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Medical & Surgical Treatment of Foot & Ankle

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What to do With a Broken Toe

Have you recently dropped something on your foot or accidentally run into a bedpost, table leg, or doorframe?  These are common causes of injuring bones in the foot.  A broken bone may result especially when swelling and pain develop.  If swelling and pain persists for a few days, a trip to your podiatrist is recommended for x-rays and evaluation.

 

X-rays allow the doctor to view the alignment of your bones and create a treatment plan.  If the fractured ends of the bone do not match up, your podiatrist may need to realign the bones in their office or with surgery.  Many times your doctor will be able to restore alignment simply by moving your toe.  Surgery for a fracture in the foot is uncommon and used for severe misalignment only.

 

Generally, broken bones require immobilization.  This can be achieved through cast, splint, hard-soled shoe, tapping technique or a walking boot.  Casts, splints, and walking boots are used when the entire foot needs to be immobilized.  Hard-soled shoes or tapping is reserved for broken toes and smaller injuries.  All devices prevent weight and movement from reinjuring the bones.  This allows the bones to heal and return to their normal condition.

 

With any broken bone, it is easier and more efficient to correct a newly fracture before healing can occur.  Better post treatment alignment will be achieved and your bone will return to its original shape.  If you injured your foot and it is not getting better, consider seeing your doctor after a few days of pain or swelling for treatment.

Bunionette: A Bunion for the Little Toe

A bunionette is very similar to a bunion, except that it is found on the pinky toe.  It is also known as a tailor’s bunion.  (This is because tailors once sat cross-legged all day with the outside edge of their feet rubbing on the ground causing a pressure area at the bottom of their little toe.)  With very few people working as tailors today, bunionette’s are more commonly caused by shoes that are too narrow.

A bunionette is found where the small toe connects to the foot.  This joint is called the metatarsophalangeal joint and is where a metatarsal (a long bone in the foot) connects with a phalange (a small bone in the base of the toe).  A bunionette is the abnormal bump on the end of the metatarsal bone.  It looks like a bunion, but for the little toe.  Bunionettes are formed from two main causes.  The most common reason is wearing inappropriately narrow shoes or not increasing shoe width as the foot naturally widens during the aging process.  Bunionettes may also be caused by a bowing of the metatarsal bone, but this occurs only in a small number of people.   Both causes of bunionettes can lead to a boney bump constantly rubbing on shoes which may cause calluses to form.

The easiest method to decrease the pain caused by a bunionette is to stop the rubbing.  This can be accomplished by changing shoe gear, placing a pad over the area, or by removing the callus.  Calluses can be removed effortlessly and without pain by the podiatrists at Brighton Family Foot Care and Fenton Foot Care.   The doctors will diagnosis a bunionette through a physical examination and use of x-ray.  If the bunionette’s symptoms aren’t reduced through shoe gear, padding, or callus removal, surgery is always a possibility.  Surgeons typically use two different procedures to treat bunionettes.  They may look to either remove the bump or change the shape and angle of the metatarsal.  After surgery, patients use a post-op shoe for a short period of time before returning to their normal shoes.

Tendon Injuries

Think of tendons as a connection between muscle and bone.  As tendons function, they convert muscle movement to a pulling action on bone.  Within the foot, there are many tendons.  The more commonly injured tendons have muscles bellies found in the calf.  These tendons, the Peroneals, Achilles, and Posterior Tibial tendon insert on to bones within the foot to help stabilize and move the foot.  These tendons can become injured as a result of overuse, improper footwear, misalignment, or trauma.  A tendon injury may occur suddenly or develop over time.  Many times tendon injuries are found in people who engage in sports that involve repetitive ankle motion.  Tendon injuries heal with rest and cannot be treated by exercising through the pain.  It is important to see a podiatrist for diagnosis and appropriate treatment.

There are two main types of tendon injuries.  Tendonitis is an inflammation of the tendon.  This is often the result of an overuse injury that weakens the tissue.  This type of tendon injury often results from repetitive use and if left untreated may worse leading to chronic pain and even tear.  Tendonosis is a degeneration of the tendon.  When this occurs, the tendon may become overstretched resulting in weakness or ankle instability.

