Feet Archives - Orthopedic & Sports Medicine

Could Your Foot Pain Be Caused by a Problem in Your Spine?

Article featured on Spine-Health

This blog provides a list of common causes of foot pain and helpful pointers to help you understand the origin of your foot pain.

Foot pain caused by a spinal problem

Nerve root irritation or compression in the lumbar or sacral spine (lower back) may cause sciatica pain to radiate down your leg and into the foot. Specifically, compression of the S1 nerve root, also called classic sciatica, can cause pain along the outer side of your foot.

Nerve roots may be compressed or irritated due to a number of causes. Common examples include:

Lumbar herniated disc: Leaking of the inner contents of an intervertebral disc
Lumbar degenerative disc disease: Age-related changes causing narrowing and shrinkage of the disc
Spondylolisthesis: Slipping of a vertebra over the one below it
Lumbar spinal stenosis: Narrowing of the bony openings for spinal nerves and/or the spinal cord

The inability to lift the front part of your foot or frequent tripping while walking may be due to a condition called foot drop. This condition is typically caused due to compression of the L5 nerve root. Rarely, compression of the L4 and/or S1 nerve roots may also cause foot drop.

Foot pain caused by compression of nerves in the hip, knee, or leg

Foot pain can also occur when nerves are compressed or damaged along their path in the hip, knee, or leg. For example:

Peroneal neuropathy, a condition where the peroneal nerve is compressed or injured near the knee may cause foot pain and foot drop when you try to move your foot.
Sciatic neuropathy or damage to the sciatic nerve in the pelvic region (hip) may cause foot pain along the top of your foot with some degree of weakness.
Tarsal tunnel syndrome or dysfunction of the tibial nerve within the tarsal tunnel of the inner ankle may cause a sharp, shooting pain in your ankle area and along the sole of your foot.
Sural nerve entrapment can occur in the leg or near the ankle and typically causes shooting pain along the outer side of your ankle and/or foot.

Additionally, a corn may develop on the skin around your toes. Corns grow over time as a result of excessive friction, and they can compress nearby nerves, causing pain and other symptoms. Another possible cause of nerve pain in your foot is Morton’s neuroma, which is a thickening of the tissue around a nerve in the foot.

How to identify the source of your foot pain

With all the possible causes of nerve pain in the foot, it may be difficult to pinpoint the exact underlying cause. Here are a few useful signs to help you identify the source of your foot pain:

Foot pain that follows recent trauma to the lower back, hip, knee, or ankle may help indicate the site of nerve damage
Foot pain due to nerve root compression or sciatica may also be associated with other symptoms, such as pain, numbness, and/or weakness in the buttock, thigh, and leg; and typically affects one leg at a time
Foot pain that develops after wearing tight boots or shoes may indicate peroneal or sural nerve compression near the knee or ankle
Foot pain that develops after a hip injection or hip surgery may indicate sciatic neuropathy.

Nerve pain in the foot may also occur due to nerve damage from systemic conditions, such as diabetes or multiple sclerosis.

Twisting, bending, or a direct hit on your ankle and/or foot may injure the foot bones, ankle joint, blood vessels, muscles, and/or tendons, causing foot pain.

Schedule a visit with your doctor

It is important to schedule an appointment with your doctor to accurately diagnose the cause of your foot pain. Treatments for foot pain can differ widely and must be directed at resolving the underlying cause; not just masking the symptoms. For example, a lumbar herniated disc may require heat therapy and exercise, while a corn on your toe can often be treated with special shoes and warm water.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

What are the Best Foot Exercises for Healthy Feet?

in Feet, Foot Pain

Article featured on Medical News Today

What are the best foot exercises for healthy feet?

Many people experience foot or ankle pain at some point. Keeping the feet strong can help alleviate this soreness and improve overall health and flexibility.

Regularly exercising and stretching the feet and ankles can help ensure that the muscles are providing the best support. These exercises may also increase range of motion in the feet, helping keep a person active for as long as possible.

Most foot exercises are simple and require no complicated equipment to perform. People can do them at home or in the gym as part of a regular exercise routine. The following exercises can improve flexibility and mobility in the feet.

1. Toe raise, point, and curl

This exercise has three stages and will help strengthen all parts of the feet and toes.

