Foot and Ankle Problems
Listed below are some of the more common foot and ankle problems we diagnose and treat in our practice. Note that this list is not all-inclusive—your condition or concern may not be listed here, but we encourage you to call us with your foot or ankle problem.
Although the Achilles tendon is the largest tendon in the human body, it is also one of the most frequently ruptured tendons. Both professional and weekend athletes can suffer from Achilles tendinitis, an inflammation of the tendon.
Symptoms of Achilles tendonitis include:
- Pain after running or exercise or pain that gradually worsens
- A sense of sluggishness in your leg
- Pain along the tendon during or a few hours after running
- Tenderness or swelling where the tendon attaches to the heel bone
- Stiffness that diminishes as the tendon warms up with use
Because several conditions such as a partial tendon tear and heel bursitis have similar symptoms, you should see your orthopedic surgeon for a diagnosis.
Depending on the severity of the injury, treatment can include rest, anti-inflammatory medication, orthoses to reduce stress on the tendon, or a brace to restrict motion of the tendon.
If friction between the tendon and its covering sheath makes the sheath thick and fibrous, surgery may be needed to remove the fibrous tissue and repair any tears. Recovery may require a temporary cast and includes a rehabilitation program to avoid weakness.
A sprained ankle means one or more ligaments on the outer side of your ankle were stretched or torn. If the sprain is not treated properly, you could have long-term problems.
Depending on how many ligaments are injured, your sprain will be classified as Grade I, II or III. For a Grade I sprain, the RICE protocol is use. This includes Rest, Ice, Compression, and Elevation of your ankle. For a Grade II sprain, you will be directed to follow the RICE guidelines and allow more time for healing. A doctor may immobilize or splint your sprained ankle. A Grade III sprain puts you at risk for permanent ankle instability. Surgery may be needed to repair the damage, especially if you are involved in competitive athletes. For severe ankle sprains, treatment may also include a short leg cast or a walking boot.
A broken ankle can involve one or more bones that make up the ankle joint, as well as injury to the surrounding tissue. Breaks occur as a result of a fall, an motor vehicle accident, or other trauma to the ankle. Symptoms of a broken ankle may include immediate and severe pain, swelling, bruising, tenderness, inability to put weight on the injured foot, and deformity, particularly if there is a dislocation as well as a fracture. A broken ankle may also involve damage to the ligaments. Because a severe sprain can often mask the symptoms of a broken ankle, every injury to the ankle should be examined by a physician.
If the fracture is stable (without damage to the ligament or the mortise joint), it can be treated with a leg cast or brace. It takes at least six weeks for a broken ankle to heal, and it may be several months before you can return to sports at your previous competitive level. An additional X-ray may be prescribed while the bones heal to make sure that changes or pressures on the ankle don't cause the bones to shift. If the ligaments are also torn, or if the fracture created a loose fragment of bone that could irritate the joint, surgery may be required to fix the bones together so they will heal properly.
Recurring or persistent pain on the outer side of the ankle can develop after an injury such as a sprained ankle. The pain may be so intense that you have difficulty walking or participating in sports. In some cases, the pain is a constant, dull ache. The most common cause for a persistently painful ankle is incomplete healing after an ankle sprain. Other causes of chronic ankle pain may include:
- Nerve injury
- Torn or inflamed tendon
- Arthritis of the ankle joint
- A break in one of the bones that make up the ankle joint
- Inflammation of the joint lining
- The development of scar tissue in the ankle after a sprain
Because there are so many potential causes for chronic ankle pain, tests will be made to pinpoint the diagnosis. These can include a physical examination, motion and flexibility tests, x-rays, and the use of a local anesthetic to help pinpoint the source of the symptoms. Treatment will depend on the final diagnosis and will be tailored to your individual needs. Both conservative (non-operative) and surgical treatment methods may be used.
A significant percentage of women in North America have bunions, a problem caused by wearing tight, narrow shoes, and high heels. Compounding the problem, many women wear shoes that are too small.
When you have a bunion, the base of your big toe gets larger and sticks out. The skin over it may be red and tender. Wearing any shoe may be painful. The larger the bunion gets, the more it hurts to walk. In extreme cases, the big toe may angle toward your second toe, or even move all the way under it. That, in turn, may force the second toe out of alignment, sometimes overlapping your third toe. An advanced bunion may make your foot look deformed.
