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Foot & Ankle

Achilles Tendonopathy

What is Achilles tendonopathy?
There are many terms for Achilles pain: the term tendinopathy includes tendinosis (a chronic problem involving micro-tears of the tendon), tendinitis (inflammation of the tendon), and paratendinitis (inflammation of the thin sheath surrounding the tendon). The pathophysiology of tendinosis is not fully understood, but likely relates to poor vascular supply and microtears occurring with overuse and excessive loading. Chronic and excessive loading may not allow sufficient time for tendon repair. Painful, tender, nodular swelling along the Achilles near the heel are typical symptoms.

Ankle Arthritis

What is ankle arthritis? footThe ankle joint is a complex structure that includes three bone: the tibia (the major leg bone), the fibula (the smaller leg bone), and the talus. These bones interact to allow for motion at the ankle joint. Ankle arthritis is a condition in which the ankle joint cartilage wears out. Patients experience pain, loss of motion, swelling, and disability. There are several causes of ankle arthritis. The most common cause is prior ankle trauma or fracture. Other causes of ankle arthritis include ankle instability, inflammatory arthritis, family history of arthritis, gout, and hemophilia. Sometimes the reason for the arthritis is unknown (“idiopathic” arthritis).

If nonsurgical treatment fails, what can be expected with surgery? Surgical options depend on the severity of the pain, amount of cartilage damage, and patient’s occupation, age, weight, and activity level. Early arthritis may benefit from an isolated removal of large bone spurs if present, with or without arthroscopy. The majority of ankle arthritis is treated by one of two methods: ankle fusion or ankle replacement. The risks and benefits of each treatment can be complicated are better suited for a full discussion with Dr. Miller.

Ankle Sprains and Ankle Instability

What is ankle instability? rolled ankleThe acute ankle sprain is the most common injury in both interscholastic and intercollegiate sports. Lateral ankle sprains are much more common than medial sprains, typically involving the anterior talofibular ligament. Simple ankle sprains are not as innocuous as many believe, with high rates of prolonged symptoms, decreased physical activity, recurrent injury, and self-reported disability.

The hallmarks of chronic ankle instability include repeated ankle sprains that have led to an altered patient activity level. Important factors include injuries sustained, frequency of events, localization of pain, and prior treatment modalities.

Bunionette (Tailor’s Bunion)

What is a bunionette? bunionA deformity of the fifth toe causing pain and swelling underneath or on the outside of the metatarsophalangeal joint. Tailor’s bunion refers to the increased frequency in tailors, who placed frequent pressure on the lateral border of the foot while sitting with their legs crossed. Redness due to rubbing and callous can occur. A bunionette is associated with wearing narrow shoes/high heels and with flat feet. With a bunionette, the foot is wide at the joint (metatarsophalangeal joint) and the rest of the small toe impinges on the 4th toe. Most often this process happens idiopathically or is a congenital deformity, and there is no identifiable direct cause. Over time the deformity may progress.

If nonsurgical treatment fails, what can be expected with surgery?
If your bunionette has progressed to the point where you have difficulty walking or experience pain despite accommodative shoes, you may electively undergo surgery to correct the malalignment of the toe. Bunionette surgery realigns bone, ligaments, tendons and nerves so your big toe can be brought back to its correct position.

Flatfoot Deformity (Posterior Tibial Tendon Dysfunction)

What is a flat foot deformity? ankle1 (3)A flat foot deformity or posterior tibial tendon dysfunction can be a pediatric deformity or an adult acquired deformity, and has been named after failure of the posterior tibial tendon. This tendon starts in the calf and attaches to bones in the middle of the foot on the inside of the arch to help maintain the arch in the foot. Pain usually develops initially along the tendon. However, the condition is caused not only by the progressive failure of the posterior tibial tendon but also the failure of associated ligaments and joints in the ankle and foot. Some patients have had a flat foot all their lives and as they grow older the foot becomes painful. Based on the severity and stage of the deformity, a flat foot can become a debilitating problem. In an adult, the foot becomes fixed in deformity and arthritis can occur.

If nonsurgical treatment fails, what can be expected with surgery? 
Surgery for a flat foot deformity attempts to repair or reconstruct the posterior tibial tendon while recreating arch of the foot. In order to recreate an arch, often various osteotomies (bone realignments) and tendon surgeries are made to reestablish a normal weightbearing foot. The combination of surgeries to be performed is selected based on the unique presentation of each patient. In later adult stages when a foot is stiff, a fusion may be necessary to restore the foot.

Hallux Rigidus (Arthritis of big toe)

What is hallux rigidus? toeHallux rigidus or degenerative arthritis of the 1stmetatarsophalangeal (MP) joint is the next most common condition affecting the big toe after hallux valgus. It is also the most common arthritic condition in the foot, and females are more commonly affected in all age groups.Pain and stiffness are common at the 1st MP joint, especially pain at the dorsal aspect of the joint in the early course of the disease. As the disease progresses, patients may complain of a dorsal prominence which may rub in footwear. Symptoms are aggravated by increased loading onto the 1st MP joint, such as during heel-off or toe-off, as well as running.

