ankle surgeon can determine the cause of your hallux rigidus and recommend the best treatment.

 

 

 

Symptoms

 

 

 

Early signs and symptoms include:

 

 

 

 

 

 

 

 

        • Pain and stiffness in the big toe with use (walking, standing, bending, etc.)

 

 

 

 

 

 

 

 

 

        • Pain and stiffness aggravated by cold, damp weather

 

 

 

 

 

 

 

 

 

        • Difficulty with certain activities (running, squatting)

 

 

 

 

 

 

 

 

 

        • Swelling and inflammation around the joint

 

 

 

 

 

 

 

 

Later development of the diseases produces:

 

 

 

 

 

 

 

 

        • Pain, even during rest

 

 

 

 

 

 

 

 

 

        • Difficulty wearing shoes because bone spurs (overgrowths) develop

 

 

 

 

 

 

 

 

 

        • Dull pain in the hip, knee, or lower back due to gait changes

 

 

 

 

 

 

 

 

 

        • Limping (in very advanced cases)

 

 

 

 

 

 

 

 

Diagnosis

 

 

 

The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle surgeon is when you first notice symptoms. If you wait until bone spurs and advanced arthritis develop, your condition is likely to be more difficult to manage, and surgical considerations also change.  

 

 

 

Non-Surgical Treatment

 

 

 

In many cases, early treatment may prevent or postpone the need for surgery in the future. Treatment for mild or moderate cases of hallux rigidus may include

 

 

 

 

 

 

 

 

        • Shoe modifications

 

 

 

 

 

 

 

 

 

        • Orthotic devices

 

 

 

 

 

 

 

 

 

        • Medications

 

 

 

 

 

 

 

 

 

        • Injection therapy

 

 

 

 

 

 

 

 

 

        • Physical therapy

 

 

 

 

 

 

 

 

When Is Surgery Needed?

 

 

 

In many cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery for treatment of hallux rigidus. In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

Hammer Toes, Claw Toes, Mallet Toes

What is it?

 

 

 

A hammer toe is a deformity that can affect any toe but mostly of the second, third, fourth and fifth toes. Toes are bent at the joint, resembling a hammer. People with hammer toes often have corns or calluses on the toes. They often are painful in shoes. Hammer toes are sometimes flexible and can be treated conservatively but, most often are rigid and require surgery.

 

 

 

Causes

 

 

 

Often inherited, hammer toes primarily result from a muscle imbalance, in addition to other factors including poorly fitting shoes. Hammertoes are progressive and usually they will get worse over time. Treatments Conservative treatment includes shoe modifications, splinting and padding, injection therapy and orthotic therapy. If conservative measures fail hammer toes can be corrected by surgery.  Surgery is done on an outpatient basis and patients can walk immediately without use of crutches.

 

 

 

For additional information: http://www.foothealthfacts.org/footankleinfo/hammertoes.htm

Ingrowing Toenail

What is it?

 

 

 

Ingrown nails occur when the sides of the nail plate irritate the surrounding skin, often leading to pain, redness and swelling. If not properly cared for, the area becomes infected requiring immediate medical treatment. The big toe is the most common location for this condition, but other toes can be affected.

 

 

 

Cause

 

 

 

Ingrown toenails may be caused by improper nail trimming, trauma and irritation to the nail, heredity, the type of shoes, and certain nail conditions (need link to nail fungus)

 

 

 

Treatment

 

 

 

Care at home rarely may provide temporary relief but seldom resolves the condition completely. This applies to treatment with antibiotics alone. Often a minor surgical procedure to remove the affected nail border, performed in the office, is the treatment of choice. Patients can expect to leave the office in very little pain after and may resume normal activity the next day. Some cases require oral antibiotics. Recurrent cases might benefit from a more permanent surgical procedure.

 

 

 

For additional information: http://www.foothealthfacts.org/footankleinfo/ingrown-toenail.htm

Nail Fungus (Onychomycosis)

What is it?

 

 

 

Toenail fungus, or onychomycosis, is an infection under the surface of the nail caused by fungi.

 

 

 

Toenail fungus often begins as an infection of the skin called tinea pedis (need link to this section). The fungus often starts under the nail fold and causes changes to its appearance, such as discoloration and thickening of the toenail.

