Foot Surgery​ Guide

 

Hammertoes

Hammertoe

Hammertoes or Mallet Toes are a common deformity that can affect one or more of the second, third, fourth, or fifth toes of the feet. Patients typically notice a bend at the joint(s) in the toe, causing a deformity.

Many will feel:

  • Pain
  • Discomfort
  • Report difficulty wearing certain shoes and often times, corns and calluses develop over the area that frequently rub in your shoe.

You also may notice:

  • Inflammation
  • Warmth
  • Redness
  • An open sore may also develop

Unfortunately, this condition is progressive and will likely worsen over time. You may wonder why hammertoes develop. They typically occur due to an imbalance of the muscles and tendons that insert into the toe and are responsible for holding it straight.

There are several potential causes that may contribute to the development of a hammertoe such as:

  • Underlying biomechanics/deformity
  • Trauma,
  • Shoe gear
  • Foot structure
  • Some medical/disease conditions

Evaluation usually starts with plain film X-rays of your feet. This will help our specialists better understand the architecture of your feet and appreciate any underlying pathology. A thorough clinical evaluation also provides valuable information regarding the proper treatment course.

Once a diagnosis is obtained, our specialists can then present you the best available treatment options. Depending upon the severity of your condition, this may involve non- surgical or surgical intervention. Sometimes, we can even perform a minimally invasive technique in the office setting to help correct this issue to take away your pain. Come see our specialists today for proper evaluation and treatment.

 

Hallux Rigidus

Hallux Rigidus foot

Are you having trouble pain or bending your big toe? Does your toe feel stiff and prevent you from performing the activity that you want?

You may be suffering from a condition called hallux limitus or hallux ridigus. These conditions essentially stem from degenerative arthritis to the joint of the big toe.

Common causes of arthritis include trauma, overuse or underlying biomechanical abnormalities that precipitate increased strain on a joint. Since this is a progressive, degenerative process you should NOT expect this to feel better with rest and time.

Symptoms you may experience include:

  • Pain
  • Burning
  • Tingling
  • Decreased range of motion
  • Stiffness to the big toe

Many patients report an inability to perform the activity they would like such as walking, running, weight-bearing activities, and sports. As your condition advances, you may experience worsening pain (during activity or at rest), difficulty wearing close-toed shoes, and alterations to your gait (how you walk).

Diagnosis usually starts with X-rays and a thorough clinical evaluation. Advanced imaging studies such as CT or MRI are less commonly recommended. Once the entire scope of the condition is assessed, our specialists will create a customized treatment plan for you.

Options typically encompass both non-surgical and surgical plans depending on the severity of your condition

 

High Arched Foot

High Arched Foot

A high arched foot, also known as a Cavus foot, is a condition in which the structure of the foot takes a different form than a normal foot. A normal foot has a natural reverse “rocker bottom” gait pattern that evenly distributes your weight and “rocks” as you ambulate.

When a high-arch (Cavus) foot develops, the weight-distribution is altered into more of a “tripod” with excessive amounts of pressure being applied to the heel, the inside and outside of the forefoot.

This can lead to a variety of problems including:

  • Pain
  • Deformity
  • Calluses
  • Alteration to your walking pattern
  • Instability of the foot

There numerous reasons a Cavus foot may develop such as an underlying structural issues and neurologic conditions (i.e. Charcot-Marie Tooth disease, cerebral palsy etc…). It is important to see a specialist to help determine not only the cause of your high arched foot but what solutions can be offered.

A thorough clinical evaluation is extremely important to assess muscle strength, instability and general position of the foot and ankle. Advanced imaging studies such as MRI or CT may be recommended.

Non-surgical treatment may involve something simple such as orthotics and bracing (hyperlink). If your condition is advanced and you are experiencing significant discomfort and pain, our specialists are here to help.

 

Flat Feet

Flat Feet

A flat foot, also known as Pes Planus, is a complex condition in which the structure of the foot collapses against the ground. It is a common condition that is seen by Foot and Ankle specialists. There are a wide variety of causes, types and treatment plans that apply to both children and adults.

Although some patients may not have any pain with their flat feet, many will find this condition problematic and it have a significant impact on their activity and quality of life.

You may notice that your child has flat feet. This may be normal, as their arches and foot structure are still developing. Sometimes, an arch never develops, or they acquire a flexible flat foot (collapse of the foot during weight bearing activity).

A flexible flatfoot retains the mobility at the joints and is typically more responsive to conservative treatment. In less common circumstances, a child may have a genetic or medical condition that can cause this to happen.