To do this exercise:

Sit up straight in a chair, with the feet flat on the floor.
Keeping the toes on the floor, raise the heels. Stop when only the balls of the feet remain on the ground.
Hold this position for 5 seconds before lowering the heels.
For the second stage, raise the heels and point the toes so that only the tips of the big and second toes are touching the floor.
Hold for 5 seconds before lowering.
For the third stage, raise the heels and curl the toes inward so that only the tips of the toes are touching the floor. Hold this position for 5 seconds.
Build flexibility and mobility by repeating each stage 10 times.

2. Big toe stretch

Keeping a wide range of motion in the big toe is important. The following exercise also has three stages and is designed to stretch and relieve pain in the toes from wearing tight shoes.

To do this exercise:

Sit up straight in a chair, with the feet flat on the floor.
Bring the left foot to rest on the right thigh.
Using the fingers, gently stretch the big toe up, down, and to the side.
Keep the big toe in each position for 5 seconds.
Repeat this 10 times before switching to the other foot.

Exercises for strength

The following exercises can help enhance the strength of the feet.

3. Toe splay

Doing the toe splay exercise can improve control over the toe muscles. People can do it on both feet at once or on alternate feet, depending on which they find more comfortable.

To do this exercise:

Sit in a straight backed chair, with the feet gently resting on the floor.
Spread the toes apart as far as possible without straining. Hold this position for 5 seconds.
Repeat this motion 10 times.
Once a person has built up their strength, they can try looping a rubber band around the toes. This will provide resistance and make the exercise more challenging.

4. Toe curls

Doing toe curls builds up the flexor muscles of the toes and feet, improving overall strength.

To do this exercise:

Sit up straight in a chair, with the feet flat on the floor.
Lay a small towel on the floor in front of the body, with the short side facing the feet.
Place the toes of one foot on the short side of the towel. Try to grasp the towel between the toes and pull it toward oneself. Repeat this exercise five times before switching to the other foot.
To make this exercise more challenging, try weighing down the opposite end of the towel with an object.

5. Marble pickup

Doing the marble pickup can increase strength in the muscles on the undersides of the feet and toes.

To do this exercise:

Sit up straight in a chair, with the feet flat on the floor.
Place an empty bowl and a bowl of 20 marbles on the floor in front of the feet.
Using only the toes of one foot, pick up each marble and place it in the empty bowl.
Repeat this exercise using the other foot.

6. Sand walking

Walking barefoot on sand is a great way to stretch and strengthen the feet and calves. This is a good exercise in general because sand’s soft texture makes walking more physically demanding.

To do this exercise:

Head to a beach, a desert, a volleyball court, or any other location with sand.
Remove the shoes and socks.
Walk for as long as possible. Try increasing the distance slowly over time to avoid overexerting the muscles in the feet and calves.
The following exercises can be helpful for pain relief.

7. Toe extension

The toe extension is useful in preventing or treating plantar fasciitis, which is a condition that causes pain in the heel when walking and difficulty raising the toes.

To do this exercise:

Sit up straight in a chair, with the feet flat on the floor.
Place the left foot on the right thigh.
Pull the toes up toward the ankle. There should be a stretching feeling along the bottom of the foot and heel cord.
Hold for 10 seconds. Massaging the arch of the foot while stretching will help ease tension and pain.
Repeat this exercise 10 times on each foot.

8. Golf ball roll

Rolling a golf ball under the foot can help relieve discomfort in the arch and ease pain associated with plantar fasciitis.

To do this exercise:

Sit up straight in a chair, with the feet flat on the floor.
Place a golf ball — or another small, hard ball — on the floor next to the feet.
Lay one foot on the ball and move it around, pressing down as hard as is comfortable. The ball should be massaging the bottom of the foot.
Continue for 2 minutes, then repeat using the other foot.
A frozen bottle of water can be a soothing alternative if no suitable balls are available.

9. Achilles stretch

The Achilles tendon is a cord connecting the heel to the calf muscles. It can strain easily, but keeping it strong may help with foot, ankle, or leg pain.