If you believe you have a tendon injury in your foot or ankle, it is important to see a podiatrist for diagnosis and treatment.  The podiatrists at Fenton Foot Care and Brighton Family Foot Care can advise you on how to treat and avoid tendon injury.

Shin Splints

Contrary to common knowledge, shin splints are not a specific diagnosis but a feeling of pain over the front of the shin.  The pain referred to as shin splints arise from problems in the muscle, bone, or attachment of muscle to bone.  To provide a specific location, the pain is felt where the tibialis anterior muscle inserts into the tibia bone (just below the knee to ½ way down the leg).  When people speak of shin splints, they most commonly refer to an overuse injury and irritation of the tibialis anterior tendon and the attachment to bone.  Medically, the condition is termed medial tibial stress syndrome.  Pain over the front of the shin can also be caused by stress fractures or exercised induced compartment syndrome.  All of these injuries are typically due to overuse injury.

 

Ordinary, the tibialis anterior muscle is overused because the foot overpronates.   Pronation occurs when the foot flattens as weight is applied.  This is a normal event in walking but during overpronation the foot becomes so flat that it rolls inward.  The increased movement in the foot increases the demand on the tibailis anterior muscle and its connection to the tibial bone.

 

People with shin splints typically complain of tenderness along the bone and may have some swelling in the area.  This pain is most commonly increased when pushing the foot into the ground, like what is done during running.  In addition to taking a detailed medical history and physical, a doctor may order an x-ray or bone scan.  While not all shin splints are the same, basic treatments are.  Applying ice packs or ice massage the area for 20 min three times a day with anti-inflammatory medication will help reduce the pain.  This should be done in addition to making sure shoes are in good condition and the foot does not excessively pronate (a good shoe insert or orthotic should prevent overpronation).  As always, it is important to be evaluated by a doctor if pain is not temporary.

My Big Toe Woke Me Up!

Gout is a type of arthritis that occurs when uric acid settles in the joints.  It most often affects the big toe, knee, or ankle joints.  Most often gout symptoms appear in acute gouty attacks with pain that feels throbbing, crushing, or excruciating that starts during the night.  The joint typically feels warm, appears red and hurts to touch (even to lay a sheet or blanket over the joint).  After the first episode, people usually have no symptoms and can go months or years between attacks.  Gout attacks may lead to chronic gouty arthritis.

 

Gout is caused by higher than normal levels of uric acid in the body.  This can develop from the body making too much uric acid or failing to reduce the levels of uric acid.  If too much uric acid enters the fluid around joints uric acid crystals can form.  It is the crystals that cause the joint to swell up and become inflamed causing the pain.  Not everyone with high uric acid levels has gout.  The exact reason why crystals from is unknown but certain groups are at a higher risk.  Gout may run in families.  It is also more common in males, postmenopausal women, people who drink alcohol, and take certain medicines.

 

Gout is treated in a few ways.  Doctors typically suggest taking ibuprofen as soon as symptoms begin and may prescribe a strong painkiller for attacks.  If several gout attacks a year, signs of gouty arthritis, or uric acid kidney stone are present, a doctor may prescribe Allopurinol or Probenecid to decrease uric acid levels in the blood.  Some diet and lifestyle changes can also help prevent gouty attacks.  These changes include avoiding alcohol, oils, organ meat, and limiting how much meat is consumed during each meal.  Eating carbohydrates is importing as well as avoiding fatty meals.

A Painful Ankle

One of the most common injuries of the foot is an ankle sprain.  Most of the time ankle sprains are thought of as a sports injury, they can be caused by daily activities such as walking off a curb, stepping on a rock, or missing a step.  The ankle joint is unique in the body as it is composed of three bones built to bear and stabilize about ½ of the body’s weight while still being fairly mobile.  To help understand the injury, some background anatomy is needed.

 

There are two bones in the lower leg and one in the foot that make up the ankle joint.  The two bones in the foot run together from the knee to the ankle.  The inner and larger bone is called the tibia.  This bone supports ½ of the body’s weight above it.  The smaller and outside bone is called the fibula.  This long skinny bone serves as an attachment point for muscles and tendons.  The tibia and fibula are joined just above the ankle joint by the distal tabiofibular ligament.  The bone in the foot is called the talus.  This bone fits into the space between the tibia and fibula.  The talus pivots in this space allowing movement between the foot and leg.  On the inside of the ankle joint the talus and tibia are connected by a group of ligaments called the deltoid ligament.  On the outside, the talus and fibula are connected by three ligaments: anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament.   The last thing to talk about is the two broad ligaments that wrap around the entire joint.  These are called the flexor retinaculum and extensor retinaculum and help stabilize and keep all of the parts of the ankle joint together.

