Foot and Ankle

Ankle Arthroscopy

Arthroscopic ankle surgery may be a treatment option for certain types of ankle pain. Some of the reasons to perform an arthroscopic ankle surgery include:

Cartilage Damage
Small, isolated areas of cartilage damage is a commonly found in people who have sustained injuries to the ankle joint. In fact, cartilage damage is estimated to occur in about 5% of people who sustain a sprained ankle. Left untreated, these cartilage areas may lead to the development of generalized arthritis of the joint. Ankle arthroscopy is often used to assess these areas of cartilage damage and try to restore the normal cartilage surface to the joint. Restoring a cartilage surface can be accomplished by either repairing the damaged cartilage, or by trying to stimulate new cartilage growth with special microfracture, or cartilage restoration procedure.

Impingement can form in the front of the ankle joint, causing the ankle to pinch when the foot is pushed all the way up towards the shin. This condition has also been called athlete’s or footballer’s ankle. Ankle arthroscopy can be used to shave down the bone spur on the front of the joint, to allow for improved motion of the ankle joint.

Removing Loose Debris/Scar Tissue
Ankle arthroscopy can be helpful whenever there is a condition causing the accumulation of loose debris or scar tissue within the ankle joint. Removing debris or scar tissue may be helpful in restoring motion and decreasing swelling and pain inside the joint.

What is the treatment?
Pain in the back of the ankle can sometimes be treated arthroscopically. While there is limited space to perform an arthroscopic procedure in the back of the ankle, there are some conditions that can be helped. Certain types of tendonitis and some bone spurs in the back of the ankle may be treated arthroscopically.

What is the rehabilitation?
After surgery, your ankle will be wrapped in a soft bandage or splint. Most patients will work with a physical therapist to regain motion and strength of the joint. The length of rehabilitation will also vary depending on what procedure is performed at the time of surgery.

What are the risks?
The most concerning complication of arthroscopic ankle surgery is injury to one of the nerves or tendons that surround the ankle joint. Other complications include infection, stiffness and possible damage to joint cartilage.

Achilles Tendon Injuries

Achilles tendon injuries affect the back of your ankle. An Achilles rupture is almost always describe as “feeling kicked in the back of the leg”. It most commonly occurs in people playing recreational sports. If you have an Achilles tendon rupture, you might feel a pop or snap, followed by an immediate sharp pain in the back of your ankle and lower leg that makes it hard to walk.

Why surgery?
Surgery is often the best treatment option to repair an Achilles tendon rupture. Surgery allows a rapid return to ankle motion, and can help prevent stiffness. There is a much higher rate of re-rupture if treated without surgery.

What happens in surgery and recovery?
I treat Achilles tears with a small incision on the back of the heel and suture the ends together. This small incision is not just cosmetic but functional. A larger scar can make it painful to wear shoes. An accelerated rehabilitation program can get you back to sports and activities reliably and quickly.

Bunions

If the joint that connects your big toe to your foot has a swollen, sore bump, you may have a bunion.

What is a bunion?
With a bunion, the base of your big toe (metatarsophalangeal joint) gets larger and sticks out. The skin over it may be red and tender. Wearing any type of shoe may be painful. This joint flexes with every step you take. The bigger your bunion gets, the more it hurts to walk. Your big toe may angle toward your second toe, or even move all the way under it. The skin on the bottom of your foot may become thicker and painful. Pressure from your big toe may force your second toe out of alignment, sometimes overlapping your third toe. If your bunion gets severe, it may be difficult to walk. Your may develop arthritis.

How is it treated?
Most bunions are treatable without surgery. If your bunion has progressed to the point where you have difficulty walking, or experience pain despite accomodative shoes, you may need surgery to realign the bones. Surgery is done for painful bunions, not for cosmetics, but the foot will look better and fit into your shoe better after realignment.

Plantar Fasciitis / Heel Pain

Excessive running or jumping can irritate the tissue band (fascia) connecting the heel bone to the base of the toes. The pain is under your heel and may be mild at first but flares up when you take your first steps after resting overnight. You may need to do special stretching exercises, wear a splint at night, and take medication to reduce swelling and wear a heel pad in your shoe. For people with a certain type of foot shape orthotics may be helpful in the treatment and prevention of future episodes.

Foot & Ankle Fractures (Tibia, Fibula, Talus, Metatarsal)

A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you not put weight on it for three months. A fracture ankle can be caused by:

  • “Twisting” or rotating your ankle
  • “Rolling” your ankle
  • Tripping or falling
  • Impact during a car accident

In 2003, 1.2 million people visited emergency rooms because of ankle problems. Nearly one-fourth of all the bones in your body are in your feet, which provide you with both support and movement.

How is it treated?
Some fractures require surgery to heal properly. These are best treated in the first few weeks after injury before there is too much scarring but after the swelling has gone down enough to operate. If you are injured keep weight off the leg and apply ice packs without direct contact with the skin. Apply the ice for no more than 20 minutes at a time. Above all elevate your ankle as high as you can to reduce swelling. We will have to take x-rays and examine your foot and ankle to determine the best action to take for your treatment.