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Podiatry– Foot & Ankle Specialist

You are here: Home1 / Podiatry– Foot & Ankle Specialist

Common conditions/topics addressed by podiatry specialists:


  • Heel pain, plantar fasciitis, & heel spurs
  • Bunions
  • High arch and low arch feet
  • Corns, calluses, and warts
  • Bone spurs
  • Ingrown and fungal toenails
  • Metatarsalgia – neuromas, stress
    fractures, and tendonitis
  • Hammertoes
  • Sports related injuries
  • Diabetes
  • Pediatric foot problems
  • Cortisone injections
  • What are orthotics?
  • Ankle and foot trauma
  • Foot fractures
  • Ankle arthritis
  • Osteoarthritis
  • Ankle replacement
  • Ankle instability
  • Achilles tendon ruptures
  • Peroneal tendonitis
  • Haglund’s deformity
  • Achilles tendinitis
  • Avascular necrosis of talus
  • Freiberg’s disease
  • Severe’s calcaneal apophysitis
  • Calcaneal fracture (heel fracture)
  • Jones fracture
  • Dancing injuries
  • Plantar fibroma and fibromatosis
  • Ankle implant
  • Stress fracture
  • Turf toe
  • Midfoot arthritis
  • Capsulitis
  • Ganglion cyst
  • Foot and ankle deformity

What is a Podiatrist/ Podiatric Surgeon?

A podiatrist is a doctor whose degree is “Doctor of Podiatric Medicine (DPM).” The podiatrist is a specialist in the treatment of foot and ankle problems. Before a DPM degree is conferred, a student must complete four years of medical training after college in all aspects of medicine and surgery with special emphasis on lower extremity conditions. Podiatrists have a three years of residency training in foot and ankle surgery following their four years of specialized medical training. After completing surgical residency training, some podiatrists go on to complete extra Fellowship surgical training focused on more complex lower extremity trauma, reconstruction and foot and ankle deformity correction. Many patients seen by the podiatrist are referred by family practice physicians and other specialists who wish to have their patients treated by a doctor trained specifically in foot and ankle disorders. In addition to their surgical training, podiatrists have extensive training in the non-surgical treatment of foot and ankle problems. There is no other specialty that has as extensive training in these areas as the podiatrist.


Heel pain, plantar fasciitis, and heel spurs

There are a variety of causes of heel pain. Heel pain can occur on the bottom of the heel or the back of the heel. The most common heel pain occurs in the bottom of the heel. Frequently this pain is worse first thing in the morning or after having been at rest. It seems to come out of nowhere or feel like a stone bruise after having been on your feet for long periods of time. Patients often describe the pain as being sharp like stepping on a “spur” or a thorn. The pain may radiate into the arch of the foot or up into the calf muscle. On occasion, leg or foot cramps accompany the condition. Often associated with a spur identified on x-rays, the condition may be referred to as “heel spurs.” A common contributing factor is tightness of the calf muscles.

The pain is caused by the pull of a very strong ligament that attaches into the bottom of the heel and fans out into the ball of the foot. This ligament, called the plantar fascia, acts as a bow string to help support the arch of the foot. It is like woven rope and does not stretch well. When something causes the arch to flatten, the ligament is stretched more than it can, and it pulls on the heel bone, causing pain. We call this plantar fasciitis. This pain often eases after a few steps as the ligament is forced to stretch. In severe cases the ligament can tear or rupture.

Home remedies should include soaking your feet in Epsom salts and warm water, taking an over-the-counter anti-inflammatory, heel cushions or shoe inserts, and calf muscle stretching. Wearing a good supportive shoe is very helpful. Surprisingly, wearing a shoe with a 1″ heel may ease the pain.

When seeking professional help, expect to have an x-ray taken to assist in the diagnosis. Treatment is tailored to the patient. Treatment may include a prescription anti-inflammatory drug, a cortisone injection, orthopedic taping of the foot to support the arch,or perhaps custom-made insoles for your shoes called orthotics. When conservative treatment fails, an operative procedure may be required.


Bunions

A bunion is a deviation of the long bone behind the big toe producing a bump on the side of the foot. Bunions can occur on one or both feet. They tend to be hereditary but can occur without a family history. They are not caused by shoes but are often aggravated by shoe gear. Abnormal movement of the joints just below the ankle joint causes the deformity. This results in the front portion of the foot splaying or widening. As a result the big toe starts to drift toward the second toe and the long bone behind the big toe starts to drift outward. This deformity gradually gets worse with time, making it more painful and difficult to wear shoes. Because the bunion deformity is progressive, it should be evaluated early. Treatment options range from a recommendation on shoes, and possibly inserts for shoes called orthotics, which are used to control the cause of the bunion and halt its progression. In many instances surgery is recommended.

Our recommendations are based upon the pain associated with the bunion, the patient’s lifestyle, and the degree of the deformity. As the bunion worsens, it becomes more difficult to treat surgically and the healing time is often increased significantly. Over time, the joint in the big toe can become arthritic, lose its flexibility, and become painful with nearly every step. At this stage the surgical treatments are limited, and a joint replacement may be required.

The selection of the procedure to be used is based upon the degree of the deformity, the underlying biomechanical cause of the bunion, and the procedure that will get the patient back to activity in the shortest period of time. There are no magic procedures and no shortcuts to healing time. Your safety and the final satisfactory outcome of your surgery are paramount to us. If you have further questions, please make an appointment for consultation.