To do this exercise:

Face a wall and raise the arms so that the palms of the hands are resting flat against the wall.
Move one foot back, keeping the knee straight. Then, bend the knee of the opposite leg.
Keep both the heels flat on the floor.
Push the hips forward until there is a stretching feeling in the Achilles tendon and calf muscles.
Hold for 30 seconds before switching sides. Repeat three times on each side.
For a slightly different stretch, bend the back knee and push the hips forward.

Foot health and safety tips

To help keep the feet strong and healthy:

Complete a thorough warmup routine before exercising.
Wear supportive footwear for day-to-day activities and sports.
Replace worn-down shoes as often as possible.
Build up strength and flexibility slowly to condition the feet and ankles.
Avoid uneven surfaces, especially when running. Try not to run uphill too often.
Listen to the body. Do not overdo activities.
Prevent any recurrence of injury by resting and seeking appropriate treatment.

Summary

Keeping the feet and ankles healthy is a good idea. Performing the exercises above can help ease existing pain, prevent discomfort, and reduce the risk of injury.

People with a diagnosed foot condition such as plantar fasciitis or strain to the Achilles tendon may wish to try exercises to help.

Always check with a healthcare professional, if possible, before starting a new exercise and stretching routine.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

8 Common Foot Injuries

in Feet, Foot Pain

Article featured on Healthgrades

What to Know About Foot (and Ankle) Injuries

Inside your foot lies machinery that would impress any engineer. A total of 26 bones, 33 joints, and more than 100 tendons, muscles and ligaments work in tandem to support your weight and propel you through your daily routine. Just as the highest-tech machine can malfunction, flaws in the inner workings of your feet—or overwhelming demands from the outside—can cause injuries. Here are eight problems that can strike your feet, along with solutions.

1. Neuromas

Too-tight or high-heeled shoes, among other causes, can compress the nerves between your toes. Most often, this occurs between your third and fourth toes, a condition called Morton’s neuroma. The pain, tingling, and numbness of a neuroma can often be relieved with padding, icing, orthotics, and wearing shoes with a wide toe box and low heels.

2. Stress Fracture

Among the more severe sports injuries, stress fractures often occur when you overdo a high-impact activity like running, dance or basketball. Fatigued muscles transfer stress to the bone. A small, hairline crack forms, causing potentially severe pain. Though stress fractures can occur in any part of your foot, they most often form in the second and third metatarsals, or long toe bones. Rest allows your bones to heal, usually in 6 to 8 weeks.

3. Plantar Fasciitis

Does the first step out of bed in the morning have you howling in pain? You likely have plantar fasciitis, an inflammation of the band of tissue—facscia—connecting your toes to your heel on the bottom of your foot. High-impact sports, extra weight, and jobs that require walking or standing on hard surfaces increase your risk. Stretch your foot and calf frequently, and consider wearing a night splint that lengthens your plantar fascia while you sleep.

4. Heel Spurs

Heel spurs occur when calcium deposits build up on the bottom of your heel bone. Often, they don’t cause pain themselves—but they can irritate the plantar fascia, triggering pain along the arch and heel. Calf and foot stretches work well to relieve it; rarely is surgery to remove the spur necessary.

5. Bunions

This bump of bone and tissue at the base of your big toe forms when the joint connecting it to your foot shifts out of place. Narrow-toed and high-heeled shoes cause most cases, though heredity plays a small role. Left untreated, bunions can cause pain so severe it limits your ability to walk. Fortunately, treatments like ice, over-the-counter foot pads, and wearing shoes with wider toe boxes often bring relief.

6. Sesamoiditis

Your sesamoids—two pea-shaped bones lodged in the tendon beneath the ball of your foot—help the big toe move normally. Activities that place strain on the ball of the foot, including running and golf, can injure the bones, tendons, or surrounding tissue. Padding, strapping, or taping the foot can relieve pressure on the sesamoids, while anti-inflammatory drugs reduce pain and swelling.

7. Achilles Tendinitis

The lengthy Achilles tendon can grow thick, inflamed, swollen or painful when asked to do too much, too soon (for example, after beginning an ambitious exercise program). Tight calf muscles may also play a role. Often, pain decreases after switching from a high-impact exercise to a cross-training program, such as biking, elliptical or swimming, paired with moves to stretch and strengthen the calves.