Children less commonly have a rigid, or “stiff” flat feet. It is important to seek evaluation from a specialist to determine the etiology and proper treatment. While children sometimes outgrow flat feet, adults that develop this condition typically do not.

The most frequent causes of flat feet in adults include:

  • Overuse
  • Tendonitis/tendinosis
  • Injury and trauma
  • Obesity
  • Arthritis
  • Tarsal coalition
  • Equinus

You may notice that other problems in your foot have developed such as:

As your condition advances, your tendons and ligaments may be further attenuated and strained. This, in turn, further exacerbates your condition and leads to worsening pain and deformity.

Symptoms can range from mild to severe and may involve pain, instability, difficulty with activity, leg, hip and back pain, problems with shoe wear, muscle cramps and fatigue. As previously discussed, it important to assess your condition and identify whether this is a flexible or rigid deformity.

To get an understanding of the severity of your condition, Xray’s are typically obtained. This will help us get a better understanding of the architecture of your feet and look for abnormalities such as arthritis, trauma, and coalitions.

Often times, advanced imaging studies are required such as MRI, CT, or Ultrasound. A thorough clinical evaluation is extremely important to assess the position of your foot, joints, stability, muscle strength and gait pattern.

It is of the utmost importance to incorporate our 3 keys for successful treatment:

  1. Early and accurate diagnosis
  2. Immediate intervention
  3. The proper treatment regimen

Non-surgical treatment for flat feet may involve something simple and effective such as:

  • Orthotics and bracing
  • Stretching and strengthening exercises
  • Physical therapy
  • Modified shoe gear
  • Anti-inflammatories
  • Injection therapy

If your condition is advanced and you are experiencing significant discomfort and pain, our specialists are here to help. Choosing an appropriate procedure to achieve a successful reconstruction is critical.

These are complex deformities that require a skilled foot and ankle surgeon. A combination of procedures are typically utilized to correct your condition including soft tissue reconstruction (tendons and ligaments), osteotomies (bone cuts) and potentially joint arthrodesis (fusion).

Your surgeon will consider all of your medical history and clinical factors when recommending a procedure. Our priority is your health and helping to educate you on the pros and cons. Regardless of surgical or non-surgical intervention, our goal is to improve the function and alignment of your feet to help reduce your pain.

 

Ganglion Cysts

ganglion cysts

A ganglion cyst is a fluid or jelly filled sac of tissue underneath your skin. These typically arise at joints or on tendons in the foot and ankle. Although non-cancerous, they can produce a significant amount of pain or discomfort.

Patients may notice they continue to increase in size and may continue to fluctuate. Depending on the location, a cyst may press upon a nerve or reduce motion at a joint, causing further discomfort and disability. You may experience sharp, burning, tingling, dull or aching pain.

  • The cause of ganglion cysts is unknown. It important to be evaluated by a Foot and Ankle specialist to determine the proper diagnosis.

Although ganglion cysts may go away on their own, your specialist may recommend a drainage of the cyst or a biopsy to confirm the diagnosis. You may also be referred for advanced imaging studies such as an MRI. Once a diagnosis is confirmed, there are various options for treatment.

 

Heel Spurs

Heel spur

Heel pain is a very common issue treated by Foot and Ankle specialists. A heel spur (extra bone formation) is a general term that can encompass and involve several different types of conditions such:

The heel bone is called the Calcaneus. There are numerous soft tissues (muscles, tendons, ligaments) that connect with this bone. It is important seek evaluation from a specialist to determine the location of your spurs and whether they are the cause of your pain.

Some patients may complain of pain underneath the foot and present with X-Rays that show a spur in that area. Often times, the spur is a result of a condition called plantar fasciitis and not directly responsible for the pain you are experiencing.

When bone enlarges on top of the calcaneal bone, it is often termed a Haglund’s deformity. This is an important distinction because the Achilles Tendon inserts into this area of the calcaneus.

This can result in significant pain and discomfort and may be associated with:

  • Bursitis
  • Tendinitis
  • Tendinosis
  • Loose bone fragments

Typically, patients exhibit the inability to tolerate shoes with rigid backs and may also have trouble with activity. You may notice redness, swelling and warmth on the back of heel.

Diagnosis usually starts with X-rays and clinical examination. Once a diagnosis is confirmed, there are various options for treatment.

 

Neuroma

Neuroma

A neuroma is a condition that involves a thickening of the tissue around a nerve in your foot. These typically are located towards the front of your foot and are notorious for presenting between your third and fourth toes (termed Morton’s Neuroma).