High arch and low arch feet

Pes cavous and pes planus are the scientific terms that describe high arch feet and low arch or “flat” feet. As Podiatrists, we are very interested not only in structure but also in function of the feet. While very few people have 20-20 vision, it is also true that very few people have perfect arch structure. High and low arch feet are just the two ends of the spectrum of foot structure. The more deviation from what is considered perfect, the worse the function becomes. We describe deviation from “the ideal” as imbalance in structure. It is the imbalance in structure that leads to abnormal function. Abnormal function causes pain and/or deformity. Deformity can manifest itself in a variety of foot problems such as bunions or hammertoes. Likewise, pain can manifest itself in a variety of ways such as heel pain (plantar fasciitis or heel spur), corns or calluses, metatarsalgia or pain in the ball of the foot (neuromas, stress fractures, or tendonitis), or even in pediatric problems.

Invariably, we treat almost all foot imbalance or biomechanical insufficiencies with orthotic therapy.


Corns, calluses, and warts

Corns, calluses and warts are areas of thickened skin irritations that can occur on the foot. Calluses are thick, painful skin irritations that can occur on the bottom of the foot. If the thickened area is on top of the toes, we call it a corn. Corns are usually caused by shoes pressing against the toes. They are made worse if the toe is crooked or contracted (hammertoe). These areas generally represent areas of excessive pressure or friction in shoes or while walking on hard surfaces. Caution should be used whenever using any type of corn or callus removers because these medications contain acids that burn the thickened skin off. If you have diabetes, you should never use these medications without a physician’s guidance. These irritations will generally reoccur after use of these medications because the source of irritation is still present. Home remedies might include shoe cushions or pads, and if they are between the toes, cotton or pads might be used. Warm water soaks and then buffing with a pumice stone may help. Creams and lotions may be of some temporary help.

Warts are hard areas that most often occur on the bottom of the foot and are called plantar warts. The bottom of the foot is called the plantar aspect of the foot, thus the name plantar warts. Plantar warts are caused by a viral infection of the skin. They do not have roots or seeds, they only live within the full thickness of the skin. Because a virus causes them, they can spread. They are not highly contagious, but will often spread to other areas of the foot. If you have plantar warts, do not pick at them and do not share your shoes with others. There are over-the-counter wart removers. They generally do not work because the skin is so thick, and it is difficult for the medicine, which is an acid, to penetrate to the depth necessary to kill the wart. Warts can be difficult to treat even for your doctor. Some can be quite persistent; so, it is best to catch them early and get treatment before they become established.


Bone spurs

Bone spurs may occur anywhere a muscle, tendon or ligament attaches to a bone. Generally a spur will only be painful if it causes pressure to some other surrounding structure. Common areas of bone spurs in the foot are in the toes, the heel, the big toe joint, the top of the foot, and the ankle. The location of the spur and the amount of discomfort determines what the doctor recommends for treatment. This may consist of something as simple as a pad or cushion, a cortisone injection, or even surgery to permanently solve the problem.


Ingrown and fungal toenails

Ingrown toenails are quite common in all age groups. Patients often live with them needlessly for months or years. The improper trimming of the nails, tight shoes, or injury to the nail can cause ingrown toenails. Often they seem to occur for no reason at all. If they become infected, you should soak them in warm water and Epsom salts, apply an antibiotic ointment and make an appointment to have them treated. Treatment is virtually painless. Following the procedure there is little to no pain and no limitation of your activities once the anesthesia has worn off.

Fungal toenails are toenails that have become infected with one of a group of microorganisms we call fungus. In many instances it is the same organism that causes athlete’s foot. As the fungus invades the nail and the nail bed, it may go unnoticed for a period of time because it is rarely painful. It usually appears at the nail edge and works its way under the nail, progressing back to the root of the toenail. Once it invades the root, or matrix, it begins to distort the way the nail grows and becomes more difficult to treat.

In early stages, clipping the diseased portion of the nail away and applying an antifungal cream after drying the toe can treat the problem. In later stages of the disease, oral medications may be useful with or without nail removal.


Metatarsalgia-neuromas, stress fractures, and tendonitis

A pain experienced in the ball of the foot may have several different origins: stress fractures, neuromas, or tendonitis.

A stress fracture often begins either gradually or abruptly and is accompanied by swelling and occasionally some discoloration.

Pain that is intermittent or sharp and radiates into the toes may be a neuroma. A neuroma is a swollen nerve that gets pinched between the long bones behind the toes. It has often been described as a nerve tumor; however, in the strictest sense it is not a tumor but rather a swelling of the nerve secondary to some form of irritation. If left untreated the symptoms will often worsen.

Tendonitis is an inflammation in the ball of the foot associated with the tendons that go into the toes. The symptoms are similar to those associated with the neuroma. Tendonitis is often seen in runners and in women who wear high heeled shoes.

Home remedies for all of these conditions consist of wearing stiff-soled shoes with plenty of room in the toe area; over-the-counter anti-inflammatories such as Advil, Tylenol, Motrin or Alieve; and foot soaks in warm water and Epsom salts.


Hammertoes

A hammertoe is a term used to describe a crooked, deviated, or contracted toe. Contrary to popular belief, hammertoes are usually not caused by ill or tight fitting shoe gear but by an imbalance in the way the bones of the foot are aligned. Over a period of years, the tendons that move the toe up and down begin to pull the toe with unequal tension, and the toe then begins to buckle or become contracted. Normally hammertoes by themselves are not painful, but with shoe gear the prominent knuckle of the toe rubs the shoe, producing an area of irritation which eventually forms a corn.

