ANKLE & FOOT CARE

The ankle joint is important during ambulation because it adapts to the surface on which one walks. The movements that occur at the ankle joint are plantarflexion, dorsiflexion, inversion, and eversion. The muscles of the leg divide into anterior, posterior, and lateral compartments. Most foot problems result from anatomic disorders or abnormal function of articular or extra-articular structures. Less commonly, foot problems reflect a systemic disorder.

In people with diabetes and people with peripheral vascular disease, careful examination of the feet, with an evaluation of vascular sufficiency and neurologic integrity, should be done at least twice a year. People with these diseases should examine their own feet at least once a day.

As experts in diagnosing and treating foot and ankle conditions, we know how much foot and ankle pain can impact your quality of life. And we also know how minor foot and ankle problems can turn into big ones. We take a multidisciplinary approach to treating all forms of foot and ankle pain from acute injuries such as sprains to long-term degenerative issues. And we offer a variety of innovative surgical and non-surgical treatments that will be individualized for your specific needs. 

Some of the foot & ankle conditions our orthopedic doctors treat include:

ACHILLES TENDONITIS

Achilles tendinitis causes pain and stiffness in the area of the tendon, especially in the morning and with activity. It's usually caused by repetitive stress to the tendon. Adding too much distance to your running routine can do it. Tight calf muscles can also contribute.

It's usually caused by repetitive stress to the tendon. Adding too much distance to your running routine can do it. Tight calf muscles can also contribute.

 

ANKLE ARTHRITIS

Osteoarthritis of the ankle, unlike other parts of the body, isn't the "wear and tear" kind that goes along with aging. Instead, it's almost always due to an injury. You might hear your doctor call it "post-traumatic" arthritis. You can get ankle osteoarthritis after one injury, like a fracture, or after many injuries over time, like repeated sprains. If you're flat-footed, bow-legged, or knock-kneed or if you have high arches, you might also get ankle osteoarthritis, because these conditions put extra strain on your joints.

When you have ankle osteoarthritis, you might have inflammation or swelling of the joint that connects your foot with the lower part of your leg. Here is an overview of things you should know about how arthritis may affect your ankles.

 

ANKLE FRACTURE

Ankle injuries are among the most common of the bone and joint injuries. Often, the degree of pain, the inability to walk, or concern that a bone may be broken is what might cause you to seek care in an emergency situation.

For the most part, your concern is the same as the doctor's: Is there a broken bone? It is often impossible to diagnose a fracture (broken bone) rather than a sprain, a dislocation, or tendon injury without X-rays of the ankle.

The ankle joint is made up of 3 bones coming together.

  • The tibia, which is the main bone of the lower leg, makes up the medial, or inside, of the ankle joint.

  • The fibula is a smaller bone that parallels the tibia in the lower leg and makes up the lateral, or outside, of the ankle joint.

  • The far ends of both the tibia and fibula are known as the malleoli (singular is malleolus). Together they form an arch that sits on top of the talus, one of the bones in the foot.

A fibrous membrane called the joint capsule, lined with a smoother layer called the synovium, which encases the joint architecture. The joint capsule contains the synovial fluid produced by the synovium. The synovial fluid allows for the smooth movement of the joint surfaces.

The ankle joint is stabilized by several ligaments, which are fibers that hold these bones in place.

 

ANKLE INSTABILITY

A condition that is characterized by recurring injury to the ankle by weak or giving away of the outer area or side of the ankle. It’s often caused by frequent sprains. Generally, giving away happens when walking or involved in other activities. It can also happen if someone is simply standing still. Athletes and others can suffer from chronic ankle injuries and instability.

Ankle instability often occurs after an ankle sprain that wasn’t completely healed or rehabilitated. An ankle sprain affects the connective tissues which stretch and tear. The balance is greatly affected. Rehabilitation is required in order to strengthen the muscles that support the ankle and it’s important to retrain the tissue within the ankle for balance purposes. If you don’t do this, you’ll have repeated sprains.

Ankle injuries are often thought of as sports injuries. But you don't have to be an athlete or even a "weekend warrior" to turn your ankle and hurt it. Something as simple as walking on an uneven surface can cause a painful, debilitating sprain.

Ankle injuries can happen to anyone at any age. However, men between 15 and 24 years old have higher rates of ankle sprain, compared to women older than age 30 who have higher rates than men. Half of all ankle sprains occur during athletic activities. Every day in the U.S., 25,000 people sprain their ankle. And more than 1 million people visit emergency rooms each year because of ankle injuries. The most common ankle injuries are sprains and fractures, which involve ligaments and bones in the ankle. But you can also tear or strain a tendon.

 

ANKLE SPRAIN/STRAIN

Your ankle joint connects your foot with your lower leg. Three ligaments keep your ankle bones from shifting out of place. A sprained ankle is when one of these ligaments is stretched too far or torn.

Anything that stretches your ankle more than it’s used to can hurt a ligament. This usually happens when your foot is turned inward or twisted, such as when you:

  • Plant your foot the wrong way when running, stepping up or down, or doing everyday things like getting out of bed

  • Step on an uneven surface, like in a hole

  • Step on someone else while playing sports. (For example, your foot might roll when you’re playing basketball, go up for a rebound, and come down on top of another player’s foot.)