8. Ankle Sprains

About 25,000 people fall, step or twist their way into an ankle sprain each day. This common injury occurs when the ligaments on the outer side of your ankle stretch or tear, causing pain, swelling, and sometimes an inability to bear weight. Talk with a doctor if that’s the case, or if you have severe swelling or deformity. For mild sprains, rest, ice, compression and elevation—the RICE protocol—usually does the trick.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Rheumatoid Arthritis of the Foot and Ankle

in Feet, Rheumatoid Arthritis

Article featured on OrthoInfo

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. It most often starts in the small joints of the hands and feet, and usually affects the same joints on both sides of the body. More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease.

Description

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.

How It Happens

The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes an overactivity of this lining. It swells and becomes inflamed, destroying the joint, as well as the ligaments and other tissues that support it. Weakened ligaments can cause joint deformities — such as claw toe or hammer toe. Softening of the bone (osteopenia) can result in stress fractures and collapse of bone.

In RA, the lining of the joint swells and becomes inflamed. This slowly destroys the joint.

Rheumatoid arthritis is not an isolated disease of the bones and joints. It affects tissues throughout the body, causing damage to the blood vessels, nerves, and tendons. Deformities of the hands and feet are the more obvious signs of RA. In about 20% of patients, foot and ankle symptoms are the first signs of the disease.

Statistics

Rheumatoid arthritis affects approximately 1% of the population. Women are affected more often than men, with a ratio of up to 3 to 1. Symptoms most commonly develop between the ages of 40 and 60.

Cause

The exact cause of RA is not known. There may be a genetic reason — some people may be more likely to develop the disease because of family heredity. However, doctors suspect that it takes a chemical or environmental “trigger” to activate the disease in people who inherit RA.

Symptoms

The most common symptoms are pain, swelling, and stiffness. Unlike osteoarthritis, which typically affects one specific joint, symptoms of RA usually appear in both feet, affecting the same joints on each foot.

Anatomy of the foot and ankle

Anatomy of the foot and ankle.

Ankle

Difficulty with inclines (ramps) and stairs are the early signs of ankle involvement. As the disease progresses, simple walking and standing can become painful.

Hindfoot (Heel Region of the Foot)

The main function of the hindfoot is to perform the side-to-side motion of the foot. Difficulty walking on uneven ground, grass, or gravel are the initial signs. Pain is common just beneath the fibula (the smaller lower leg bone) on the outside of the foot.

As the disease progresses, the alignment of the foot may shift as the bones move out of their normal positions. This can result in a flatfoot deformity. Pain and discomfort may be felt along the posterior tibial tendon (main tendon that supports the arch) on the inside of the ankle, or on the outside of the ankle beneath the fibula.

Midfoot (Top of the Foot)

With RA, the ligaments that support the midfoot become weakened and the arch collapses. With loss of the arch, the foot commonly collapses and the front of the foot points outward. RA also damages the cartilage, causing arthritic pain that is present with or without shoes. Over time, the shape of the foot can change because the structures that support it degenerate. This can create a large bony prominence (bump) on the arch. All of these changes in the shape of the foot can make it very difficult to wear shoes.

Rheumatoid arthritis of the midfoot

This x-ray shows signs of RA of the midfoot. Note that the front of the foot points outward and there is a large bump on the inside and bottom of the foot.

Forefoot (Toes and Ball of the Foot)

The changes that occur to the front of the foot are unique to patients with RA. These problems include bunions, claw toes, and pain under the ball of the foot (metatarsalgia). Although, each individual deformity is common, it is the combination of deformities that compounds the problem.

The bunion is typically severe and the big toe commonly crosses over the second toe.

Illustration of bunion and claw toe

People with RA can experience a combination of common foot problems, such as bunions and clawtoe.

There can also be very painful bumps on the ball of the foot, creating calluses. The bumps develop when bones in the middle of the foot (midfoot) are pushed down from joint dislocations in the toes. The dislocations of the lesser toes (toes two through five) cause them to become very prominent on the top of the foot. This creates clawtoes and makes it very difficult to wear shoes. In severe situations, ulcers can form from the abnormal pressure.

Severe claw toes can become fixed and rigid. They do not move when in a shoe. The extra pressure from the top of the shoe can cause severe pain and can damage the skin.

Doctor Examination

Medical History and Physical Examination

After listening to your symptoms and discussing your general health and medical history, your doctor will examine your foot and ankle.

