Injuries, Symptoms & Treatments

Ankle & Foot

You are a foot away from a finely turned ankle !

Your ankle and foot are an intricate network of bones, ligaments, tendons and muscles. Strong enough to bear your body weight, they can be prone to injury and pain.

 

Ankle/Foot pain can affect any part of your ankle or foot, from your toes to your Achilles tendon at the back of your heel. Although mild pain often responds well to home treatments, it can take time to resolve. Dr. Bellapianta should evaluate severe foot pain, especially if it follows an injury.

 

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Use the convenient search tool to find information on orthpedic conditions and treatments offered by our practice.. his assures that the information you are researching has been confirmed by Dr. Bellapianta as well as The American Academy of Orthpaedic Surgeons.

Diseases/Conditions of the ankle and foot

Common Ankle & Foot Injuries/Disorders
Sprained Ankle
Stress Fractures
Achilles Tendinitis
Bunions
Claw Toe
Clubfoot
Hammer Toe
Plantar Fasciitis and Bone Spurs
Rheumatoid Arthritis of the Foot and Ankle
Common Ankle & Foot Injuries/Disorders

Common Ankle & Foot Injuries/Disorders

 

Achilles Tendonitis

Achilles Tendonitis is an overuse injury of the Achilles (uh-KILL-eez) tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone. It most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It's also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends. Most cases of Achilles tendinitis can be treated with relatively simple, at-home care under your doctor's supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.

 

Achilles Tendon Rupture

Achilles Tendon Ruopture is an injury that affects the back of your lower leg. It most commonly occurs in people playing recreational sports. The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture) completely or just partially. If your Achilles tendon ruptures, you might feel a pop or snap, followed by an immediate sharp pain in the back of your ankle and lower leg that is likely to affect your ability to walk properly. Surgery is often the best option to repair an Achilles tendon rupture. For many people, however, nonsurgical treatment works just as well.

 

Broken Ankle/Foot

A broken ankle or broken foot is a common injury. You may experience a broken ankle or broken foot during a car crash or from a simple misstep or fall. The seriousness of a broken ankle or broken foot varies. Fractures can range from tiny cracks in your bones to breaks that pierce your skin. Treatment for a broken ankle or broken foot depends on the exact site and severity of the fracture. A severely broken ankle or broken foot may require surgery to implant plates, rods or screws into the broken bone to maintain proper position during healing.

 

Bunion

Bunion is a bony bump that forms on the joint at the base of your big toe. A bunion forms when your big toe pushes against your next toe, forcing the joint of your big toe to get bigger and stick out. The skin over the bunion might be red and sore. Wearing tight, narrow shoes might cause bunions or might make them worse. Bunions can also develop as a result of an inherited structural defect, stress on your foot or a medical condition, such as arthritis. Smaller bunions (bunionettes) also can develop on the joint of your little toes.

 

Bursitis

Bursitis is a painful condition that affects the small, fluid-filled sacs — called bursae (bur-SEE) — that cushion the bones, tendons and muscles near your joints. Bursitis occurs when bursae become inflamed. The most common locations for bursitis are in the shoulder, elbow and hip. But you can also have bursitis by your knee, heel and the base of your big toe. Bursitis often occurs near joints that perform frequent repetitive motion. Treatment typically involves resting the affected joint and protecting it from further trauma. In most cases, bursitis pain goes away within a few weeks with proper treatment, but recurrent flare-ups of bursitis are common.

 

Flatfeet

Flatfeet you have flatfeet when the arches on the inside of your feet are flattened, allowing the entire soles of your feet to touch the floor when you stand up. A common and usually painless condition, flatfeet can occur when the arches don't develop during childhood. In other cases, flatfeet develop after an injury or from the simple wear-and-tear stresses of age. Flatfeet can sometimes contribute to problems in your ankles and knees because the condition can alter the alignment of your legs. If you aren't having pain, no treatment is usually necessary for flatfeet.

 

Gout

Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe. Gout — a complex form of arthritis — can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause. An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.

 

Hammer Toe and Mallet Toe

Hammer Toe and Mallet Toe are foot deformities that occur due to an imbalance in the muscles, tendons or ligaments that normally hold the toe straight. The type of shoes you wear, foot structure, trauma and certain disease processes can contribute to the development of these deformities. A hammertoe has an abnormal bend in the middle joint of a toe. Mallet toe affects the joint nearest the toenail. Hammertoe and mallet toe usually occur in your second, third and fourth toes. Relieving the pain and pressure of hammertoe and mallet toe may involve changing your footwear and wearing shoe inserts. If you have a more severe case of hammertoe or mallet toe, you might need surgery to get relief.