Hallux Valgus (Bunion)

What is hallux valgus? toe (1)If the joint that connects your big toe to your foot is enlarged, swollen or sore you may have a bunion. Hallux valgus is associated with wearing narrow shoes or high heels, a family history, and is more common in women (90% of bunions). A progressive bunion may lead to other disabling foot problems such as corns, calluses and hammer toes.With a bunion, the foot widens at the joint (metatarsophalangeal joint) and the rest of the big toe (hallux) impinges on the other toes. Most often this process happens idiopathically and there is no identifiable direct cause. Over time the deformity may progress or become arthritic. If nonsurgical treatment fails, what can be expected with surgery? If your bunion has progressed to the point where you have difficulty walking or experience pain despite accommodative shoes, you may electively undergo surgery to correct the malalignment of the toe. Bunion surgery realigns bone, ligaments, tendons and nerves so your big toe can be brought back to its correct position. Orthopaedic surgeons have several techniques to ease your pain based on individual deformity.

Lesser Toe Deformity/Pain

What are lesser toe deformities?toe (2)The toes may deviate in various directions based upon abnormal weight distribution in the foot, a bunion, or for other reasons. Common deviations include: hammer toe, mallet toe, claw toe, crossover toe and cock-up toe. They are more common in women. Pain often occurs where the toe rubs in the shoe. Pain and callous may also occur underneath, along the ball of the foot, called metatarsalgia. This can also occur for similar reasons, excessive stress on the metatarsals, and more than one abnormality is common.

Midfoot Arthritis

What is midfoot arthritis? foot (2)Midfoot arthritis is a painful condition of the bones in the middle of the foot. There can be associated swelling, stiffness, and bony prominences on the top of the foot. Severe arthritis can restrict your mobility and limit your quality of life. There are different types of arthritis: osteoarthritis, degeneration of the joints; traumatic arthritis, due to a previous injury or fracture; and inflammatory arthritis, due to rheumatoid or other diseases. Over time arthritis may lead to increased stiffness, pain and deformity of                                                                                            the foot.

Morton’s Neuroma

What is a Morton’s Neuroma? foot (3)A neuroma is a benign thickening of nerve tissue leading to the toes. It occurs as the nerve passes under the ligament connecting the metatarsals in the forefoot. Morton’s neuroma most frequently develops between the third and fourth toes, usually in response to irritation, trauma or excessive pressure. The incidence of Morton’s neuroma is eight to 10 times greater in women than in men. Commonly, one feels like they are “walking on a marble” or have persistent pain in the ball of their foot.If nonsurgical treatment fails, what can be expected with surgery? They majority of people with Morton’s neuroma improve without surgery. If nonsurgical treatment does not relieve your symptoms, surgery can resect a small portion of the nerve and release the tissue around the nerve. This is generally done through an incision from the top of the foot. The nerve being resected provides sensation to the area between the toes, and for this reason there will be numbness in this area.

Osteochondritis Dissecans (OCD) of Ankle

What is an OCD of the ankle? foot (4)An OCD is most commonly an injury to the talus (the bottom bone of the ankle joint) that involves both the bone and the overlying cartilage. These injuries may include blistering of the cartilage layers, cyst-like lesions within the bone underlying the cartilage, or fracture of the cartilage and bone layers. The majority of OCD’s, as many as 85 percent, occur after a traumatic injury to the ankle joint. Ankle sprains (rolling-inward injuries to the ankle) are a common cause of OCD’s. With this type of injury, a section of the talus surface may impact another part of the ankle joint (tibia or fibula). As this happens, an impaction, crushing or shearing injury to the talus may occur. If nonsurgical treatment fails, what can be expected with surgery? The goals of surgery are to restore the normal shape and gliding surface of the talus in order to re-establish normal mechanics and minimize symptoms. Depending on the characteristics and location of the OCD, surgery may be done arthroscopically or by opening the skin. Treatments may include removing injured cartilage and bone, fixation of the injured fragment, microfracture or drilling of the lesion, and/or transfer or grafting of bone and cartilage. The chosen treatment depends on the size and nature of the lesion.

Peroneal Tendonitis/Instability

What is peroneal tendonitis/instability? foot (5)The peroneal tendons run on the outside of the ankle just behind the bone called the fibula. These tendons help to move the foot and protect the ankle. With overuse, inflammation, enlargement and thickening can occur in the tendon. Less commonly the tendons can become unstable behind the fibula and potentially dislocate during sudden activity. Patients will usuallypresent with pain right around the back of the ankle. There is usually no history of a specific injury. As for instability, this is more sudden and a specific injury may be recalled. Patients who have a high arch or a heel turned inward are prone to such injuries.If nonsurgical treatment fails, what can be expected with surgery?The goals of surgery are to restore the normal stability of the tendons and minimize symptoms. Depending on the characteristics of the tendonitis, surgery commonly repairs smaller tears in the tendons. If larger tears cannot be salvaged, there are reconstructive options that are possible. If the tendons are prone to dislocating behind the fibula, this channel is deepened for stability. Associated injuries to the ankle are common and these would be treated concurrently.

Stress Fracture

foot (6)What is a stress fracture? Stress fractures are analogous to bending a paper clip. If you gently bend a paper clip a single time, it will not break. However, if you continue to bend it back and forth, over time it weakens and eventually breaks. This weakening of bone (also called “fatigue”) is technically called a “stress reaction.” When the bone goes on to actually break, it becomes a stress fracture.For more info, Visit the American Orthopaedic Foot and Ankle Society’s information page.



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