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Foot & Ankle Services



Total Ankle Replacement

Ankle arthroplasty (Total Ankle Replacement) is surgery to replace the damaged parts of the three bones that make up the ankle joint. Your symptoms may be pain and loss of movement of the ankle, and the causes of the damage may include osteoarthritis, rheumatoid arthritis, infection, bone fracture or arthritis caused by ankle surgery in the past. Artificial joint parts are used to replace your own bones, and they come in different sizes for different sized people.

After surgery, you will go home the same day. Your ankle will be in a cast or a splint after surgery. To keep swelling down, keep your foot raised higher than your heart while you are sleeping or resting. Your doctor may recommend physical therapy to teach you exercises that will help you move more easily.

A successful ankle replacement will get rid of your pain and allow you to move your ankle up and down. Usually, total ankle replacements last 10 or more years. How long yours lasts will depend on your activity level, overall health, and the amount of damage to your ankle joint before surgery.


Plantar Fasciitis

Plantar Fasciitis is a condition that occurs when the thick band of tissue on the bottom of the foot is overstretched or overused, causing pain and making walking more difficult. It is seen in both men and women, and can be caused by foot arch problems, long distance running, a tight Achilles tendon, or shoes with poor arch support. The most common symptom is pain and stiffness in the bottom of the heel, and the pain can be worse in the morning when you take your first steps, after standing or sitting, while climbing stairs or after intense activity. The pain may develop slowly over time, or suddenly after intense activity.

Treatment

Your health care provider will usually first recommend heel and foot stretching exercises, anti-inflammatories, night splints and wearing a different shoes. Steps to relieve pain may include icing the affected area, a heel cup or shoe inserts.

If these treatments do not work, your provider may recommend:

  • Wearing a boot cast
  • Custom-made shoe inserts (orthotics)
  • Steroid shots or injections into the heal
  • In severe cases, foot surgery may be needed to relieve pain.

While nonsurgical treatments almost always help improve the pain, treatment can last for several months before symptoms get better. Because some patients may need surgery to relieve pain, it is important to talk to your doctor about the best treatment options for you.




High Arch

A high arch is an arch in the foot that is raised more than normal. Much less common than flat feet, it is more likely to be caused by a bone or nerve condition. Unlike flat feet, highly arched feet tend to be more painful because more stress is placed on the section of the foot between the ankle and toes (metatarsals). Symptoms of this condition can include shortened foot length, difficulty fitting shoes, and foot pain when walking, standing and running, although not everyone has this symptom.

Your health care provider will check to see if the high arch is flexible, and tests may include:

  • Elctromyography
  • Xray of the Feet

While corrective shoes may help relieve pain and include walking, surgery may be needed in severe cases.



Flat Feet

Flat feet is a common condition in which the foot does not have a normal arch when standing. While normal in infants and toddlers until the joints and tissue develops, adults with flat feet may experience aches or become tired after standing for a long period of time. To diagnose, your health care provider will ask you to stand on your toes. If the arch does not form with toe-standing, or there is pain, other tests may be needed such as CT scans to observe the bones in the foot, MRI scans for the tendons or an Xray of the foot.

Treatment

In older children and adults, flexible flat feet that are painless and do not cause problems do not need further treatment once a health care provider has evaluated them. If you have pain due to flexible flat feet, orthotics and arch-supporting shoes can help.

In the most severe cases, surgery may be needed to clean or repair the tendon, or fuse some of the joints into the correct position. This is the last option is some cases, however.




Broken Ankle

Ankle fractures are partial or complete breaks in the bone, and can occur in tibia, fibula or both. They are most often caused by rolling the ankle inward or outward, and are commonly mistaken for an ankle sprain. Ankle fractures may include one or all of the following symptoms:

  • Pain at the site of the fracture
  • Significant swelling, sometimes occurring along the length of the leg
  • Blisters over the fracture site
  • Bruising that develops soon after the injury
  • Change in the appearance of the ankle
Treatment

After an ankle injury, it is important for an evaluation by a foot and ankle surgeon for proper diagnosis. The limb will be examined by the foot and ankle surgeon, and xrays and other imaging studies may be ordered as well. Treatment depends on the severity of the injury.

Immobilization: Certain fractures can be treated by restricting the ankle and foot in a cast or splint to protect it and allow the bone to heal.

Surgery: In severe cases, surgery may be needed to repair the fracture and any injuries to the soft tissue. Your surgeon will use a procedure most appropriate for your injury.