 

Osteoarthritis

Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage on the ends of your bones wears down over time. Although osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, knees, hips and spine. Osteoarthritis symptoms can usually be effectively managed, although the underlying process cannot be reversed. Staying active, maintaining a healthy weight and other treatments may slow progression of the disease and help improve pain and joint function.

 

Plantar Faciitis

Plantaf Faciitis is one of the most common causes of heel pain. It involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes. Plantar fasciitis commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position. Plantar fasciitis is particularly common in runners. In addition, people who are overweight and those who wear shoes with inadequate support are at risk of plantar fasciitis.

 

Rheumatoid Arthritis

Rheumatoid Arthritis is one of the most common causes of heel pain. It involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes. Plantar fasciitis commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position. Plantar fasciitis is particularly common in runners. In addition, people who are overweight and those who wear shoes with inadequate support are at risk of plantar fasciitis.

 

Stress Fractures

Stress fractures are tiny cracks in a bone. Stress fractures are caused by the repetitive application of force, often by overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also arise from normal use of a bone that's been weakened by a condition such as osteoporosis.Stress fractures are most common in the weight-bearing bones of the lower leg and foot. Track and field athletes are particularly susceptible to stress fractures, but anyone can experience a stress fracture. If you're starting a new exercise program, for example, you may be at risk if you do too much too soon.

Content by the American Academy of Orthopaedic Surgeons 

Sprained Ankle
Stress Fractures
Achilles Tendinitis
Bunions
Claw Toe
Clubfoot
Hammer Toe
Plantar Fasciitis and Bone Spurs
Rheumatoid Arthritis of the Foot and Ankle

Ankle Sprains

An ankle sprain is a common, painful injury that occurs when one or more of the ankle ligaments is stretched beyond the normal range of motion. Sprains can occur as a result of sudden twisting, turning or rolling movements.

Stress Fractures

Stress fractures are one or more tiny cracks in a bone. These fractures are common in the legs and feet. That's because your legs and feet have to support your weight and absorb the forces of walking, running and jumping.

Plantar Fasciitis

Plantar fasciitis is an irritation of the plantar fascia. This thick band of connective tissue travels across the bottom of the foot between the toes and the heel.

Bunion

This deformity affects the joint at the base of the big toe. It is a bony bump beneath the skin on the inner side of the foot. A bunion starts small, but over time it can grow to become very large. Bunions are more common in women.

Common Treatments of General Orthopedics 

Ankle Fractures
Ankle Sprains
Plantar Fasciitis and Bone Spurs
Bunion Surgery
Ankle Fractures

Ankle Fractures (Broken Ankle)

 

Treatment: Lateral Malleolus Fracture

 

A lateral malleolus fracture is a fracture of the fibula.

 

There are different levels at which that the fibula can be fractured. The level of the fracture may direct the treatment.

 

Nonsurgical Treatment

You may not require surgery if your ankle is stable, meaning the broken bone is not out of place or just barely out of place. A stress x-ray may be done to see if the ankle is stable. The type of treatment required may also be based on where the bone is broken.

 

Several different methods are used for protecting the fracture while it heals. ranging from a high-top tennis shoe to a short leg cast. Some physicians let patients put weight on their leg right away, while others have them wait for 6 weeks.

 

You will see your physician regularly to repeat your ankle x-rays to make sure the fragments of your fracture have not moved out of place during the healing process.

 

Surgical Treatment

If the fracture is out of place or your ankle is unstable, your fracture may be treated with surgery. During this type of procedure, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with special screws and metal plates attached to the outer surface of the bone. In some cases, a screw or rod inside the bone may be used to keep the bone fragments together while they heal.

 

 

Treatment: Medial Malleolus Fracture

 

A medial malleolus fracture is a break in the tibia, at the inside of the lower leg. Fractures can occur at different levels of the medial malleolus.

 

Medial malleolar fractures often occur with a fracture of the fibula (lateral malleolus), a fracture of the back of the tibia (posterior malleolus), or with an injury to the ankle ligaments.

 

Nonsurgical Treatment

If the fracture is not out of place or is a very low fracture with very small pieces, it can be treated without surgery.

 

A stress x-ray may be done to see if the fracture and ankle are stable.

 

The fracture may be treated with a short leg cast or a removable brace. Usually, you need to avoid putting weight on your leg for approximately 6 weeks.