The good news is that most bunions are treatable without surgery. The first step begins with the shoes you wear. Choose shoes that conform to the shape of your feet, with wide insteps, broad toes and soft soles. Avoid shoes that are short, tight or sharply pointed, and those with heels higher than 2 1/4 inches. And never force your foot into a shoe that doesn't fit!
If you already have a bunion, switch to shoes that are roomy enough to avoid putting pressure on it. This should relieve most of your pain. You may also try protective pads to cushion the painful area.
If your bunion has progressed to the point where you have difficulty walking, or if you experience pain despite better shoes, surgery may be required. Bunion surgery realigns bone, ligaments, tendons, and nerves so your big toe can be brought back to its correct position. Most bunion surgeries are done on an outpatient basis.
Hammer toe is a deformity of the second, third or fourth toe. The toe is bent at the middle joint, so that it resembles a hammer. Hammer toe is caused by a muscle imbalance, or by shoes that don't fit properly. In the case of muscle imbalance, muscles fail to work as intended, that is, in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and cannot stretch out.
Narrow or pointed shoes push the smaller toes into a bent position. The toes rub against the shoe, leading to the formation of corns and calluses, which further aggravate the condition. A higher heel forces the foot down and squishes the toes against the shoe, increasing the pressure and the bend in the toe. Eventually, the toe muscles become unable to straighten the toe, even when there is no confining shoe.
Treatment starts with shoes that are wider and have room for the toes. Tight, narrow, and high-heeled shoes should be avoided. Sandals may help, as long as they do not pinch or rub other areas of the foot.
Toe exercises may also be prescribed to stretch and strengthen the muscles. One exercise uses the toes to pick things up off the floor. Another can be done while watching television or reading and involves using the toes to crumple a towel under the foot.
In more severe cases, hammer toe can be corrected by surgery, usually performed on an outpatient basis.
Patients with a condition known as Morton's Neuroma say it feels as if they are "walking on a marble," and complain of a persistent pain in the ball of the foot. Morton's Neuroma is a thickening of the tissue that surrounds a nerve leading to the toes. The condition usually develops between the third and fourth toes, usually caused by irritation, trauma or excessive pressure. Women are eight to ten times more likely to develop Morton's Neuroma than men.
There usually are no outward signs of the condition. The patient may feel a burning pain in the ball of the foot that may radiate into the toes. The pain generally intensifies with activity or wearing shoes. There can also be numbness in the toes or an unpleasant feeling in the toes.
During your exam, the doctor will feel for a mass or a click between the bones. Putting pressure on the spaces between the toe bones is an attempt to duplicate the sensation. A check for calluses or evidence of stress fractures in the bones will also be made. An X-ray and a test for range of motion may be needed to rule out a stress fracture or arthritis of the joints that join the toes to the foot. Nonsurgical treatments can involve changes in footwear, shoe inserts to lift and separate foot bones, and corticosteroid injections to reduce swelling and inflammation. If nonsurgical treatments do not relieve your symptoms, surgery may be an option.
An important tendon in the lower leg is the posterior tibial tendon. This tendon helps hold your arch up and provides support as you step off on your toes when walking. When it gets inflamed or is over-stretched or torn, you may experience pain on the inner ankle and gradually lose the inner arch on the bottom of your foot, leading to flatfoot. Signs and symptoms of progressive flatfoot include pain and swelling, loss of the arch, weakness and an inability to stand on the toes.
Progressive flatfoot often occurs in women over 50 and may be caused by an abnormality of the tendon. Other risk factors include obesity, diabetes, high blood pressure, and previous trauma such as an ankle fracture. Other factors may include certain inflammatory diseases and athletic activities that place excessive force on the foot.
Diagnosis of progressive flatfoot is based on your medical history and a physical examination. X-rays, ultrasound, or an MRI of the foot may also be needed. Treatment will depend on how far the condition has progressed. In the early stages, treatment is simply rest, non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen, and the use of a rigid below-knee cast or boot to prevent overuse. After the cast is removed, shoe inserts such as a heel wedge or arch support may be helpful. If the condition is advanced, your doctor may recommend that you use a custom-made ankle-foot orthosis or support.
