Foot & Ankle
The human foot and ankle are anatomical wonders. Comprised of 26 bones, 33 joints, and more than a hundred muscles, tendons, and ligaments, these structures carry your body weight as well as absorbing the shock of each step you take. During an average day of walking, the forces on your feet can total hundreds of tons, roughly equal to a fully loaded cement truck.
Orthopaedic services for feet and ankles
Fractures, Breaks, and Sprains
The medical term for any break in a bone is fracture. Although the word fracture may seem to imply an incomplete break, there is actually no distinction between the two terms. A fracture is a break, and a break is a fracture.
Commonly, foot and ankle fractures are the result of twisting the ankle, landing “feet-first” in a fall, or being involved in a high-velocity impact such as a car or sports accident. A broken foot or ankle is typically quite painful, and you will likely not be able to put weight on the injured foot. In some cases, the ankle may be dislocated.
Besides a physical exam, X-rays are the most common way to evaluate a possible fracture. Treatment normally involves immobilizing the injured area with a cast or splint, but severe cases might require surgical intervention.
A sprained ankle has causes and symptoms similar to a fracture, but instead of a broken bone, the injury involves your ligaments.
Ligaments are bands of tough, fibrous tissue that connects bones to other bones, forming a joint. When your ligaments stretch beyond their normal range of motion, they are said to be sprained.
It is important to see a doctor to diagnose a sprained ankle, both to rule out a fracture of the bone and to determine the extent of your injury. If the ligament is actually torn rather than simply over-stretched, your ankle could become unstable and cause additional joint damage. Your orthopaedist will recommend the best method of treatment for your particular case.
A common approach to dealing with simple sprains of the ankle or foot is known by its acronym “PRICE.”
Protection – Use support such as a brace or high-top boot if able.
Rest – Avoid walking when possible and use crutches to avoid pain.
Ice – For at least the first 24 hours, apply an ice pack for 10 to 20 minutes every hour or two during the day.
Compression – Using a compression wrap, such as an elastic bandage, will help reduce swelling.
Elevation – Raise your ankle above the level of your heart for 2 to 3 hours a day if possible to help reduce swelling and bruising.
Although the term arthritis is applied to a wide variety of disorders, arthritis describes the inflammation of a joint. This can be the result of a disease, an infection, a genetic defect, or some other cause.
Osteoarthritis, also known as “wear and tear” arthritis, is a common problem as we age. Over the years, the cartilage that helps the ends of bones glide past each other in a joint simply wears out, causing swelling and pain.
By contrast, rheumatoid arthritis (RA) is a system-wide disease where your own immune system attacks normal tissue. As your ligaments are weakened, it can cause joint deformities. RA can also cause softening of your bone.
The most common symptoms of arthritis are pain, swelling, and stiffness. Routinely, these problems are addressed through a variety of means including occupational or physical therapy, orthotics/inserts, prescription medicine, physician-administered injections, and sometimes surgery to correct joint damage and restore mobility.
Interestingly, the base of the big toe is commonly susceptible to arthritis. The metatarsophalangeal, or MTP joint, bends with every step you take, so when the joint begins to stiffen with osteoarthritis, walking can become painful and difficult. This particular condition is known as hallux rigidus. In later stages, bony spurs may develop from the wearing away of the cartilage.
To remove bone spurs from the base of the big toe, a Cheilectomy surgery is often performed. This procedure is usually recommended when damage is mild or moderate. It involves removing the bone spurs as well as a portion of the foot bone, so the toe has more room to bend.
Charcot arthropathy is a serious foot condition that can occur in diabetic patients who have developed nerve damage due to uncontrolled high blood sugar. This diabetic neuropathy masks the sensation of pain in the foot. Over time, repeated microtraumas to the foot go unnoticed. The body’s natural inflammation response becomes unbalanced and leads to severe degeneration of the bone, ulcers and infections, and eventual deformity.
Onset of Charcot arthropathy is usually insidious. Typically, the first sign is that the foot suddenly becomes very swollen and warm to the touch. Other indicators of the disease are the disproportionate lack of pain, absence of an obvious injury, and persistent swelling.
Although individual outcomes vary depending on the location of the disease and the degree of damage to the joint, many Charcot patients successfully recover and experience long-term relief through surgical reconstruction.
Bunions and Hammer Toes
Orthopaedists understand that footwear is far more than a fashion statement. First and foremost, shoes are a means of protection for the complex musculoskeletal structure of the feet and ankles.