Skin. The location of callouses indicate areas of abnormal pressure on the foot. The most common location is on the ball of the foot (the underside of the forefoot). If the middle of the foot is involved, there may be a large prominence on the inside and bottom of the foot. This can cause callouses.

Foot shape. Your doctor will look for specific deformities, such as bunions, claw toes, and flat feet.

Flexibility. In the early stages of RA, the joints will typically still have movement. As arthritis progresses and there is a total loss of cartilage, the joints become very stiff. Whether there is motion within the joints will influence treatment options.

Tenderness to pressure. Although applying pressure to an already sensitive foot can be very uncomfortable, it is critical that your doctor identify the areas of the foot and ankle that are causing the pain. By applying gentle pressure at specific joints your doctor can determine which joints have symptoms and need treatment. The areas on the x-ray that look abnormal are not always the same ones that are causing the pain.

Imaging Tests

Other tests that your doctor may order to help confirm your diagnosis include:

X-rays. This test creates images of dense structures, like bone. It will show your doctor the position of the bones. The x-rays can be used by your doctor to make measurements of the alignment of the bones and joint spaces, which will help your doctor determine what surgery would best.

Computerized tomography (CT) scan. When the deformity is severe, the shape of the foot can be abnormal enough to make it difficult to determine which joints have been affected and the extent of the disease. CT scans allow your doctor to more closely examine each joint for the presence of arthritis.

Magnetic resonance imaging (MRI) scan. An MRI scan will show the soft tissues, including the ligaments and tendons. Your doctor can assess whether the tendon is inflamed (tendonitis) or torn (ruptured).

Rheumatology Referral

Your doctor may refer you to a rheumatologist if he or she suspects RA. Although your symptoms and the results from a physical examination and tests may be consistent with RA, a rheumatologist will be able to determine the specific diagnosis. There are other less common types of inflammatory arthritis that will be considered.

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Nonsurgical Treatment

Although there is no cure for RA, there are many treatment options available to help people manage pain, stay active, and live fulfilling lives.

Rheumatoid arthritis is often treated by a team of healthcare professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.

Although orthopaedic treatment may relieve symptoms, it will not stop the progression of the disease. Specific medicines called disease-modifying anti-rheumatic drugs are designed to stop the immune system from destroying the joints. The appropriate use of these medications is directed by a rheumatologist.

Orthopaedic treatment of RA depends on the location of the pain and the extent of cartilage damage. Many patients will have some symptom relief with appropriate nonsurgical treatment.

Rest

Limiting or stopping activities that make the pain worse is the first step in minimizing the pain. Biking, elliptical training machines, or swimming are exercise activities that allow patients to maintain their health without placing a large impact load on the foot.

Ice

Placing ice on the most painful area of the foot for 20 minutes is effective. This can be done 3 or 4 times a day. Ice application is best done right after you are done with a physical activity. Do not apply ice directly to your skin.

Nonsteroidal Anti-inflammatory Medication

Drugs, such as ibuprofen or naproxen, reduce pain and inflammation. In patients with RA, the use of these types of medications should be reviewed with your rheumatologist or medical doctor.

Orthotics

An orthotic (shoe insert) is a very effective tool to minimize the pressure from prominent bones in the foot. The orthotic will not be able to correct the shape of your foot. The primary goal is to minimize the pressure and decrease the pain and callous formation. This is more effective for deformity in the front and middle of the foot/

For people with RA, hard or rigid orthotics generally cause too much pressure on the bone prominences, creating more pain. A custom orthotic is generally made of softer material and relieves pressure on the foot.

Braces

A lace-up ankle brace can be an effective treatment for mild to moderate pain in the back of the foot and the ankle. The brace supports the joints of the back of the foot and ankle. In patients with a severe flatfoot or a very stiff arthritic ankle, a custom-molded plastic or leather brace is needed. The brace can be a very effective device for some patients, allowing them to avoid surgery.

Ankle brace

A custom-molded leather brace can be effective in minimizing the pain and discomfort from ankle and hindfoot arthritis.

Steroid Injection

An injection of cortisone into the affected joint can help in the early stages of the disease. In many cases, a rheumatologist or medical doctor may also perform these injections. The steroid helps to reduce inflammation within the joint. The steroid injection is normally a temporary measure and will not stop the progression of the disease.