Conservative care may include padding, wider shoes, thicker socks, or even orthotics to try to correct the underlying imbalance. If the problem cannot be managed and produces continual pain, then surgical correction can be accomplished either in the offices or at an outpatient surgical center.


Sports related injuries

Biomechanics is the basis of all lower extremity sports related injuries. The doctors are also members of the American Academy of Podiatric Sports Medicine.

In many instances the treatment of sports related injuries begins with understanding the underlying biomechanics of their cause. There is such an array of these injuries that space does not permit outlining all of them. The more common injuries include shin splints, arch pain, heel pain, Achilles tendonitis, ankle injuries, stress fractures, tendon injuries about the ankle and rear foot, toenail injuries, nerve injuries, and blistering of the skin, to list just a few.

Our advice to all athletes is to incorporate a rigorous stretching program into your workout. The adage of “no pain, no gain” could not be further from the truth. Pain is a warning sign; and if the pain is recurrent and ignored, then the amateur athlete is asking for trouble and, possibly, significant down time from his or her sport or exercise program.

You should choose your athletic shoes with care and be timely in replacing them when they wear out. A good pair of over-the-counter insoles is often useful for minor areas of foot irritation. Following a particularly rigorous workout, areas of soreness are often eased with the use of an over-the-counter anti-inflammatory such as Tylenol, Advil or Aleve. Icing the area can also be useful. If your pain persists, make an appointment and allow us to evaluate your condition and make recommendations for your treatment. Many sports medicine problems are also treated with orthotics.


Diabetes

Diabetic patients are particularly at risk for significant foot problems that can lead to the loss of their feet or legs. The most common cause of hospitalization for the diabetic patient is foot infections. Foot related problems for the diabetic patient are responsible for significant time off work. Foot ulcerations can take weeks or months to heal.

Our physicians are experts in the treatment of diabetic foot disorders, infections, and limb saving techniques. Both doctors are members of the American Diabetes Association and attend regular educational meetings dealing with the treatment of the diabetic’s foot conditions.

There are two conditions that are associated with diabetes that put the patient at risk. The first is called neuropathy, which is a nerve condition that frequently affects the feet. There is a gradual loss in the patient’s ability to perceive the protective sensations. The protective sensations are the ability to feel pain, to feel the difference between hot and cold, sharp and dull, vibration, and excessive pressure. This loss of sensation can become quite profound. Patients can step on sharp objects or cut themselves and not feel pain. They may burn themselves with scalding water and not be aware of it, and they can develop pressure sores and infections and experience little or no pain.

Because of this condition, diabetic patients must be constantly aware of their feet and inspect them daily. They should avoid walking barefoot and always check the temperature of their bath water or foot baths prior to immersing their feet. Special care should be taken when trimming the toenails. The sharp trimming of corns and calluses and over-the-counter corn removers should be avoided. Shoe gear must be appropriately fitted to avoid areas of irritation. Frequently this condition causes a burning pain that makes sleeping difficult. Other patients may feel like their feet are ice cold and have difficulty warming them. These patients must not use heating pads or hot water bottles to warm their feet or they risk burns to the skin that may not heal and could lead to the loss of their foot or leg.

The other condition is called angiopathy, which is the loss of blood circulation to the feet and legs. Loss of circulation results in prolonged healing of cuts or sores on the feet. In severe cases it can lead to gangrene and limb loss. This condition is often accompanied by thinning of the skin, loss of hair growth and color changes to the feet. The feet are cool to the touch and can be very sensitive, making it painful to walk for even short distances.

Of course, the diabetic may have both of these conditions. In this situation, the patient is at significant risk of limb loss and must be monitored very closely.

Common problems the diabetic might encounter are ingrown or fungal toenails, thick calluses on the bottom of the feet, or corns on or between the toes. These relatively simple problems are the precursors of more significant problems. Our recommendation is that diabetic patients have their feet checked on a regular basis by a podiatrist. If they notice any areas of possible skin irritations, sores, or infection, they should be treated professionally by a podiatrist. If they notice a change in the shape of their feet, the arches falling, or notice swelling of sudden onset, they should be seen by a podiatrist. The diabetic patient’s best defense against infections and possible loss of feet or legs is prevention by daily inspection and having regular foot exams.


Pediatric foot problems

Our physicians have extensive training in diagnosing and treating child related foot disorders. Infants and young, growing children have special circumstances that necessitate they be evaluated by a specialist familiar with normal development. Many conditions, if caught early, can be easily treated, correcting the problem before it becomes a life-long deformity. Common foot disorders that we treat include in-toeing and out-toeing, flat feet, curved feet, toe walking, inflamed growth plates in the bones, leg cramps and night cramps, ingrown toenails, athlete’s foot, and other skin conditions. We also treat young athletes and sports related injuries of all ages. Children will often not complain about pain associated with their sport. The demands of soccer, baseball, dance, and gymnastics on the growing child will often uncover underlying developmental problems.

One common myth is that children have “growing pains”. Growth is not painful and soreness and cramping in the feet and legs are not normal. This generally is the result of muscle imbalance or flat feet, which strains the muscles in the feet and legs that are trying to support the foot. A family history of foot problems is significant since many foot problems are hereditary. Often parents are told that their children may “grow out of it.” This may be true in some cases but a level of reassurance from a specialist can go a long way in easing a parents’ concern. If you have concerns about your child’s feet, please make an appointment and let’s discuss your concerns and evaluate your child.