Patients typically exhibit sharp, burning pain that often radiates throughout the foot. Some patients even report numbness. Patients also state that it feels like they have a marble in their shoe or they are walking on a pebble.

Neuromas typically pop up after some sort of irritation, injury to the affected nerve, with tight fitting shoes, or with an underlying deformity. This, in turn, causes the nerve to enlarge and leads to further damage.

X-rays, MRI or Ultrasound may be utilized to help confirm a clinical diagnosis. Once a diagnosis is confirmed, there are various options for treatment.

 

Posterior Tibial Tendon Dysfunction

Posterior Tibial Dysfunction

The posterior tibial tendon (also called tibialis posterior tendon) is one of the primary tendons responsible for supporting the structure of your foot. When trauma and degeneration to the tendon occurs, it can progress to a problem called posterior tibial tendon dysfunction.

This progressive condition is the most common cause of adult acquired flat foot. Degeneration, tendonitis, and tendinosis typically occurs due to repetitive forces and loading on this tendon. There are many factors that can contribute to this such as injury (trauma) and foot structure.

Symptoms may include:

  • Pain on the inside of your foot and ankle
  • Weakness
  • Decreased mobility
  • Flattening of your foot (with or without weight-bearing)
  • Swelling
  • Increased difficulty with activity

 

It is pivotal to see a specialist early on to help treat this condition as this could progress from a flexible deformity to a more rigid deformity. Typically, evaluation starts with X-ray and a thorough clinical evaluation is performed.

Advanced imaging studies such as MRI and CT are often recommended to help further evaluate the state of your muscles, tendons, ligaments, and foot architecture. Our specialists will create a customized treatment plan focused on the severity of your condition, which may include both non-surgical and surgical options.

 

Tailor’s Bunion (Bunionette)

tailors bunion

A Tailors bunion is painful, bony prominence that develops on the outside of the foot by your little toe. Although less common than a traditional bunion (by your big toe), this condition can cause significant pain and dysfunction.

The cause of this condition is likely related to the underlying biomechanics and structure of your foot.

You may notice:

  • Pain
  • Redness
  • Swelling
  • Increased pressure with certain footwear on the outside of your foot

Diagnosis typically begins with X-rays and clinical evaluation.

 

Tarsal Coalition

Tarsal Coalition

A joint, also called an articulation, is comprised by the ends of two bones that are covered by a smooth, spongy surface called cartilage. The purpose of joints is to withstand large compressive and loading forces while allowing fluid movement between the two bones.

A tarsal coalition is a condition that occurs when bone, fibrous tissue or cartilage replaces the normal articular cartilage comprising the joint. This, in turn, alters the functionality of the joint and can lead to limited movement, pain and dysfunction. The most common place for this to occur and have pain is in the rearfoot, i.e. the bones towards the back of foot such as the calcaneus, navicular, talus and cuboid.

You may be wondering how this condition is diagnosed. The first step is to visit with a specialist for a thorough clinical evaluation and to obtain X-rays. Advanced imaging studies are often recommended and may be crucial to a definitive diagnosis.

This may help your specialist further refine the type of coalition present to customize a proper treatment plan for you. The most common reason for this condition developing is due to your genetics and how your foot has formed.

Symptoms typically include:

  • Pain
  • Flattening of your foot or both feet
  • Inability to perform sports or activities
  • Decreased motion
  • General fatigue of your feet

 

Trauma and Fractures

Trauma

Injuries to the foot and ankle can be serious, life-altering events. We understand that this is a challenging time in you and your family’s life and we are here to help. Whether it be a fall, trip, car accident or sports injury, our specialists can expertly diagnose your injury and recommend a proper treatment regimen.

After an injury or suspect you have had an injury, you may be experiencing:

  • Severe pain
  • Swelling
  • Bruising
  • Tenderness to the touch
  • Difficulty walking or performing activity
  • Throbbing
  • Increased warmth
  • Possible deformity

 Treatment of your condition depends on:

  1. The location
  2. Severity
  3. Timing of the injury

Some trauma and fractures that our specialists commonly see include:

  • Ankle fractures (fibular, bimalleolar, trimalleolar, pilon),
  • Calcaneal fractures,
  • Cuboid fractures,
  • Lisfranc fracture/dislocations,
  • Jones fractures,
  • Metatarsal fractures,
  • Navicular fractures,
  • Stress fractures,
  • Talus fractures,
  • Toe fracture/dislocations

It is important to come see a specialist as soon as possible to get the proper evaluation and treatment. If left untreated, it could lead to significant debilitation and dysfunction!

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