 

You will need to see your physician regularly for repeat x-rays to make sure the fracture does not change in position.

 

Surgical Treatment

If the fracture is out of place or the ankle is unstable, surgery may be recommended.

 

In some cases, surgery may be considered even if the fracture is not out of place. This is done to reduce the risk of the fracture not healing (called a nonunion), and to allow you to start moving the ankle earlier.

 

A medial malleolus fracture can include impaction or indenting of the ankle joint. Impaction occurs when a force is so great it drives the end of one bone into another one. Repairing an impacted fracture may require bone grafting. This graft acts as a scaffolding for new bone to grow on, and may lower any later risk of developing arthritis.

 

Depending on the fracture, the bone fragments may be fixed using screws, a plate and screws, or different wiring techniques.

 

 

Treatment: Posterior Malleolus Fracture

 

A posterior malleolus fracture is a fracture of the back of the tibia at the level of the ankle joint.

In most cases of posterior malleolus fracture, the lateral malleolus (fibula) is also broken. This is because it shares ligament attachments with the posterior malleolus. There can also be a fracture of the medial malleolus.

 

Depending on how large the broken piece is, the back of the ankle may be unstable. Some studies have shown that if the piece is bigger than 25% of the ankle joint, the ankle becomes unstable and should be treated with surgery.

 

It is important for a posterior malleolus fracture to be diagnosed and treated properly because of the risk for developing arthritis. The back of the tibia where the bone breaks is covered with cartilage. Cartilage is the smooth surface that lines a joint. If the broken piece of bone is larger than about 25% of your ankle, and is out of place more than a couple of millimeters, the cartilage surface will not heal properly and the surface of the joint will not be smooth. This uneven surface typically leads to increased and uneven pressure on the joint surface, which leads to cartilage damage and the development of arthritis.

 

Nonsurgical Treatment

If the fracture is not out place and the ankle is stable, it can be treated without surgery.

Treatment may be with a short leg cast or a removable brace. Patients are typically advised not to put any weight on the ankle for 6 weeks.

 

Surgical Treatment

If the fracture is out of place or if the ankle is unstable, surgery may be offered.

 

Different surgical options are available for treating posterior malleolar fractures. One option is to have screws placed from the front of the ankle to the back, or vice versa. Another option is to have a plate and screws placed along the back of the shin bone.

 

 

Treatment: Bimalleolar Fractures or Bimalleolar Equivalent Fractures

 

"Bi" means two. "Bimalleolar" means that two of the three parts or malleoli of the ankle are broken. (Malleoli is plural for malleolus.)

 

In most cases of bimalleolar fracture, the lateral malleolus and the medial malleolus are broken and the ankle is not stable.

 

A "bimalleolar equivalent" fracture means that in addition to one of the malleoli being fractured, the ligaments on the inside (medial) side of the ankle are injured. Usually, this means that the fibula is broken along with injury to the medial ligaments, making the ankle unstable.

 

A stress test x-ray may be done to see whether the medial ligaments are injured.

 

Bimalleolar fractures or bimalleolar equivalent fractures are unstable fractures and can be associated with a dislocation.

 

Nonsurgical Treatment

These injuries are considered unstable and surgery is usually recommended.

 

Nonsurgical treatment might be considered if you have significant health problems, where the risk of surgery may be too great, or if you usually do not walk.

 

Immediate treatment typically includes a splint to immobilize the ankle until the swelling goes down. A short leg cast is then applied. Casts may be changed frequently as the swelling subsides in the ankle.

You will need to see your physician regularly to repeat your x-rays to make sure your ankle remains stable.

In most cases, Weightbearing is not be allowed for 6 weeks. After 6 weeks, the ankle may be protected by a removable brace as it continues to heal.

 

Surgical Treatment

Surgical treatment is often recommended because these fractures make the ankle unstable.

 

Lateral and medial malleolus fractures are treated with the same surgical techniques as written above for each fracture listed.

 

 

Treatment: Trimalleolar Fractures

 

"Tri" means three. Trimalleolar fractures means that all three malleoli of the ankle are broken. These are unstable injuries and they can be associated with a dislocation.

 

Nonsurgical Treatment

These injuries are considered unstable and surgery is usually recommended.

 

As with bimalleolar ankle fractures, nonsurgical treatment might be considered if you have significant health problems, where the risk of surgery may be too great, or if you usually do not walk.

Nonsurgical treatment is similar to bimalleolar fractures, as described above.