When we wear shoes that are too small, too tight, too high-heeled, or too pointed in the toe box, it can lead to the formation of a painful bunion or hammer toe, especially in cases where someone is genetically pre-disposed to develop these deformities.
Bunions occur when pressure is applied to the side of the big toe. When forced toward the other toes, and sometimes over or under them, the tissues surrounding the joint may become swollen and tender. Often, a bump appears at the base of the big toe where it joins the foot (mesophalangeal joint). The bigger your bunion gets, the more it hurts to walk.
A hammer toe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. If the toe is bent and held in one position long enough, the muscles tighten and cannot stretch out. Hammer toe frequently results from shoes that don’t fit properly, but other types of nerve or joint damage can also be the cause.
Bunions and hammer toes may be treated conservatively with changes in shoewear, physical therapy, orthotics, and medications. These sorts of treatments address symptoms more than they correct the actual deformity. Surgery may be necessary if discomfort is severe enough.
Diagnostic Ankle Arthroscopy
Diagnosing ankle injuries and diseases always begins with a careful physical exam and thorough patient history interview. X-rays, MRI scans, or CT scans are also useful tools in determining the exact nature of an ankle problem. However, these scans do not always provide the most complete picture of what is happening inside the ankle joint.
Arthroscopy is a procedure orthopaedic surgeons use to both diagnose and to surgically treat problems inside a joint. The word arthroscopy comes from two Greek words: “arthro” (joint) and “skopein” (to look). The term literally means “to look within the joint.”
In an arthroscopic exam, an orthopaedic surgeon makes a small incision(s) in the patient’s skin and inserts pencil-sized instruments that contain a small camera lens and lighting system to magnify and illuminate the structures inside the joint.
By attaching the arthroscope to a monitor, the surgeon is able to see the interior of the joint and to discover the exact scope of the problem. He can determine the best options for treating the ankle, either through surgery or traditional open surgery methods.
Total Ankle Joint Replacement
This surgical procedure is performed to remove portions of the ankle that are diseased (due to arthritis affecting the ankle joint) or severely injured, often related to sport, car accident or recurring injuries; and to implant a device that will help manage pain and restore mobility to the ankle
Ankle replacement is done through coordinated steps by your orthopaedic surgeon. They make an incision through the skin on the front of the ankle and top of the ankle. Next, the orthopaedic surgeon will make resurfacing bone cuts on the tibia and talus to carefully remove the remaining worn off cartilage and make room for the new implant.
Once the tibia and talus are made ready for use, the final implants are placed in the joint and the procedure is complete. In addition, your orthopaedic surgeon may perform extra procedures at the same time as necessary. The incision is closed and places the foot in a splint.
In-House Orthotics for Feet and Ankles
Orthotics is a specialty focusing on the design, manufacture and application of devices that are externally applied to the body in order to adjust the structure and function of muscles, bones and joints. Orthotics may sometimes be purchased over the counter, but are often custom-made specifically for you.
An orthotic device may be used to:
- Control, guide, limit and/or immobilize the ankle or foot
- To reduce weight bearing forces
- To correct the shape and/or function of the ankle or foot
Any orthotic device recommended by your doctor will depend on your symptoms, the underlying cause for those symptoms, and the shape of your feet and ankles. In some cases, your doctor may prescribe something as simple as an insert for your shoes; in other cases, more sophisticated bracing may be required.
Foot and Ankle Conditioning Program (Physical Therapy)
Your specific plan of care may include (or solely consist of) an exercise conditioning program. Physical therapy can help you safely return to daily activities after surgery or train you in techniques to overcome mobility-limiting conditions. For foot and ankle issues, therapy will likely focus on strength, flexibility, and balance so that you can enjoy a more active lifestyle.
Strength: Exercises may include calf raises, walking on the heels, or resistance bands. Keeping these muscles strong can relieve foot and ankle pain and prevent further injury.
Flexibility: Activities like pointing the toes, flexing the foot, or drawing the alphabet with your foot can help you stretch after strengthening exercises, reducing muscle soreness and keeping your muscles long and flexible.
Balance: Your physical therapist may use a wobble board or test your ability to walk over a variety of surfaces. These exercises will ultimately help you progress toward a safe return to normal activity.
To ensure that a conditioning program is safe and effective for you, it should be performed under a qualified practitioner’s care. Talk to your doctor or a Southlake Orthopaedics physical therapist about setting appropriate and personalized rehabilitation goals.