Cortisone injections

Cortisone is a very safe and useful medication. The type of cortisone given is similar to the type of cortisone your body produces naturally. It is useful in halting an ongoing inflammatory process that is impeding your body’s ability to heal itself. It can, in many instances, halt the painful process permanently. In other instances, it is useful in the short-term treatment of pain so additional modalities have a greater opportunity to effect a cure of the problem. Cortisone will not dissolve bone spurs, but it is useful in shrinking swollen and inflamed soft tissues.

If a cortisone injection is suggested and you have concerns, we encourage you to discuss them with us. Our goal is to provide you with the highest quality care. Part of providing that care is ensuring that you are comfortable with the plan and understand the treatment.


What are orthotics?

Orthotics, which are often used in the treatment of biomechanical disorders, are custom molded inserts for shoes that correct foot function and improve efficiency during gait. They are not only useful for the treatment of foot problems but also can be used for the treatment of ankle, knee, hip, and lower back complaints when these disorders have their origin with abnormal foot function and gait.

Why do I need orthotics?

Everyone’s foot structure is different. Just as each individual’s eyesight, personality, and medical problems are unique to that person, so is his foot structure unique. The foot is composed of 26 bones, 107 ligaments, numerous tendons, and 19 muscles originating in the leg and the foot. The way these bones, muscles, and tendons work together determines the balance and alignment of the foot. This, together with your weight, the type of work you do, the amount of time you are on your feet, and the type of surface you stand on all day, not to mention the type of shoes you wear, also contributes to the delicate balance and alignment of your feet. A perfectly balanced and aligned foot is extremely rare.

Practically all foot problems are directly or indirectly related to foot malalignments. If you are experiencing any foot pains, deformities, fatigue, cramps, etc., you probably have an imbalance in your feet. Orthotics are designed to correct or rebalance that abnormality. Just as glasses or contact lenses help to correct your eyesight, orthotics help re-balance your foot structure to reduce abnormal stresses or abnormal areas of weight bearing in your feet that lead to discomfort and that can cause more serious problems as time passes.

What do orthotics look like?

Orthotics look much like supports. There are many types that can be prescribed: some are rigid, some soft and flexible. The doctor will decide which type you need depending on the problems you are having. In all cases, the devices fit in closed shoes and can be transferred from one pair of shoes to another.

How long do I have to wear orthotics?

Depending on your problem, orthotics should be worn the majority of the time you are on your feet, if possible. Once you become accustomed to them, you will probably feel uncomfortable without them. This is not to say that you must wear orthotics when you want to dress up on occasion with shoes that are not compatible with the devices.

What type of shoes are compatible with orthotics?

Most closed shoe with a heel height of 1-1/2″ or less. Orthotics are useless in high heeled shoes and will usually slip out of sandals. Obviously, they can’t be worn when you are barefoot. The most compatible shoe is a closed lace up type of shoe such as an athletic shoe. For women, as the shoe becomes more “dressy” the orthotic may become incompatible. In theses instances, a second pair of “dress orthotics” may be needed.

Can orthotics be used for sports activities, i.e., running, aerobics, etc.?

Definitely! In fact, many professional and amateur athletes treated in this offices would be unable to perform without their orthotics.

Do orthotics ever have to be replaced? Can they break?

If you are an adult, it is not likely that your orthotic prescription will have to be changed. Occasionally your foot structure may change over a period of time and a new prescription may be necessary, but this is rare. In children, new prescriptions may be necessary, and orthotics need to be changed after two to four years of use, and possibly sooner if the child has a growth spurt. Most orthotics will not break depending on the material they are made of, however they are not invulnerable to extreme heat, theft, or the dog chewing them up! Occasionally, they may need to be refurbished when the corner or heal post wear thin.

What is involved in having orthotics made?

A detailed biomechanical evaluation with objective measurements of the joint movements in your feet, ankles, knees, and hips is necessary to prescribe orthotics to fit your individual foot. Occasionally certain muscle groups may also be treated, along with posture, evaluation of pelvic tilt, back problems or malalignments such as scoliosis of the spine. Gait or walking analysis may also be included. This examination, along with angular measurements of the bones of the foot seen in your x-rays, is used to determine a prescription for your orthotics.

We use modern technology to take a 3D scan of your foot, so your orthotics will be 100% specific to your foot.


Ankle Fractures

Ankle fractures are a common injury. Assessment should include looking at the mechanism of injury, comorbidities, associated injuries, soft tissue status and neurovascular status. Emergent reduction is required for clinically deformed ankles. Investigations should include plain radiographs and a computed tomography scan for more complex injuries or those with posterior malleolus involvement. An assessment of ankle stability determines treatment, taking into account comorbidities and preoperative mobility which need special consideration. Non-operative management includes splint or cast, allowing for early weightbearing when the ankle is stable. Operative management includes open reduction and internal fixation, intramedullary nailing (of the fibula and hindfoot) and external fixation. Syndemosis stabilisation includes suture button or screw fixation. The aim of treatment is to restore ankle stability and this article explores the current evidence in best practice.


Foot and Ankle Arthritis

As you get older, you have a higher risk of arthritis. The joint damage from this condition can cause swelling, pain, and physical changes in your feet and ankles.

Foot and Ankle Arthritis Types

Arthritis is a general term for a group of more than 100 diseases. It can involve inflammation and swelling in and around your joints and the nearby soft tissue.

With many kinds of arthritis, your joints wear down over time. You slowly lose the smooth “cushioning” cartilage inside them. As a result, your bones rub and wear against each other. Soft tissues in your joints also may begin to wear down. After some time, the joint might not work or move the way it should.

