Ankle/Foot

The Achilles tendon represents the insertion of the calf muscle onto the heel bone. It is important for strength with push off of the foot with walking, running and jumping. Ruptures of this tendon typically occur in men more than women in their 30’s to 50’s. These injuries can be treated non-operatively with casting and bracing or with surgery to repair the tear. Surgery is often recommended for healthy, active people as the re-rupture rate is lower with this form of treatment.

The ankle is a hinge joint between the leg and the foot. Stability of this joint is maintained by ligaments but also by the bony architecture of the joint. The two important bones are the medial and lateral malleolus which are the ends of the tibia and fibula respectively. With a twist, fall or inversion of the ankle, these bones can break. If both are broken, the ankle joint is unstable and the fractures must be fixed with surgery. Sometimes only one of the two breaks. In these situations, the fracture is treated non-operatively with bracing versus or with surgery depending on the stability of the joint. This decision is based on the x-rays and the severity of the fracture.

Flat feet, also known as “fallen arches,” are a common cause of foot pain. Many people are born with flat feet and often do not have pain, but others may develop pain in the arch or ankle. The foot can become flatter over time and lead to worsening pain and difficulty walking. The most common cause of pain associated with a flat foot is tendonitis of the posterior tibial tendon. Numerous conservative and surgical treatments are available that can significantly improve pain and function.

A bunion, or hallux valgus, is a common cause of foot pain. Bunions can often make it impossible to find comfortable shoes, and over time can cause difficulty in activities such as running and sports. Unfortunately, a bunion is a complex deformity of the foot and often cannot be corrected by simply shaving off bone from the base of the big toe. There are, however, many reliable surgeries that can reduce or eliminate a bunion, and thereby reduce pain.

The foot is made up 28 different bones, any of which can develop a stress fracture. This condition is common in active patients such as runners, as well as less active patients who have osteopenia or osteoporosis. Most stress fractures can be treated without surgery, but a few types of fractures heal poorly and often require surgery. X-rays are often normal in the early stages of a stress fracture and MRI is often necessary for the diagnosis. Early diagnosis can shorten the overall recovery time.

Though not as common as arthritis of the hip or the knee, ankle arthritis can be a very disabling condition. Common symptoms are pain and swelling around the ankle. The most common cause is previous trauma such as fractures or recurrent ankle sprains. Simple conservative treatments such as steroid injections and bracing can be helpful, but if these fail, surgery can often be helpful. Arthrodesis (or fusion) of the ankle is the traditional surgical treatment, but ankle replacement and distraction arthroplasty are two newer treatments that are an attractive alternative for select candidates

Ankle sprains are the most common athletic injury. Typically, an “ankle sprain” represents partial tearing of the ligaments on the outside of the ankle. The injury occurs when the ankle awkwardly turns or twists while walking or running. Unfortunately, some patients diagnosed with an ankle sprain may actually have a more severe injury such as a fracture or tendon tear. These more severe injuries may not be evident on initial exam and x-rays. Patients with more severe pain and swelling after an ankle injury should consider consultation with a specialist in order to expedite proper diagnosis and treatment.

The calcaneus (or heel bone) is commonly fractured with falls from a height, such as off a ladder or roof. This is a painful and disabling injury that in most cases is best treated with surgical reconstruction with a plate and screws. Historically, this injury has resulted in chronic pain and dysfunction after both surgical and non-surgical treatment. Newer, more minimally invasive techniques have shown some promise in improving these outcomes.

This is the medical term for arthritis of the big toe. Hallux rigidus is a common cause of pain and bone spurs around the big toe. Simple measures such as modified shoe wear and rigid inserts can alleviate the pain from this condition. If conservative measures fail, numerous surgical options exist, including simple bone spur resection, as well as partial great toe replacement or arthrodesis (fusion).