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Surgical Treatment

Your doctor may recommend surgery depending upon the extent of cartilage damage and your response to nonsurgical options.

Fusion. Fusion of the affected joints is the most common type of surgery performed for RA. Fusion takes the two bones that form a joint and fuses them together to make one bone.

During the surgery, the joints are exposed and the remaining cartilage is removed. The two bones are then held together with screws or a combination of screws and plates. This prevents the bones from moving.

Because the joint is no longer intact, this surgery does limit joint motion. Limited joint motion may not be felt by the patient, depending on the joints fused. The midfoot joints often do not have much motion to begin with, and fusing them does not create increased stiffness. The ankle joint normally does have a lot of motion, and fusing it will be noticeable to the patient. By limiting motion, fusion reduces the pain.

Fusion can be a successful technique. However, because patients with RA also show damaged cartilage and loose ligaments, the success rate of this type of surgery is lower in patients with RA than in patients without RA. The use of newer generation medication can slow the progression of the disease and impact the type of surgeries that can be performed successfully.

Other surgeries. The front of the foot is where there are more surgical options for some patients. Surgeons can now perform joint sparing operations to correct the bunion and hammertoes in some patients. Your surgeon will review the most appropriate options for your case.

Ankle

Ankle fusion and total ankle replacement are the two primary surgical options for treating RA of the ankle. Both treatment options can be successful in minimizing the pain and discomfort in the ankle. The appropriate surgery is based upon multiple factors and is individualized for every patient.

Ankle fusion and ankle replacement

This patient had arthritis of the hindfoot. It was treated by fusing all three joints of the hindfoot (triple fusion). An ankle replacement was also done in order to improve mobility and avoid the severe stiffness that would result from another ankle fusion. The ankle replacement implants can be seen here from the front and the side.

Patients with severe involvement of other joints around the heel or patients who have previously undergone a fusion on the other leg, may be more suited for ankle replacement. In addition, patients who have fusions within the same foot may be more suited for an ankle replacement.

Newer generation ankle replacement implants have shown promising early results. Ankle replacement implants have not yet been shown to be as long-lasting as those for the hip or knee, due to the fact that the newer generation of implants have not been available long enough to determine how long they will last.

Ankle fusion

These x-rays show an ankle fusion from the front and the side. The number and placement of screws and the use of a plate are dependent upon the surgeon’s technique.

Following ankle fusion, there is a loss of the up and down motion of the ankle. The up and down motion is transferred to the joints near the ankle. This creates a potential for pain in those joints, and possibly arthritis.

Patients are able to walk in shoes on flat, level ground without much difficulty after an ankle fusion, despite the loss of ankle motion. The joints in the foot next to the ankle joint allow for motion similar to the ankle joint, and help patients with fused ankle joints walk more normally.

Arthritis in subtalar joint

Over time, the increased stress that is placed on the rest of the foot after an ankle fusion can lead to arthritis of the joints surrounding the ankle. This patient had pain in the subtalar joint (arrow) and required an additional fusion of that joint to minimize the pain. Increased stress on other joints is the most concerning problem following ankle fusion.

Hindfoot (Heel Region of the Foot)

A fusion of the affected joints of the hindfoot is the most common surgery used to treat patients with flatfoot or arthritis of the hindfoot. A triple arthrodesis is a fusion that involves all three joints in the back of the foot. Occasionally, the joint on the outside of the foot is not fused if there is minimal to no involvement of that joint (this is at the surgeon’s discretion). This type of fusion eliminates the side-to-side motion of the foot, while preserving most of the up and down movement.

If RA is only in one joint, then a fusion of just that affected joint may be all that is needed.

Ankle fusion

(Left) In this x-ray, two of the three joints in the hindfoot have been fused. (Right) Just the subtalar joint is fused in this x-ray.

Any fusion of the hindfoot will limit side-to-side motion of the foot. This will affect walking on uneven ground, grass, or gravel. There is no method to replace the joints of the hindfoot.

Midfoot (Middle of the Foot)

Fusion is the most reliable surgical method to treat RA of the midfoot joints. If the shape of the foot is not normal, surgery is designed to help restore the arch and minimize the prominences on the foot.