Certain people are more likely to sprain their ankles. Women, children, and teenagers tend to have more sprains. You might also be at higher risk if you:

  • Play sports, especially on an indoor court

  • Have balance problems

  • Wear high heels or shoes that don’t fit well

  • Have weak or stiff ankles, such as because of a previous injury

 

FLAT FOOT DEFORMITY

If you look at an adult foot from the inside, you'll usually notice an upward curve in the middle. This is called an arch. Tendons tight bands that attach at the heel and foot bones form the arch. Several tendons in your foot and lower leg work together to form the arches in your foot.

When the tendons all pull the proper amount, then your foot forms a moderate, normal arch. When tendons do not pull together properly, there is little or no arch. This is called a flat foot or fallen arch.

 

FOOT DROP

Foot drop, sometimes called "drop foot," is the inability to lift the front part of the foot. This causes the toes to drag along the ground while walking.

To avoid dragging the toes, people with foot drop may lift their knees higher than normal. Or they may swing their leg in a wide arc. Foot drop can happen to one foot or both feet at the same time. It can strike at any age.

In general, foot drop stems from weakness or paralysis of the muscles that lift the foot. It can have many different causes. Treatments for foot drop vary according to the cause.

BIG TOE ARTHRITIS

If you have psoriatic arthritis (PsA), you’re no stranger to joint pain, swelling, and stiffness. The disease affects everyone a little differently, but foot problems are especially common.

Your feet have 28 bones, 30 joints, and more than 100 tendons, muscles, and ligaments. That gives PsA a whole lot of places to attack. But the disease tends to strike some areas of the foot more than others.

Swollen, painful toes are a telltale sign of PsA -- especially when an entire toe (or finger) swells and looks like a sausage. Doctors call this dactylitis or sausage digits. Research shows that dactylitis in PsA typically:

 
 

FOOT FRACTURE

Fractures (broken bones) in the foot are very common. In fact, about 1 out of every 10 broken bones occur in the foot. The human foot has 26 bones. Bones usually break when something happens to crush, bend, twist, or stretch the bone.

Toes are often broken when you accidentally kick something hard.

Heels are often broken when you fall from a height and land on your feet.
Other bones in the foot sometimes break when you twist or sprain an ankle.
Most bones break suddenly because of an accident. Occasionally, small cracks can form in bones over a longer period of time from repeated stress on the bones. These are called stress fractures. They occur most commonly in soldiers hiking in full gear or in athletes, such as dancers, runners, and gymnasts.

Broken bones are more common in children than in adults. In adults, bones are stronger than ligaments (which connect bones to other bones) and tendons (which connect bones to muscles). But in children, ligaments and tendons are relatively stronger than bone or cartilage. As a result, injuries that may only cause a sprain in an adult may cause a broken bone in a child. However, a child's forefoot is generally flexible and very resilient to injuries of any kind.
When metatarsal or phalangeal fractures do occur, they may be difficult to recognize, because many parts of a growing child's bone do not show up well on X-rays. For this reason, it is sometimes helpful to get X-rays of the child's other, uninjured foot to compare to the hurt foot.

 

PERONEAL TENDINOPATHY

Peroneal tendinitis is a condition that can be acute or become chronic (peroneal tendinopathy) whereby there is an irritation to one or both peroneal tendons with subsequent degeneration and inflammation.

Peroneal tendon pathology occurs due to a wide range of etiologies including, most commonly, overuse and ankle sprain. An estimated 628,000 ankle sprains occur in the United States every year with 10 to 20 percent of those injuries developing into chronic ankle symptoms.1,2 Injury from forced inversion during an ankle injury with no prior peroneal pain or dysfunction can lead to overt peroneal tears, micro-tears, and scar tissue. Peroneal tendon pathology can also exist prior to an injury due to the role of peroneal tendons as active stabilizers for the ankle joint.

Initial treatment for the acute stage should correlate to the severity of pain and/or injury. Immobilization in a boot or lace-up ankle brace to allow the tendon to rest along with ice and non-steroidal anti-inflammatory drugs (NSAIDs) is appropriate in the initial one to six weeks. We often only immobilize for six weeks if an acute peroneal tear or subluxation is present to allow the healing of soft tissues.

Physical therapy is important to help decrease inflammation and increase strength. It is also beneficial in patients with signs of ankle instability to aid in proprioception training. Most patients who have timely treatment will show signs of improvement in the course of two to four weeks.

 

PLANTAR FASCIITIS

Plantar fasciitis is inflammation of the thick band of tissue (also called a fascia) at the bottom of your foot that runs from your heel to your toes. Doctors once thought bony growths called heel spurs brought on the pain. Now they believe that heel spurs are the result not the cause of plantar fasciitis.

Plantar fasciitis causes pain in your heel. It’s usually worse when you take your first steps in the morning or after you’ve been sitting for a long time. It tends to feel better with activity but worsens again after you spend a long time on your feet.

Once you begin treatment, you’ll usually see improvement within 10 months. If you aren’t better then, your doctor might try treatments like shots of cortisone, a type of steroid, to ease inflammation. In rare cases, you might need surgery.