Several types of arthritis can cause pain in your feet and ankles, including:

  • Osteoarthritis, or “wear-and-tear” arthritis, is the most common type. Doctors also call it degenerative joint disease or age-related arthritis. Osteoarthritis usually causes changes over many years. The foot and ankle joints where it’s most common are:
    • The three joints involving your heel bone, your inner mid-foot bone, and your outer mid-foot bone
    • The joint of your big toe and foot bone
    • The joint where your ankle and shinbone meet
  • Rheumatoid arthritis is one of the most serious forms. It’s an autoimmune disease in which your immune system attacks the joint. It usually happens in the same joint on both sides of your body.
  • Gout happens when you have a buildup of uric acid from your diet. It’s most common in your big toe because it’s the farthest body part from your heart.
  • Psoriatic arthritis can happen in one or more joints, including your ankles and the ends of your toes. It may also cause toe swelling called dactylitis.
  • Post-traumatic arthritis happens after an injury, especially a dislocation or bone fracture. You might not notice problems for years.

Foot and Ankle Arthritis Symptoms

Symptoms of foot and ankle arthritis often include:

  • Tenderness when you touch the joint
  • Pain when you move it
  • Trouble moving, walking, or putting weight on it
  • Joint stiffness, warmth, or swelling
  • More pain and swelling after you rest, such as sitting or sleeping

Foot and Ankle Arthritis Treatment

Depending on your symptoms and what’s causing your arthritis, you might have one or more of these treatments:

  • Steroid medications injected into your joints
  • Anti-inflammatory drugs to help with swelling
  • Pain relievers
  • Pads or arch supports in your shoes
  • Canes or braces for support
  • Shoe inserts that support your ankle and foot (orthotics)
  • Physical therapy
  • Custom-fitted shoes

Surgery for foot and ankle arthritis

Some people need at least one kind of surgery to treat foot and ankle arthritis. Your doctor will suggest the treatment that’s best for you. Surgeries for arthritis include:

  • Fusion surgery. This is also called arthrodesis. It involves fusing bones together with rods, pins, screws, or plates. After they heal, the bones remain joined.
  • Joint replacement surgery. This is mostly used in severe cases. Your doctor may call it arthroplasty. They’ll take out damaged bone and cartilage and replace it with metal or plastic.

Home Remedies for Foot Arthritis Pain

When you have arthritis in your foot or ankle, one of the most important things is to wear comfortable shoes. Look for these details:

  • Shoes shaped like your foot
  • Shoes with good support (for example, no slip-ons)
  • Rubber soles for more cushioning
  • Flexibility
  • Proper fit; ask a salesperson for help

Exercise can help keep your feet strong, flexible, and pain-free. Moves that can be good for your feet include:

  • Achilles stretch. Face a wall with your palms flat against it. Step one foot forward and one foot back. Lean forward, keeping your heels on the floor. Feel the pull in the Achilles tendon and calf of your rear leg. Hold for 10 seconds. Repeat this exercise three times on each side.
  • Big-toe stretch. Put a thick rubber band around your big toes. Use your muscles to pull them away from each other and toward your other toes. Hold this position for 5 seconds. Repeat 10 times.
  • Toe pull. Put a rubber band around the toes of each foot, and spread your toes. Hold this position for 5 seconds, and repeat the exercise 10 times.
  • Toe curl. Pick up marbles with your toes.

Lifestyle Changes for Foot Arthritis

A few changes to your daily life can help you feel better and may keep your arthritis from getting worse.

  • If a certain activity triggers a flare-up of symptoms, try to keep it to a minimum.
  • Instead of high-impact exercises like jogging, do low-impact ones like swimming or cycling.
  • Keep a healthy weight so your joints aren’t under as much stress.

Ankle Instability

Are you experiencing pain in your ankle that affects your daily activities? Do you ever have a dull ache on the outside of your ankle? Do you ever feel like your ankles are weak? If so, you may be suffering from chronic ankle instability.

What is chronic ankle instability?

Ankle instability is a recurring or chronic pain on the outside of the ankle that develops after trauma such as an ankle sprain. Several other conditions, however, may also cause ankle pain.

What are the symptoms of chronic ankle instability?

  • Pain – usually on the outside of the ankle
  • Stiffness
  • Swelling – can be constant or sometimes come and go
  • Tenderness around the ankle
  • Repeated ankle sprains or sensation of your ankle giving out

What causes ankle instability?

The most common cause of ankle instability is incomplete healing after the foot rolls under the ankle during an ankle sprain. This causes the soft tissue between the bones to become over stretched or torn. Without complete rehabilitation, the ligaments and surrounding tissue will remain weak. As a result, you may experience additional injuries. Other causes of chronic ankle pain include:

  • Arthritis of the ankle joint and/or surrounding joints
  • An injury to the nerves that pass through the ankle
  • Torn or inflamed tendons
  • A fracture
  • Scar tissue

How is chronic ankle instability diagnosed?

The first step is seeing a podiatric foot and ankle specialist. There are many potential causes of ankle pain and your doctor will often order X-rays and/or a MRI to better evaluate your ankle. A detailed and thorough physical examination will occur.

What are treatment options?

Treatment will be personalized to your individual needs. Your podiatrist will determine if nonsurgical or surgical treatment is necessary.

Nonsurgical treatments include:

  • Anti-inflammatory medicine
  • Physical therapy
  • Bracing
  • In the case of fracture, immobilization

Surgical treatments include:

  • Removing loose fragments
  • Cleaning the joint surface
  • Repairing or tightening the ligaments around the ankle joint

And, if surgery is necessary, it is often done through small incisions allowing you to go home the same day.