There are joint replacement implants available for joints on the outside of the midfoot. This may preserve some midfoot motion. However, the use of these implants is at the surgeon’s discretion. These implants are not available for the joints on the inside of the midfoot.

Although the foot cannot be returned to a normal shape, the goals are to reduce pain in the foot and improve the potential for the patient to wear more normal shoes.

Reconstruction of collapsed arch

(Top) This x-ray shows RA of the midfoot that has collapsed the arch. (Bottom) The surgical reconstruction involved a fusion of the middle of the foot with plates and screws.

Forefoot (Toes and Ball of the Foot)

The choice of treatment for patients with a bunion or lesser toe deformities (hammer or claw toes) depends on a number of factors.

If the disease is very mild, joint-sparing procedures that preserve motion can be considered. The decision is dependent on the medication that the patient is taking and the amount of damaged cartilage that is present. A fusion of the great toe may be recommended despite that fact the bunion is very mild. If there is damage to the cartilage of the great toe joint, correcting the bunion will not minimize the arthritic pain.

If the RA has progressed and the lesser toes (two through five) have dislocated, a complex operation to minimize the pain and restore the shape of the foot may be recommended. The operation involves fusion of the big toe and removing a portion of bone of each of the metatarsals. This surgery removes the prominent bone on the bottom of the foot that is a source of the pain and allows the toes to re-align into a better position.

Occasionally, the lesser toe metatarsals can be preserved by shortening them to allow the toes to resume their position within the joints. This is not always possible, however, and the joint may have to be removed.

RA of the forefoot before and after fusion

(Left) RA of the forefoot. The big toe is deviated and crosses over the second toe, a typical appearance of a bunion. The lesser toes (two through five) are dislocated, resulting in painful and severe claw toes. (Right) This x-ray taken immediately after fusion of the big toe shows that the prominent bones on the ball of the foot were removed and the claw toes were corrected. The pins hold the toes in place while the soft tissues heal. The pins are removed in the office after 4 to 6 weeks with minimal discomfort.

To fix the bend in the toes themselves, the surgeon may suggest cutting a tendon or removing a small portion of bone of the toes to allow them to straighten. Pins that stick out of the foot are temporarily required and will be removed in the office after healing takes place.

There are some newer implants available that can be buried within the toes, which avoid the need for pins sticking out of the foot. These implants may not work if the bone is soft, or if significant destruction of the joints has occurred.

This operation puts a lot of stress on the blood vessels and skin of the foot. In severe cases, the toes may not survive the operation and may require amputation of a portion or the entire toe. This operation can provide the patient with a high level of function and the ability to enjoy a wider variety of shoewear.

Footwear

Reconstruction of the foot does not mean that a patient will be required to wear bulky and unappealing shoes every day. The patient shown here had both feet reconstructed. She is able to wear sandals and mild heels without difficulty. Although these types of shoes are not recommended all the time, they can be worn from time to time. Not all patients will achieve such an excellent result.

Preparing for Surgery

Many of the medications that help with RA also affect the ability of the body to heal wounds and fight infection. Your surgeon will work with your rheumatologist or medical doctor to review which of your medications will need to be stopped prior to surgery. Once the wounds are healed, the medication is typically resumed.

This period of time can be very difficult for patients with other areas of the body that are affected by RA. Many fusions require at least 6 weeks of time where no pressure can be placed on the foot. Making appropriate preparations to ensure you have help at home is crucial for success after surgery.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

All About Foot Pain

in Feet, Foot Pain

From WebMD

Feet. They carry you from here to there every day. But you may not think much about them until they hurt. And when they do, you want relief. To get the right treatment, you need to know the problem. The first thing to consider is where your pain is located.

What you should know about a broken pinky toe

in Feet, Toe Injuries

Article Featured on MedicalNewsToday

A broken pinky toe is a fracture of the smallest toe. The term “broken toe” usually describes a traumatic fracture, which can occur due to a direct blow or impact, such as stubbing the toe or dropping something on it. The pinky toe is a commonly broken toe, and the fracture usually occurs at its base.

This article looks at the symptoms of a broken small toe, along with some other problems that can cause pain and swelling in the area. It also examines the treatment and management options for this injury.