 

Surgical Treatment

Each fracture can be treated with the same surgical techniques as written above for each individual fracture.

 

 

Treatment: Syndesmotic Injury

 

The syndesmosis joint is located between the tibia and fibula, and is held together by ligaments. A syndesmotic injury may be just to the ligament -- this is also known as high ankle sprain. Depending on how unstable the ankle is, these injuries can be treated without surgery. However, these sprains take longer to heal than the normal ankle sprain.

 

In many cases, a syndesmotic injury includes both a ligament sprain and one or more fractures. These are unstable injuries and they do very poorly without surgical treatment.

 

Your physician may do a stress test x-ray to see whether the syndesmosis is injured.

 

 

Recovery

 

Because there is such a wide range of injuries, there is also a wide range of how people heal after their injury. It takes at least 6 weeks for the broken bones to heal. It may take longer for the involved ligaments and tendons to heal.

 

As mentioned above, your doctor will most likely monitor the bone healing with repeated x-rays. This is typically done more often during the first 6 weeks if surgery is not chosen.

 

Pain Management

Pain after an injury or surgery is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover faster.

 

Medications are often prescribed for short-term pain relief after surgery or an injury. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

 

Be aware that although opioids help relieve pain after surgery or an injury, they are a narcotic and can be addictive. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your treatment.

 

Rehabilitation

Rehabilitation is very important regardless of how an ankle fracture is treated.

 

When your physician allows you to start moving your ankle, physical therapy and home exercise programs are very important. Doing your exercises regularly is key.

 

Eventually, you will also start doing strengthening exercises. It may take several months for the muscles around your ankle to get strong enough for you to walk without a limp and to return to your regular activities.

 

Again, exercises only make a difference if you actually do them.

 

Weightbearing

Your specific fracture determines when you can start putting weight on your ankle. Your physician will allow you to start putting weight on your ankle when he or she feels your injury is stable enough to do so.

It is very important to not put weight on your ankle until your physician says you can. If you put weight on the injured ankle too early, the fracture fragments may move or your surgery may fail and you may have to start over.

 

Supports

It is very common to have several different kinds of things to wear on the injured ankle, depending on the injury.

 

Initially, most ankle fractures are placed in a splint to protect your ankle and allow for the swelling to go down. After that, you may be put into a cast or removable brace.

 

Even after the fracture has healed, your physician may recommend wearing an ankle brace for several months while you are doing sporting activities.

 

Complications

People who smoke, have diabetes, or are elderly are at a higher risk for complications after surgery, including problems with wound healing. This is because it may take longer for their bones to heal.

 

Nonsurgical Treatment

Without surgery, there is a risk that the fracture will move out of place before it heals. This is why it is important to follow up with your physician as scheduled.

 

If the fracture fragments do move out of place and the bones heal in that position, it is called a "malunion." Treatment for this is determined by how far out of place the bones are and how the stability of the ankle joint is affected.

 

If a malunion does occur or if your ankle becomes unstable after it heals, this can eventually lead to arthritis in your ankle.

 

Surgical Treatment

General surgical risks include:

 

  • Infection
  • Bleeding
  • Pain
  • Blood clots in your leg
  • Damage to blood vessels, tendons, or nerves
  • Risks from the surgical treatment of ankle fractures include
  • Difficulty with bone healing

 

Arthritis

Pain from the plates and screws that are used to fix fracture. Some patients choose to have them removed several months after their fracture heals

 

 

Outcomes

 

Although most people return to normal daily activities, except for sports, within 3 to 4 months, studies have shown that people can still be recovering up to 2 years after their ankle fractures. It may take several months for you to stop limping while you walk, and before you can return to sports at your previous competitive level. Most people return to driving within 9 to 12 weeks from the time they were injured.

Content by the American Academy of Orthopaedic Surgeons 

Ankle Sprains
Plantar Fasciitis and Bone Spurs
Bunion Surgery

Achilles Tendon Lengthening

This procedure is designed to treat problems with the Achilles tendon, such as chronic tendonitis or a short or contracted Achilles tendon.

Bunionectomy

This outpatient procedure is performed to correct a bunion, a deformity of the toe joint. During the procedure, the surgeon may remove excess bone and then shift the toe into proper alignment.

Ankle Fracture Surgery

This surgery fixes an unstable break in your ankle. The break could be in the small bone of your lower leg, called the "fibula" or the larger bone, called the "tibia."

Plantar Fascia Release

This outpatient procedure is a surgical cutting of part of the plantar fascia, a thick band of connective tissue that supports the foot's arch.

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