Achilles tendon rupture

Achilles (uh-KILL-eez) tendon rupture is an injury that affects the back of your lower leg. It mainly occurs in people playing recreational sports, but it can happen to anyone.

The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture) completely or just partially.

If your Achilles tendon ruptures, you might hear a pop, followed by an immediate sharp pain in the back of your ankle and lower leg that is likely to affect your ability to walk properly. Surgery is often performed to repair the rupture. For many people, however, nonsurgical treatment works just as well.

Symptoms

Although it’s possible to have no signs or symptoms with an Achilles tendon rupture, most people have:

  • The feeling of having been kicked in the calf
  • Pain, possibly severe, and swelling near the heel
  • An inability to bend the foot downward or “push off” the injured leg when walking
  • An inability to stand on the toes on the injured leg
  • A popping or snapping sound when the injury occurs

When to see your doctor

Seek medical advice immediately if you hear a pop in your heel, especially if you can’t walk properly afterward.

Causes

Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you walk and move your foot.

Rupture usually occurs in the section of the tendon situated within 2 1/2 inches (about 6 centimeters) of the point where it attaches to the heel bone. This section might be prone to rupture because blood flow is poor, which also can impair its ability to heal.

Ruptures often are caused by a sudden increase in the stress on your Achilles tendon. Common examples include:

  • Increasing the intensity of sports participation, especially in sports that involve jumping
  • Falling from a height
  • Stepping into a hole

Risk factors

Factors that may increase your risk of Achilles tendon rupture include:

  • Age. The peak age for Achilles tendon rupture is 30 to 40.
  • Sex. Achilles tendon rupture is up to five times more likely to occur in men than in women.
  • Recreational sports. Achilles tendon injuries occur more often during sports that involve running, jumping, and sudden starts and stops — such as soccer, basketball and tennis.
  • Steroid injections. Doctors sometimes inject steroids into an ankle joint to reduce pain and inflammation. However, this medication can weaken nearby tendons and has been associated with Achilles tendon ruptures.
  • Certain antibiotics. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles tendon rupture.
  • Obesity. Excess weight puts more strain on the tendon.

Prevention

To reduce your chance of developing Achilles tendon problems, follow these tips:

  • Stretch and strengthen calf muscles. Stretch your calf until you feel a noticeable pull but not pain. Don’t bounce during a stretch. Calf-strengthening exercises can also help the muscle and tendon absorb more force and prevent injury.
  • Vary your exercises. Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming. Avoid activities that place excessive stress on your Achilles tendons, such as hill running and jumping activities.
  • Choose running surfaces carefully. Avoid or limit running on hard or slippery surfaces. Dress properly for cold-weather training, and wear well-fitting athletic shoes with proper cushioning in the heels.
  • Increase training intensity slowly. Achilles tendon injuries commonly occur after an abrupt increase in training intensity. Increase the distance, duration and frequency of your training by no more than 10 percent weekly.

Achilles tendinitis

Achilles tendinitis is an overuse injury of the Achilles (uh-KILL-eez) tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone.

Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It’s also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends.

Most cases of Achilles tendinitis can be treated with relatively simple, at-home care under your doctor’s supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.



Ankle Replacement

Total ankle replacement, is a surgical treatment for ankle arthritis that is appropriate for some patients.

Can Ankles Be Replaced?

Ankle replacement surgery has been an option for many years. Recent advancements in technology and techniques have made it the preferred option for treating patients with ankle arthritis.

Ankle replacement can take away the pain from the arthritis and preserve the motion at the joint. This helps patients perform tasks such as walking on uneven ground and going up and down stairs. It also protects the other joints of the foot to help prevent them from getting arthritis.

What is Ankle Replacement Surgery?

Ankle replacement is a surgical treatment for ankle arthritis in which portions bone and cartilage in joint removed and replaced with prosthetic implants. A total ankle replacement prosthesis is made up of three different parts: A titanium metal component is attached to the tibia, a cobalt-chrome piece is connected to the talus, and a polyethylene (plastic) implant is placed between the two. An ankle replacement takes away pain from arthritis, while also preserving motion at the joint.


Peroneal Tendonitis

Peroneal tendonitis is inflammation in one or both of the tendons that connect your lower leg to your foot. It’s usually due to overusing the tendons, but it can also be the result of a sudden injury such as an ankle sprain. Pain and swelling in your peroneal tendons usually go away after several weeks of conservative treatments.

Causes of Peroneal Tendonitis:

  • Repetitive running on sloped streets can cause peroneal tendonitis; as your foot rolls outward, the friction increases between the tendon and the bone, and this over pronation can increase this tension between the tendon and the bone.
  • Marathoners or long distance runners commonly get peroneal tendonitis from the repetitive motion of running long distances.
  • Tight calf muscles increase the tension on the tendons and causes them to rub more which can cause peroneal tendonitis.
  • People who have recurrent ankle sprains are more likely to develop peroneal tendonitis because the ankle is weaker around the injury.

What are the symptoms of Peroneal Tendonitis?

Immediate symptoms of peroneal tendonitis include pain and swelling in the ankle. If the pain does not subside with rest you may need to be evaluated for peroneal tendonitis. Other symptoms of peroneal tendonitis include:

  • Tenderness behind the ankle bone
  • Pain the first thing in the morning when you wake up

What are treatments for peroneal tendonitis?