Plantar Fasciitis Treatments: How to Treat Plantar Fasciitis

in Feet, Plantar Fasciitis

By Corie Richter, PA | Article Featured on PPP

If you feel the sharp pain of plantar fasciitis in your heel, rest assured—you may just be a few days away from pain relief. Your doctor and physical therapist can make great strides in just a couple of visits, and you’ll probably be pain-free within a few months.

How to Tell if you Have Flat Feet: Symptoms of Flat Feet

in Feet

Article Featured on AAOS

A variety of foot problems can lead to adult acquired flatfoot deformity (AAFD), a condition that results in a fallen arch with the foot pointed outward.

Most people — no matter what the cause of their flatfoot — can be helped with orthotics, braces and physical therapy. In patients who have tried these treatments without any relief, surgery can be a very effective way to help with the pain and deformity. This article provides a brief overview of the problems that can result in AAFD.

One of the more common signs of flatfoot is the “too many toes” sign. Even the big toe can be seen from the back of this patient’s foot. In a normal foot, only the fourth and fifth toes should be visible.

Symptoms of Flat Feet

Depending on the cause of the flatfoot, a patient may experience one or more of the different symptoms below:

Pain along the course of the posterior tibial tendon which lies on the inside of the foot and ankle. This can be associated with swelling on the inside of the ankle.
Pain that is worse with activity. High intensity or impact activities, such as running, can be very difficult. Some patients can have difficulty walking or even standing for long periods of time.
When the foot collapses, the heel bone may shift position and put pressure on the outside ankle bone (fibula). This can cause pain on the outside of the ankle. Arthritis in the heel also causes this same type of pain.
Patients with an old injury or arthritis in the middle of the foot can have painful, bony bumps on the top and inside of the foot. These make shoewear very difficult. Occasionally, the bony spurs are so large that they pinch the nerves which can result in numbness and tingling on the top of the foot and into the toes.
Diabetics may only notice swelling or a large bump on the bottom of the foot. Because their sensation is affected, people with diabetes may not have any pain. The large bump can cause skin problems and an ulcer (a sore that does not heal) may develop if proper diabetic shoewear is not used.

Causes of Flat Feet

As discussed above, many health conditions can create a painful flatfoot.

Posterior Tibial Tendon Dysfunction (PTTD)

Damage to the posterior tibial tendon is the most common cause of AAFD. The posterior tibial tendon is one of the most important tendons of the leg. It starts at a muscle in the calf, travels down the inside of the lower leg and attaches to the bones on the inside of the foot.

The main function of this tendon is to hold up the arch and support your foot when you walk. If the tendon becomes inflamed or torn, the arch will slowly collapse.

Anatomy of the foot

The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot.

Women and people over 40 are more likely to develop problems with the posterior tibial tendon. Other risk factors include obesity, diabetes, and hypertension. Having flat feet since childhood increases the risk of developing a tear in the posterior tibial tendon. In addition, people who are involved in high impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use.

Arthritis from Flat Feet

Inflammatory arthritis, such as rheumatoid arthritis, can cause a painful flatfoot. This type of arthritis attacks not only the cartilage in the joints, but also the ligaments that support the foot. Inflammatory arthritis not only causes pain, but also causes the foot to change shape and become flat.

The arthritis can affect the back of the foot or the middle of foot, both of which can result in a fallen arch.

Injuries as a Result of Flat Feet

An injury to the ligaments in the foot can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from moving. If the ligaments are torn, the foot will become flat and painful. This more commonly occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot.

In addition to ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity.

Diabetic Collapse (Charcot Foot)

People with diabetes or with a nerve problem that limits normal feeling in the feet, can have arch collapse.

This type of arch collapse is typically more severe than that seen in patients with normal feeling in their feet. This is because patients do not feel pain as the arch collapses. In addition to the ligaments not holding the bones in place, the bones themselves can sometimes fracture and disintegrate – without the patient feeling any pain. This may result in a severely deformed foot that is very challenging to correct with surgery. Special shoes or braces are the best method for dealing with this problem.

Summary

Adult acquired flatfoot is one of the most common problems affecting the foot and ankle. Treatment ranges from nonsurgical methods — such as orthotics and braces — to surgery. Your doctor will create a treatment plan for you based on what is causing your AAFD.

Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm