Foot Conditions

On average, Foot and Ankle conditions combined constitute over 20 percent of all visits to an Orthopaedic Surgery practice.  Our physicians have specialized training in treatment of all foot and ankle conditions including:

• Fractures
• Bunions
• Hammertoes
• Rheumatoid and inflammatory arthropathies and changes
• Diabetic foot deformities
• Torn tendons and ligaments
• Gait and pressure abnormalities
• Neuromas
• Arthritis
• Congenital deformities

Foot Fractures

A fracture is a break in a bone. It may be a crack in the bone (a stress fracture) or a complete break; the bones may shift out of place or break the skin. Fractures in the bones of the foot and ankle cause a variety of symptoms and require different treatments depending on the location and severity of the break as well as the patient’s overall health.

• Digits (toes/phalanges) and metatarsals (long bones of the forefoot) – There are many different kinds of fractures that can happen to the bones of the forefoot and toes. They are painful but often heal without the need for surgery. The metatarsals are prone to stress fractures, or cracks in the bone. These are usually related to a recent increase or change in activity. The fifth metatarsal below the small toe may fracture if it is landed on badly or if the ligament of a twisted ankle pulls off a piece of the bone. Symptoms of a toe or metatarsal fracture include pain that gets worse when walking; swelling; and sometimes bruising.
• Lisfranc joint (midfoot) – Often caused by dropping something heavy on the top of the foot or by falling after catching the foot in a hole. Symptoms are similar to a sprain and include swelling and pain at the top of the foot; bruising; possible inability to bear weight; and pain when moving the foot while the ankle is held steady. If you think you have a sprain and it does not improve with rest and ice after one to two days, you may have a Lisfranc joint fracture and should see a doctor to prevent further injury.
• Calcaneus (heel) – Usually the result of an automobile accident or fall from a great height. Symptoms include pain on the outside of the ankle or under the heel; inability to bear weight; swelling and stiffness. May be accompanied by back or knee injury due to the amount of force required to break the heel bone.

Bunion Treatment

A bunion is a common condition that involves an abnormal, bony bump at the base of the big toe, causing the joint to swell outward and become painful. The big toe may also turn inward toward the second toe as a result of the enlarged joint, which can then lead to difficulty walking, ingrown toenails and corns and calluses.

Bunions can form when there is an improper balance of forces exerted on the joints of the foot, causing instability in the joint of the big toe. This often occurs as a result of shoes that do not fit properly, abnormal walking habits or an inherited foot type. Bunions can also be caused by injury, birth defects, arthritis or certain neuromuscular disorders.

Although bunions are not usually a serious condition, they can be painful and embarrassing. If left untreated, they will usually grow larger and more painful over time. It is important to seek medical attention and discuss treatment options with your doctor.

Bunion treatment depends on the severity of the condition, although early treatment is considered most effective. Mild bunions may be relieved of pain simply by changing shoes, applying ice or taping your foot into a normal position. Medication, orthotics and physical therapy may also be recommended by your doctor. Surgical treatment, usually reserved for more severe cases, can improve pain, inflammation, deformities and stiffness.

Medications

While Tylenol can be taken to control pain, anti-inflammatory drugs (NSAIDs) may be more effective in both relieving pain and reducing inflammation. Cortisone injections may also be used.

Orthotics

Padded shoe inserts help restore the foot to a normal position and restrict any abnormal movement. While over-the-counter inserts may help, custom-made orthotics are usually much more beneficial.

Physical Therapy

The pain and inflammation of bunions can often be reduced through therapeutic techniques such as ultrasound therapy or whirlpool baths.

Surgery

Surgery to treat bunions is often used for more severe cases, or after conservative treatment methods have failed. There are several different surgical options available, depending on the cause and symptoms of the bunion.
The most common surgical procedure for bunions is a bunionectomy, which includes:

• Removing the swollen tissue from the big toe joint
• Removing part of the bone to straighten the big toe
• Permanently joining the bones of the big toe joint

A bunionectomy may be performed alone or in conjunction with other procedures that may:

• Shave off the swollen bump
• Repair the tissue in the joint
• Fracture and realign the bones of the toe
• Remove part of the bone to decrease the angle of the toe
• Remove the bump on the toe joint

Some of these procedures will require the use of metal screws, wires or plates to hold the joint structures together, especially after pieces have been removed. Your doctor will help you decide which procedure will be most effective for your individual condition after evaluating your medical history and X-ray images.