Rest, ice and anti-inflammatory medications are the first line treatments for peroneal tendonitis.

When necessary more advanced treatments for peroneal tendonitis include:

  • Orthotics
  • Splint or brace
  • Physical therapy & rehabilitation
  • Platelet rich plasma (PRP) injection

Haglund’s Deformity

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

What are the causes of Haglund’s Deformity?

Haglund’s deformity commonly develops when wearing shoes with rigid backs including pumps, men dress shoes and roller skates. These types of shoes put pressure on the back of the heel creating a bony bump on the calcaneus. The bump will dig into the soft tissue surrounding the area, causing irritation and swelling in the bursa and other tissues.

People with pre-existing conditions including a bump under the achilles, high arches, pre-existing abnormalities in foot-structure, and a tight achilles tendon, have an increased susceptibility to this condition.

What are treatments for Haglund’s Deformity?

Non-Surgical Treatment

In minor cases, the swelling of the bursa and soft tissue can be relived with:

  • Rest: Limit the use of your heel which will relieve pain and swelling
  • Ice and compression: These work together to alleviate pain and swelling in the heel
  • Medication: Anti-inflammatory medication and painkillers at the discretion of your doctor can help reduce discomfort in the heel
  • Physical therapy and exercises: Working with a physical therapist to stretch out the achilles tendon can assist in relieving agitation in the heel
  • Orthotics: Soft padding and shoes with additional arch support can help keep the foot aligned, lessening the pressure on your heel

Surgical Treatment

While many cases of Haglund’s Deformity often respond to non-surgical treatments, severe cases involving bone protrusion or enlargement may require a surgical procedure. The surgery procedure involves repairing Achilles tendinitis or tendinosis and removing the bony lumps.


Avascular Necrosis of the Talus (AVN)

Avascular necrosis of the talus (AVN) refers to a cutoff of the blood supply to the talus, which is a bone within the ankle. The blood vessels are typically damaged due to an fracture in the ankle. When AVN takes place, the bone may soften and begin to break down. If the blood flow is not restored, arthritis will often develop, severe pain occurs and joint function is reduced.

What are treatment options?

There are several surgical options available to treat AVN. Depending upon the progression of the condition, your doctor may consider ankle fusion, decompression of the talus, a muscle flap to restore blood flow or a bone graft.

  • Ankle Fusion – when arthritis of the ankle joint occurs after AVN and talus fracture, a fusion of the ankle might be recommended. The fusion is generally a complicated operation with the results of the fusion not always being predictable and ankle motion can be lost. Alternative treatments are typically more desirable due to some uncertainty.
  • Core Decompression – a surgical procedure where a hole is drilled in the talus, that may lead to decompression of the bone and resultant healing of the talus because it increases the blood supply to the talus. This method can only be used at the early stages of AVN.

Freiberg’s Disease

Freiberg’s disease is rare condition that primarily affects the second or third metatarsal (the long bones of the foot). Some common symptoms may include pain and stiffness in the front of the foot around the affected to, which often turns into a limp. People may also experience limited range of motion, swelling in the foot and tenderness within the foot that is affected. Symptoms are typically triggered with weight-bearing activities, such as standing and walking. The cause of Freiberg’s disease remains unknown. Patients sometimes only recognize the symptoms as they get older. X-rays are used to identify and diagnose the disease.

What are the treatment options?

Non-Surgical Treatment

The treatments goal is to reduce pressure on the affected area of the foot when you are active. This option includes custom footwear and/or correctly placed padded insoles. While this doesn’t cure the disease, it is suitable for many patients.

Surgical Treatment

Surgery options aim to “tidy up” the joint to decrease inflammation in the affected toe. Another surgical option is to reposition the metatarsal bone by cutting and realigning it held together with a tiny screw. This helps the joint fit together nicely to reduce pain and inflammation.


Sever’s Calcaneal Apophysitis

Sever’s disease is an inflammatory condition in the heel bone that causing heel pain. It happens frequently in young athletes typically between the ages of 10 and 13, causing pain in one or both heels while walking. Tenderness and swelling can also be present.

What causes Sever’s disease?

The heel bone is divided by a layer of cartilage in younger people. During years of growth, the bone grows faster than the surrounding tendons. In this case, the heel cord will typically be growing faster than the tendons making the tension against the heel bone be greater. In younger athletes, the stress of running and jumping while playing sports such as football, soccer and basketball may cause inflammation of the growth center of the heal. The growth plate is sensitive to repeated running and pounding with hard surfaces.

What are common symptoms of Sever’s disease?

Common symptoms of Sever’s Calcaneal Apophysitis may include:

  • Pain in the bottom or back of the heel
  • Limping in attempt to alleviate pain
  • Walking on toes
  • Troubles with jumping, running or participating in sports and activities
  • Pain when squeezing the sides of the heels
  • Tiredness

What are treatment options for Sever’s disease?

Various treatments may include modification of a child’s activity level, various stretching exercises, and use of shoes that have appropriate hindfoot support. Doctors may also suggest:

  • Physical therapy: stretching and/or physical therapy methods can sometimes be used to promote healing of the inflamed tissue within the heel
  • Immobilization: In more severe cases, a cast might be used to promote the healing of the heal and keeping the foot and ankle completely immobile

In many cases, the heel pain may return after treatment due to the bone still growing. If children have reoccurring pain in the heel, it is advised to make an appointment with a Dr to ensure nothing more serious is going on.

Are there ways to prevent Sever’s Calcaneal?