 

Now that some of the anatomy is clear it’s time to read about the different types of ankle sprain, how they are caused, and graded.  The term “sprain” is used when a ligament is damaged or ruptured.  The three basic types of ankle sprains are inversion, eversion, and syndesmosis or high-ankle sprains.  The most common is an inversion sprain.  This occurs when the foot is pointed toward the floor and the foot rolls inward placing the body weight over the outside of the foot and ankle.  An inversion sprain usually happens by stepping or landing on uneven ground or making a cutting motion.  These sprains damage the ligaments on the outside of the ankle with the anterior talofibular ligament most commonly damaged.    Eversion ankle sprains require a large amount of force to occur.  The most common way they occur is when an athlete has a foot planted and there is a blow from the side of the planted leg.  The syndesmosis or high-ankle sprain is a stretch of the distal talofibular ligament.  This occurs when the talus bone twists between the tibia and fibula, forcing the two leg bones unnaturally apart.  This injury is most common when the foot is planted and the body twists over the planted foot.

 

During the diagnosis of a joint sprain, doctors may use the following scale.  This helps them categorize the degree of damage to the joint and develop a treatment plan.

 

Grade 1:   The joint has mild pain with little to no swelling.  Minor tears and stretching of the ligament have occurred.  There is only minimal loss of function and stiffness of the joint.  Expected recovery is a few days.

 

Grade 2:   The joint has moderate to severe pain with swelling.  A partial tear of ligaments and moderate loss of function has occurred to the joint.  Joint is also experiencing stiffness.  Full recovery is within 2-3 months.

 

Grade 3:  Initially there is severe joint pain but afterwards little or no pain.  The joint becomes very stiff with large amounts of swelling.  Ligaments are completely ruptured and joint has complete loss of function.  Full recovery can take up to 4 months.

What is a Bunion?

A bunion is an enlargement of the metatarsophalangeal joint (the joint at the base of the big toe).  It is created when bone or tissue of the joint moves.  Bending of this altered joint is the source of pain, which is made worse with the joint normally supporting much of the body’s weight while walking.    Other typical symptoms of a bunion are: a firm bump on the outside edge of the foot at the base of the big toe, redness, swelling, pain, corns or other skin irritation, and restricted or painful movement of the big toe.

 

Short-term pain relief is easy to do at home.  Examples of ways to ease the pain include over the counter bunion pad placed around the bony prominence, wearing shoes with a wide and deep toe area, avoiding high-heeled shoes, and using ice to reduce the swelling.  The best treatment for bunion pain is to see your podiatrist.  Depending on the size and pain of the bunion, nonsurgical or surgical treatments are both options.  Early management tries to relieve pressure on the bunion and stop increased joint deformity.  These methods include taping, anti-inflammatory injections, physical therapy, and orthotics.  If surgery is required, the surgeon will remove the bony enlargement and restore the natural joint form.

 

While some foot types have an increased risk of forming bunion, the following list provides tips on preventing bunions.  As always, see your podiatrist if you have questions or pain due to a bunion.

 

  • Wear comfortable shoes that mold to your feet
  • Always fit the larger foot if you have different sized feet when buying shoes
  • Avoid high-heeled shoes over two inches tall
  • Wear shoes with plenty of room in the toe area

What is this bump on the top of my foot?

Many times, people notice a large lump on the top of their foot.  This lump can cause redness, irritation, and sometimes a dull pain or ache when wearing shoes.  You many notice this lump is fluid or jellylike and seems to grow and shrink from time to time.  You may be confused as to what caused this lump, as you cannot seem to remember bumping your foot, dropping anything on it, or causing your foot any harm.

 

This lump is typically known as a ganglion cyst and is a very common soft tissue growth.  It is a sac filled with a jellylike fluid that originates from tissue covering tendons or joints.  The exact cause of ganglion cysts is unknown but they seem to arise following an accident to the foot.  The accident may be so long ago or so little in pain that it is not remembered or noticed.