 

 

 

 Causes

 

 

 

Fungal organisms thrive in warm, moist places such as locker rooms and showers. Poor sanitary conditions during manicures and pedicures can be a source. Organisms can thrive in shoes as well.

 

 

 

Treatment

 

 

 

Treatment includes trimming the layers of nail in addition to using topical or prescription oral medication and/or LASER therapy. Your Doctor can diagnose the cause of toenail problem and recommend individualized treatment

 

 

 

For additional information: http://www.apma.org/learn/FootHealth.cfm?ItemNumber=1523

Tailor's Bunion (Bunionette Of The 5th Metatarsal)

What is it?

 

 

 

Tailor’s bunion, sometimes referred to as a bunionette, is a prominence of the fifth metatarsal bone at the base of the fifth toe.  Much like a bunion, the bump may be the only visible change, but the bones in the forefoot are misaligned. Tailor’s bunions are not as common as bunions, but they are similar in symptoms and causes

 

 

 

Causes

 

 

 

The type of foot that makes a person prone to developing a tailor’s bunion is hereditary.  Changes occur in the foot’s bone structure, leading to the deformity. The fifth metatarsal bone starts to protrude outward, while the fifth toe moves inward. Poorly fitting shoes can contribute to making the deformity worse.

 

 

 

Treatments

 

 

 

Much like for bunions, conservative treatment includes shoe modifications, splinting and padding, oral medications, injection therapy and orthotic therapy. If conservative measures fail to relieve symptoms, surgery might be necessary. Usually, surgery is done on an outpatient basis and the patient can walk immediately without use of crutches. The procedure your doctor selects will depend on your particular case, taking into consideration the extent of the deformity, age, activity level, and other factors.

 

 

 

For additional information: http://www.foothealthfacts.org/footankleinfo/tailors-bunion.htm

Vascular Disease (Poor Circulation, PAD, Venous Insufficiency)

Vascular disease can be broken down into two categories arterial or venous, arterial disease is usually more severe and often will manifest as symptoms in the feet before any other body part. If it is present in your foot it is likely to be affecting other end organs such as heart, kidneys, brain and eyes. It is important not to ignore symptoms because by the time symptoms manifest the arteries typically have significant blockage. Common symptoms are leg pain with walking otherwise known as claudication, or leg pain and cramping at rest, leg weakness, leg numbness, cold feet, sores that take extended amounts of time to heal, changes in color or loss of hair to feet or legs. Ignoring these symptoms could lead to amputation, heart attack, blindness, stroke or even death.

 

 

 

Venous insufficiency is caused by the valves of your veins not adequately functioning. This loss of function could lead to: varicose veins, skin discoloration, water retention, ulcerations, cellulitis, infections, and if untreated could lead to loss of limb.

 

 

 

At Foot & Ankle Surgeons of New York we have sophisticated non-invasive equipment to test both your arteries and veins. When this technology is coupled with a thorough vascular physical examination, by one of our physicians, a comprehensive plan can be initiated that could prevent serious future health conditions.

Warts (Verruca)

What is it?

 

 

 

A wart is a small growth on the skin as a result of viral infection. Warts can develop anywhere on the foot and ankle, but usually appear on the sole (plantar side) of the foot and hence is commonly known as plantar’s wart.  Plantar warts can affect people of all ages but is more prevalent in children and adolescents.

 

 

 

Cause

 

 

 

The virus that causes warts enters the skin through small or invisible cuts and abrasions. The plantar wart is usually contracted by walking barefoot on infected surfaces. The virus is often found in warm, moist environments such as locker rooms, pools and spas.

 

 

 

Treatment

 

 

 

The goal of treatment is to remove the wart using topical or oral medications, LASER therapy, cryotherapy (freezing), or surgical excision. Home care and consistent follow-up visits with the Doctor is important as warts may often return, requiring further treatment. Often a wart can be diagnosed on examination but certain cases require further diagnostic evaluation. Also, some malignancies can resemble warts. In such cases, a biopsy is necessary to rule out other potential causes.

 

 

 

For more information: http://www.apma.org/learn/FootHealth.cfm?ItemNumber=989