Most bunion procedures are performed on an outpatient basis under local anesthesia. General anesthesia may be used in certain situations depending on the complexity of the procedure and the preference of the patient. Complications from these procedures are rare but may include infection, recurring bunion or nerve damage.

Recovery from bunion surgery depends on the complexity of the procedure. Some people will be able to walk on their foot immediately after surgery, while others may need to use crutches or a cane and may not be able to walk for a few weeks or longer. It is important to keep your dressing clean and dry to ensure proper healing. Most patients require the use of orthotics after surgery in order to maintain stable and correctly-positioned feet.

While these procedures can be beneficial, they are usually only recommended for patients with bunions that cause severe pain. There is also a chance that a bunion may form again after surgery. Patients with realistic expectations are usually satisfied with the results of their surgery. Call us today to speak to a doctor about how bunion treatments can help you.

Rheumatoid and inflammatory arthritis and deformities

Patients with rheumatoid arthritis in the feet are at an increased risk of developing certain physical deformities such as bunions, metatarsalgia and hammertoes, which are extremely painful and disabling conditions. These conditions develop as a result of joint inflammation, loosening of the ligaments and capsule lining and a degeneration of cartilage in the joint. Patients with these conditions often have difficulty walking and wearing shoes as the foot becomes more and more inflamed.

Treatment of forefoot deformities may vary depending on the type and severity of the condition, but aims to relieve pain and restore the normal appearance and alignment of the foot. Conservative treatments may include modifying your shoes or wearing orthotics, while most patients will need to undergo surgery for this condition. Surgery for rheumatoid forefoot deformities may involve the Hoffman procedure, joint fusion or osteotomy of the metatarsals in severe cases.

After surgery, most patients are able to walk and wear shoes without pain. Deformities rarely recur and patients are able to enjoy these results for many years.

Diabetes Mellitus

People with diabetes are at high risk for developing problems with their feet. More than half of diabetics lose sensation in their feet due to nerve or blood vessel damage, and can hurt themselves without knowing it. To make things worse, diabetes slows healing and weakens the immune system, so what may seem like an inconsequential injury can quickly become a major problem. Even the smallest of foot and ankle injuries such as a blister or ingrown toenail can lead to infection and tissue death. One of the most serious complications of the diabetic foot is Charcot foot, a deformity that develops when people fracture bones in their feet without realizing it and then continue to walk on the injury because they don’t feel any pain.

If you or a loved one has diabetes, be sure to inspect your feet every day and visit your doctor regularly to ensure that you and your feet remain healthy.

Diabetic Reconstructive Surgery

Diabetic patients with foot problems often experience pain, difficulty walking and other symptoms that may affect their overall quality of life. Surgery is often needed to correct these conditions and to keep the foot as healthy as possible and prevent more serious problems that can require amputation of the foot.

The type of surgery performed depends on the type and severity of the condition, but aims to restore function and stability to the foot, as well as relieving pain and restoring a proper appearance. Surgery may involve any part of the foot, including the tendons, bones, joints, tissue or skin. Metal screws, pins, wires and plates may be used to help the foot heal and ensure a full recovery. Most reconstructive procedures can be performed on an outpatient basis using minimally invasive techniques.

It is important to exercise extreme care when undergoing surgery, as patients with diabetes are at a higher risk for infection and other complications. Choosing an experienced doctor to perform your procedure can help reduce the associated risks.

Neuromas

A neuroma is a painful swelling of a nerve, usually in the ball or heel of the foot. Symptoms include sporadic pain; burning, tingling or numbness of one or more toes; and a popping sensation when walking. Pain is often soothed by taking weight off the foot or by massaging the area.

In the foot, there are the long bones (metatarsals) and thin nerves running between them. The nerves split in a Y-shape when they reach the toes. If the metatarsals move abnormally, they can pinch the nerve between them, causing inflammation and, eventually, permanent nerve damage. Morton’s Neuroma is the most common of this type and affects the nerve between the third and fourth toes. Neuromas may also occur after a nerve has been injured, either from a traumatic wound or from damage suffered during surgery.

A physical examination and one or more imaging tests will determine whether the pain is caused by a neuroma or by a condition with similar symptoms such as arthritis, stress fractures, tendon inflammation, tarsal tunnel syndrome and nerve compressions in the ankle or leg. Treatment begins with a combination of cortisone injections to reduce swelling and orthotic inserts to correct problematic metatarsal movement. If the nerve is permanently damaged, the patient may decide to undergo chemical destruction of the nerve, have the nerve surgically removed, or endure the pain.