Foot and Ankle Conditions
Common Conditions of the Foot & Ankle
Posterior tibial tendon dysfunction
Plantar Fasciitis is an inflammation caused by excessive stretching of the plantar fascia. The plantar fascia is a broad band of fibrous tissue that runs along the bottom surface of the foot, attaching at the bottom of the heel bone and extending to the forefoot. When the plantar fascia is excessively stretched, this can cause plantar fasciitis, which can also lead to heel pain, arch pain, and heel spurs.
The key for the proper treatment of plantar fasciitis is determining what is causing the excessive stretching of the plantar fascia. Common treatments include stretching exercises, plantar fasciitis night splints, wearing shoes that have a cushioned heel to absorb shock, and elevating the heel with the use of a heel cradle or heel cup.
Bunions, or Hallux Valgus, are one of the most common forefoot problems. A bunion is a prominent bump on the inside of the foot around the big toe joint. This bump is actually a bone protruding towards the inside of the foot. With the continued movement of the big toe towards the smaller toes, it is common to find the big toe resting under or over the second toe. This causes a common forefoot condition called overlapping toes. Some of the symptoms of bunions include inflammation, swelling, and soreness on the side surface of the big toe. The discomfort commonly causes a patient to walk improperly.
Another type of bunion which some individuals experience is called a Tailor's Bunion, also known as a Bunionette. This forms on the outside of the foot towards the joint at the little toe. It is a smaller bump that forms due to the little toe moving inwards, towards the big toe.
The best way to alleviate the pain associated with bunions is to wear properly fitting shoes. If conservative treatments fail, surgery may be necessary.
A hammer toe is a toe that is contracted at the PIP joint (middle joint in the toe), potentially leading to severe pressure and pain. Ligaments and tendons that have tightened cause the toe's joints to curl downwards. Hammer toes may occur in any toe except the big toe. There is often discomfort at the top part of the toe due to rubbing against the shoe. Hammer toes are classified based on the mobility of the toe joints. There are two types - flexible and rigid. In a flexible hammer toe, the joint has the ability to move. This type of hammer toe can be straightened manually. A rigid hammer toe does not have that same ability to move. Movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses.
The best way to deal with hammer toes is to wear properly fitting shoes. Other conservative measures include splints designed to relieve hammer toes. If conservative treatments fail, surgery may be necessary.
A sprained ankle is a very common injury. Ankle sprains happen when the foot twists, rolls or turns beyond its normal motions. A great force is transmitted upon landing. You can sprain your ankle if the foot is planted unevenly on a surface causing the ligaments to stretch beyond their normal range in an abnormal position.
The amount of force determines the grade of the sprain. A mild sprain is a Grade 1. A moderate sprain is a Grade 2. A severe strain is a Grade 3
Grade 1 sprain:
Slight stretching and some damage to the fibers of the ligament.
Grade 2 sprain:
Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs.
Grade 3 sprain:
Complete tear of the ligament. If the examiner pulls or pushes on the ankle joint in certain movements, gross instability occurs.
Conservative treatment for sprained ankle:
For a Grade 1 sprain, use R.I.C.E (rest, ice, compression and elevation):
- Rest your ankle by not walking on it.
- Ice should be immediately applied. It keeps the swelling down. It can be used for 20 minutes to 30 minutes, three or four times daily. Combine ice with wrapping to decrease swelling, pain and dysfunction.
- Compression dressings, bandages or ace-wraps immobilize and support the injured ankle.
- Elevate your ankle above your heart level for 48 hours.
For a Grade 2 sprain, the RICE guidelines can also be used. Allow more time for healing to occur. The doctor may also use a device to immobilize or splint the ankle.
A Grade 3 sprain can be associated with permanent instability. Surgery is rarely needed. A short leg cast or a cast-brace may be used for two weeks to three weeks.
Surgical treatment for ankle sprains is rare. Surgery is reserved for injuries that fail to respond to nonsurgical treatment, and for persistent instability after months of rehabilitation and non-surgical treatment.
Achilles tendinitis is a common condition that causes pain along the back of the leg near the heel.
The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump.
Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis, including:
Conservative treatment includes Rest, Ice, Compression and Elevation or RICE. Non-steroidal anti-inflammatory drugs reduce the pain and swelling but do not reduce the thickening of the degenerated tendon. Physical therapy is very helpful in treating Achilles tendonitis.
Surgical treatment should only be considered after failing to heal with 6 months of conservative care.
Posterior tibial tendon dysfunction
Posterior tibial tendon dysfunction is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be able to provide stability and support for the arch of the foot, resulting in flatfoot.
The posterior tibial tendon is one of the most important tendons of the leg. A tendon attaches muscles to bones, and the posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot. The main function of the tendon is to hold up the arch and support the foot when walking.
The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot.
Common conservative treatments include RICE (rest, ice, compression, elevation), non-steroidal anti-inflammatory drugs, orthotics, bracing and physical therapy.
Surgical treatment should be reserved for those who fail 6 months of conservative treatment.
What is a Neuroma?
A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton's neuroma, which occurs at the base of the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. "Intermetatarsal" describes its location -- in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot). Neuromoas may also occur in other locations in the foot.
The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage.
If you have a Morton's neuroma, you will probably have one or more of these symptoms where the nerve damage is occurring:
- Tingling, burning, or numbness
- A feeling that something is inside the ball of the foot, or that there's a rise in the shoe or a sock is bunched up
The progression of a Morton's neuroma often follows this pattern:
- The symptoms begin gradually. At first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.
- The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.
- Over time the symptoms progressively worsen and my persist for several days or weeks.
- The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.
What Causes a Neuroma?
Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box.
People with certain foot deformities --bunions, hammertoes, flatfeet, or more flexible feet -- are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to a neuroma.
Treatment approaches vary according to the severity of the problem. For mild to moderate cases of neuroma, treatment options include:
- Padding. Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
- Icing. Placing an icepack on the affected area helps reduce swelling.
- Orthotic devices. Custom orthotic devices provided by your podiatric surgeon provide the support needed to reduce pressure and compression on the nerve.
- Activity modifications. Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
- Changes in shoe wear. Avoid narrow-toed shoes or shoes with high heels.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
- Injection therapy. If there is no significant improvement after initial treatment, injection therapy may be tried.
- Surgery may be considered in patients who have not received adequate relief from other treatments. Generally, there are two surgical approaches to treating a neuroma -- the affected nerve is either removed or released. Your podiatric surgeon will determine which approach is best for your condition. (ACFAS)