Bunion

A bunion is when your big toe points toward the second toe, causing a bump to appear on the outside edge of your toe. Bunions are more common in women and can sometimes run in families. People born with abnormal bones in their feet are more likely to form a bunion.

  • Wearing narrow-toed, high-heeled shoes may lead to the development of a bunion.
  • The condition may become painful as the bump gets worse, and extra bone and a fluid-filled sac grow at the base of the big toe.
Symptoms
  • Red, calloused skin along the inside edge of the big toe
  • A bony bump at this site
  • Pain over the joint, which pressure from shoes makes worse
  • Big toe turned toward the other toes
Treatment

When a bunion first begins to develop, take good care of your feet.

  • Wear wide-toed shoes. This can often solve the problem and prevent you from needing more treatment.
  • Wear felt or foam pads on your foot to protect the bunion, or devices called spacers to separate the first and second toes. These are available at drugstores.
  • Try cutting a hole in a pair of old, comfortable shoes to wear around the house.

If the bunion gets worse and more painful, surgery to realign the toe and remove the bony bump (bunionectomy) can be effective. There are more than 100 different surgical procedures to treat this condition




Diabetic (Charcot) Foot

Charcot foot is a condition in which the bones of the foot weaken as a result of nerve damage. The weakened bones may fracture, and can cause the foot to change shape over time. As the disorder becomes more severe, the joints may collapse and cause the foot to take on an abnormal shape.

Symptoms
  • Soreness and pain
  • Swelling
  • Loss of appetite
  • Redness and warmth
Treatment

It is critical for Charcot foot to be identified early. Nonsurgical treatments are available depending on the severity of the condition, and consist of immobilization until the bones repair themselves, and using special shoes and inserts after the bones have healed. Surgery may sometimes be needed to repair the foot, although the procedures depend on the timing and severity.

Clubfoot

Clubfoot is a condition typically present at birth where the foot turns inward and downward. While the cause of clubfoot is not known, it is the most common congenital disorder of the legs, and can vary greatly in severity.

Symptoms
  • Foot is turned inward and downward at birth
  • Smaller calf and foot muscles than normal
Treatment

Treatment may involve moving the foot into the correct position and casting it. Treatment should be started as early as possible, as it is easiest to reshape the foot shortly after birth. Recasting will be done every week to improve the position of the foot, and requires between five and ten casts. The final cast will remain in place for three weeks. After removal of the final cast and the foot is in the correct position, a brace must be worn for three months. Afterwards, the child will only need to wear the brace at night for a period of time up to three years.

Hammer Toe

Hammer toe is a condition in which the end of the toe is bent downward into a claw-like position. The most common cause of hammer toe is wearing short, narrow shoes that are too tight, which force the toe into a bent position. At first, you may be able to move and straighten the toe. Over time, you will no longer be able to move the toe and it will be painful.

Symptoms
  • Pain when walking or wearing shoes
  • Corn formation on the top of the toe
  • Calluses present at the sole of the foot
Treatment

Wearing the right size shoes and avoiding high heels can relieve symptoms associated with hammer toe. For people with severe hammer toe, surgery may be required. Patients are able to go home the same day as surgery.




Neuroma

Neuroma is a painful condition that involves a thickening of the tissue around one of the nerves leading to your toes. It affects the ball of your foot, most commonly the area between your third and fourth toes. High-heeled shoes have been linked to the development of neuroma, and people tend to experience relief just by switching to lower-heeled shoes with wider toe boxes.

Symptoms
  • Feeling as if you're standing on a pebble or fold in your sock
  • Burning sensation in the ball of the foot or toes
  • Tingling or numbness in your toes
Treatment

Treatment depends on the severity of the symptoms. Some people with milder symptoms may greatly improve from more conservative methods, such as using arch support and foot pads to help reduce pressure on the nerves. Others may require steroid injections into the painful area, surgical removal of the growth or surgery.

Sesamoiditis

Sesamoiditis is a foot condition that involves pain and inflammation of the sesamoid bones. The sesamoid bones are located in the part of the ball of the foot that is just behind the big toes. Causes vary from trauma and wearing high heels, to elevated age and osteoporosis.

Symptoms

Pain is usually only felt during activity, and when the weight is taken off the feet, it usually rapidly subsides.

  • Pain when walking, or other physical activity especially under the ball of the foot by the base of the big toe
  • Swelling or bruising
  • Difficulty in bending and straightening the great toe
Treatment

Treatment is generally non-operative. However, if conservative measures fail, like resting and taking OTC meds, you may need surgery on the affected sesamoid bone.



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