Chances of children developing this condition can be reduced by:

  • Maintaining a healthy weight
  • Wearing supportive shoes that are appropriate for each activity
  • Avoiding/limiting wear of shoes that are cleated
  • Avoiding any activity that above the child’s activity capabilities

Calcaneal (Heel bone) Fracture

A fracture of the calcaneus (heel bone), can be a painful and disabling injury. This type of fracture commonly occurs during a high-energy event, such as a car crash or a fall from a ladder, when the heel is crushed under the weight of the body. When this happens, the heel can widen, shorten, and become deformed.

Heel fractures are typically quite severe. Treatment often involves surgery to reconstruct the normal shape of the heel and to restore mobility to ensure patients can return to normal activity after treatment. Even with the appropriate treatment in patients, these injuries can result in long-term complications including pain, loss of motion, swelling and arthritis. Many patients with this fracture become unable to return to their labor-intensive jobs.

How does the severity of Calcaneal Fracture’s vary?

There are varying severity of Calcaneal Fracture’s including:

  • The number of fractures in the heel
  • The amount and size of each broken fragment
  • The amount of pieces of bone that become displaced. In some cases the fragments line up close to correct. In more severe cases, there may be large gaps between pieces, or they may overlap each other
  • Injury of the cartilage surface in the subtalar joint
  • Injury to the surrounding soft tissues including the muscles, tendons and the skin

If the bone breaks and a fragment sticks out from the skin (open fracture), it causes more damage to the surrounding skin, muscles, tendons and ligaments it will take longer time to heal. This also will have higher risk of infections in the bone and wound itself.

What are common symptoms?

People who experience Calcaneal Fractures will experience:

  • Pain
  • Bruising
  • Swelling
  • Heel deformity
  • Inability to put weight on the heel or walk at all

Minor cases of heel fractures might not prevent patients from walking, but may still have a limp. This is due to the achilles tendon acting through the heel to support body weight. If the fracture is severe, the muscle and tendon will be unable to generate enough power to support body weight and will feel unstable.

What are treatment options for Calcaneal Fractures?

Doctors will evaluate multiple factors to decide the proper form of treatment for each patient:

  • Cause of the injury
  • Overall patient health
  • Severity of injury
  • Extent of soft tissue damage in the heel/foot

Since most calcaneus fractures cause the bone to shorten or widen, the goal is typically not to restore the normal anatomy of the heel. In general, patients whose heel anatomy is restored have better outcomes in treatment. Recreating the heel anatomy most often involves surgery.

Nonsurgical Treatment

A nonsurgical treatment option may be recommended if the fractures are not displaced by the event that fractures it. Various options may include immobilization in a cast, splint or brace to hold bones in place while they heal. Casts are typically warn for 6 to 8 weeks and sometimes longer depending on each individual case. During the time of wearing a case, you will not be able to put any weight on your heel until the bone has completely healed.

While nonsurgical options are non-invasive, they can still lead to some long-term complications. These complications can include wound healing issues, infections and nerve damage.

Surgical Treatment

If the bones from the fracture become displaced, your doctor may recommend surgery. Surgery will repair the calcaneus fracture to restore the normal shape of the bone. It is sometimes associated with complications including wound healing issues, infections and nerve damage.


Jones Fracture

A Jones fracture is a fracture of the pinky toe side of your foot – the fifth metatarsal bone. This fracture can happen by increasing the pressure on your feet by gaining weight or stepping on uneven surfaces. You can also fracture the bone during side-to-side (lateral) movement or while dancing en pointe, such as in ballet. Repeated overuse, sports injuries, and falls or slips are the most common causes of Jones fractures.

How can I prevent a Jones fracture?

Ways to help prevent a Jones fracture are:

  • Wear proper shoes for your activity
  • Use proper training techniques
  • Avoid running on uneven terrain

Are Jones fractures common?

Jones fractures are the most common types of foot fractures. They’re very common among athletes, dancers and people with jobs that are required to be on their feet for long hours. Also, men around 30 and women over 70 are also much more likely to experience Jones fractures.

What are symptoms of a Jones fracture?

Common symptoms of Jones fracture include:

  • Pain
  • Swelling
  • Difficulty walking normally
  • Tenderness in the foot
  • Bruising and/or discoloration
  • An abnormal bump or deformity on your foot

How can I treat a Jones fracture?

Jones fractures are identified with the use of X-rays, MRI’s and CT scans. Treatment options will depend on severity.

Nonsurgical Treatment

  • Immobilization: Using a cast or boot to help immobilize the foot for up to 8 weeks if the break is mild and the bones didn’t move too far out of place
  • Close Reduction: More severe breaks require a closed reduction, or realignment, to set the bones. During this non-surgical procedure, your doctor will physically push and pull your body on the outside in order to line up your broken bones on the inside. To prevent pain, local anesthesia, sedatives or general anesthesia may be administered. After the surgery, your foot will be in a boot or cast.

Surgical Treatment

More severe fractures will require the help of surgical procedures to heal the bone.

  • Internal Fixation: Realigning of the bone to their correct position and secure them in place to grow back together. They will insert metal pieces into the bones to hole it in place while it heels. This may include rods, plates/screws, or pins and wires. Some people keep them inserted forever while others have a follow up to remove the metal.
  • Bone Grafting: Some patients might need a bone graft if the fracture is severely displaced or the bone isn’t healing correctly. An additional bone tissue will be inserted to rejoin the fractured bone.

Full treatment of a Jones fracture can take up to 4 months to resume to normal activities including sports. If pain continues to occur, it is important to go in for a follow up.

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