 

To diagnose a ganglion cyst, a podiatrist will perform an examination of the foot.  They may press on the lump making sure it is freely movable underneath the skin.  They may also shine a light through the bump or remove a small portion of the fluid to send for lab studies.  Your doctor may take an x-ray or additional imaging studies.

 

Since a ganglion cyst poses no harm treatment may just consist of monitoring the area.  If the cyst does interfere with daily activities or cause pain, simple steps may be taken to modify your shoes to prevent irrational.  The cyst may be aspirated to remove the fluid in a simple office procedure.  However, many times removing the fluid is only a temporary fix as the fluid may return.  If these treatments do not work, the cyst may need to be surgically removed.

Causes of Heel Pain

Every mile you walk places a tremendous amount of stress on your feet.  The good news is your feet can handle a heavy load, but too much stress may push them past their limit.  The shoes you wear or surfaces you train or walk on can increase the stress level.  Heel pain is commonly one of the first signs that too much stress is being placed on your feet.  A sore heel with usually get better on its own with adequate rest.  The problem is many people try to ignore the early signs of heel pain and continue the activities that caused it.

 

Heel pain can have many causes.  It is important to see the podiatrists at Coastal Podiatry Associates right away to determine why your foot is painful and determine the proper treatment.  The doctors will begin by asking where exactly the pain is located and how long you have had it.  Next, they will examine your foot, looking and feeling for signs of tenderness, swelling, and bruising.  The doctors may ask you to walk, stand on one foot, or other physical tests that help determine the pain’s cause.  Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel.

 

If the pain is greatest under you heel, you may have a condition causing inflammation in that area.  A stone bruise occurs after stepping on a hard object such as a rock or stone.  The object can bruise the fat pad on the underside of the heel and pain gradually reduces with rest.  Plantar fasciitis typically occurs after too much running, jumping, or stretching of the tissue band that connects the heel bone and the base of the toes.  The pain in centered under the heel and is most intense with taking your first steps after resting.  A heel spur is another cause of pain and can form from long standing plantar fasciitis.  An X-ray may be used to visualize the increased boney projection from the heel.

 

Pain behind the heel is generally due to the Achilles tendon.  This condition is called retrocalcaneal bursitis and is an inflammation of the insertion of the Achilles tendon into the heel bone.  People often develop this by running too much or wearing shoes that rub or cut into the back of the heel.  This irritation can cause a slow increase in skin thickness, redness, or swelling.  A bump that is tender and warm to touch may also develop.  Pain is most severe with first activity after resting.  It is not uncommon for the pain to be so severe that normal shoes cannot be worn.  After taking X-rays, a podiatrist will common prescribe stretching exercises, anti-inflammatory medications, and icing.

When to be Concerned about Your Child’s Feet

Foot and ankle problems in children are hard to spot.  Signs and symptoms are small and sometimes children can’t explain when or what’s wrong.  Any parent would agree that it is important to protect their children and have problems checked out early.  If your child is experiencing any of these warning signs it is time for a trip to the podiatrist:

 

Your Child Often Trips and Falls

Repeated falls can point to a number of conditions.  If the clumsiness continues, it might be caused by in-toeing, balance problems, or neuromuscular conditions.

 

Your Child Complains of Pain

It is never normal for a person to experience pain.  If your child has foot pain or swelling for more than a few days, even after a minor injury, it’s time to have their feet examined.

 

Your Child Can’t Keep Up with Their Peers

If your child cannot keep pace in sports or backyard play, it may be due to tired feet or legs.  Fatigue is common in children with flat feet.  The muscles in the feet and legs tire easily due to abnormal functioning.

 

Your Child Voluntarily Withdraws from Activities They Like

This is a common complaint of active children complaining of heel pain.  Repetitive stress from sports and running can cause inflammation of the heel’s growth plate.  The growth plate is especially prone when the child is between 8 and 14 years old.

 

Your Child Doesn’t Want to Show You Their Feet

Some children don’t want to talk to their parents about pain or change in appearance because they fear a trip to the doctor’s office.  It is important for parents to discourage this feeling.  It is also a good idea for parents to make a habit of inspecting their child’s feet for any changes like calluses, skin discoloration, warts, redness, or swelling.