If conservative treatments don't work, surgery may be required. There are several procedures that can be used to treat progressive flatfoot. More than one procedure may be performed at the same time. Without treatment, the posterior tibial tendon eventually becomes stiff. Arthritis develops and pain increases and spreads to the outer side of the ankle. Walking may be affected and wearing shoes becomes difficult.
Rheumatoid Arthritis of the Foot and Ankle
Rheumatoid Arthritis (RA) attacks multiple joints throughout the body. In the foot or ankle, symptoms appear in the toes and front of the feet first, then in the back of the feet, and finally in the ankles. While the cause of RA is uncertain, genetic and environment factors are believed to be triggers of the disease. When a person develops RA, the body's immune system turns against itself, actually producing substances that attack and inflame the joints.
Symptoms of RA in the foot are pain, swelling, and stiffness, usually appearing in several joints on both feet. Patients may feel pain and the joint may feel warm to touch. Corns or bunions may develop and toes can begin to curl and stiffen in positions called claw toe or hammer toe. Because RA affects the entire system, patients may also feel feverish, get tired easily, and lose their appetites.
In diagnosing the disease, a patient's medical history, occupation, and recreational activities will be considered, as well as any other persistent or previous conditions in the feet and legs. Symptoms in the same joint on both feet or in several joints is an indication that RA might be involved. X-rays will be used to see how much damage may be present in the joints. Blood tests will show whether anemia or an antibody called the rheumatoid factor are present.
Many patients with RA can control their pain and the disease with medication and exercise. Some medications, such as aspirin or ibuprofen, help control pain. Others, including methotrexate, prednisone, sulfasalazine, and gold compounds, help slow the spread of the disease itself. In some cases, an injection of a steroid medication into the joint can help relieve swelling and inflammation.
To ease the effects on the feet and ankles, shoes with an extra deep toe box may be prescribed. Arch supports may also help. In more severe cases, you may need to use a molded ankle-foot orthotic device, canes, or crutches. Exercise is very important in the treatment of RA. A physical therapist may be recommended to help with stretching as well as range of motion and other exercises.
While surgery can correct several of the conditions associated with RA of the foot and ankle, the most successful surgical option is fusion. In this procedure, joint cartilage and some adjacent bone is removed. The bones are held in place with screws, plates and screws or a rod through the bone. A bone graft from the hip or leg may be used. Eventually, the adjacent bones unite, creating one solid bone. While there is loss of motion, the foot and ankle remain functional and generally pain-free.
Replacing the ankle joint with an artificial joint (arthroplasty) may also be possible. Please see the Ankle Replacement page on this website for more information about this exciting technology solution.
Although RA is a progressive disease that currently has no cure, medications, exercises, and surgery can help lessen the effects of the disease and may slow its progress.
Stress fractures are caused by a cycle of forces on the foot or ankle that cause damage to the bone. If these forces continue and the bone can't repair itself fast enough, a stress fracture may result. In the foot, the five long bones between the toes and the mid-foot are the most common location for a stress fracture. However, stress fractures can occur anywhere in the foot or ankle. Stress fractures can also take place when there is a sudden increase in activity, resulting from training errors, improper exercise techniques, or incorrect use of exercise or sports equipment.
Stress fractures can also result from bone loss caused by osteoporosis or other metabolic diseases involving bone. Under these conditions, a stress fracture can actually take place under normal usage, sometimes called an "insufficiency fracture." Since osteoporosis can progress without symptoms for many years a stress fracture may be the first sign of osteoporosis.
Pain is the most common symptom of a stress fracture. The pain may occur suddenly or increase over several days. Swelling is also common, especially in the foot. X-rays taken in the first two or three weeks of symptoms may appear normal. After this time a faint fracture line or new bone formation can usually be seen.
Pain and swelling usually decrease with lower activity levels and less weight on the affected bone. This decrease in loading forces allows the bone to repair itself. The extent and duration of treatment may vary.
In more severe stress fractures, immobilization in a cast or the use of crutches may be needed. Stress fractures in some sites may heal very slowly or not at all due to poor blood supply. In rare instances, surgery may be needed. If an underlying cause can be identified, it too should be addressed, if possible, to minimize the risk of recurrent stress fractures.
No matter what your foot or ankle concern may be, please feel free to call us to schedule an examination. Click the Contact button for our telephone number and office location.