The Foot & Ankle Center

Achilles Tendon Rupture - Treatment and Surgery in Wayne & Paramus, NJ

A complete tear of the Achilles tendon, a large tendon that runs down the back of the leg and connects to the heel of the foot.

The Achilles is a large tendon that runs down the back of the leg and connects to the heel of the foot. This is the largest tendon found in the body and is used when walking, running, jumping, etc. While this tendon is very strong and can withstand a great deal of stress, a partial tear or rupture can still occur if that stress becomes too great (i.e. forceful jumping or pivoting, sudden accelerations or decelerations, tripping or falling). While anyone can experience an Achilles tendon rupture, these are most often seen in those who exercise infrequently (sometimes referred to as “weekend warriors”), those taking certain medications which can affect the integrity of the tendons in the body (i.e. some steroids and antibiotics), and those with Achilles tendinitis. Patients often feel a sudden snap or “pop” with immediate pain to the back of the ankle followed by swelling and difficulty walking. This injury tends to be an obvious diagnosis, but in some cases an MRI may be obtained to evaluate the degree of the tear. Surgery to repair the tendon is often performed in a timely manner to ensure optimal healing and functionality. In some cases, if the tendon is not completely torn or the patient is not an optimal surgical candidate, non-surgical treatment may be implemented. In either case, physical therapy is an important component to the overall healing process.

 

Achilles Tendinitis Treatment and Surgery in Wayne & Paramus, NJ

Inflammation and pain to the Achilles, a large tendon that runs down the back of the leg and connects to the heel of the foot.

The Achilles is a large tendon that runs down the back of the leg and connects to the heel of the foot. This is the largest tendon found in the body and is used when walking, running, jumping, etc. With overuse and/or degeneration, this tendon can become irritated and inflamed which is commonly referred to as tendonitis. Sometimes bone spurs can form at the heel bone (calcaneus). This condition usually develops from repetitive stress to the tendon, sudden increased intensity during exercise or other physical activity, calf muscle tightness and bone spurs. You may feel pain and stiffness along the tendon, pain that worsens with activity, thickening of the tendon, soft tissue swelling around the area, and a decreased range of motion of the ankle. Achilles tendinitis leaves the Achilles tendon vulnerable to Achilles tendon ruptures (see more on this under our “Conditions” section). Imaging usually isn’t necessary for a diagnosis; however, an x-ray may show bone spurs at the calcaneus if degenerative changes are present. Treatment is often conservative with rest, ice, NSAIDs and physical therapy focusing on stretching exercises, but it may take several months before symptoms improve. Prevention is key when avoiding this condition — stretching calf muscles before and after physical activity and wearing the correct footwear.

Ankle Fractures - Treatment and Surgery in Wayne & Paramus, NJ

An ankle fracture is a break in one or more of the bones that form the ankle joint.

There are three bones that make up the ankle joint: the tibia (shinbone), the fibula (smaller bone of the lower leg) and the talus (bone found between the heel bone and the tibia/fibula). There are also multiple ligaments found at the ankle joint that help keep the ankle stable. When speaking in terms of ankle fractures there are three boney areas that we refer to: the medial malleolus (the inside protrusion of the tibia that we associate with the ankle), the lateral malleolus (the outside protrusion of the fibula that we associate with the ankle) and the poster malleolus (the back part of the tibia). Ankle fractures are classified according to the area of the bone that is broken (i.e. medial malleolus fracture). If two of these malleoli are broken, we refer to this as a bimalleolar fracture. Bimalleolar fractures most often include the medial and lateral malleoli. Trimalleolar fractures involve a fracture to all three of the malleoli. The severity of the fracture involves the number of breaks that have occurred, stability of the ankle joint and if ligamentous injury is present. The most common ligamentous injury seen with ankle fractures is a syndesmotic injury. The syndesmosis joint can be found between the two bones of the lower leg (tibia and fibula) which are held together by ligaments (for isolated syndesmotic injuries, please see “Ankle Sprains” in our “Conditions” section). Ankle fractures can be caused by direct impact to the area, twisting or rotating the ankle, “rolling” the ankle, or tripping/falling. Symptoms can include severe and immediate pain, bruising, swelling, tenderness, inability to bear weight or an obvious deformity. X-rays are often the first imaging tool when diagnosing an ankle fracture and its severity. Nonsurgical treatment may be utilized by your doctor if the ankle remains stable and the fractured bones are still in anatomic alignment or if the patient is not a surgical candidate. In these cases, a CAM boot or a cast will be applied and non-weight bearing measures are taken to allow the fracture to heal. Serial x-rays are then used to ensure proper fracture healing occurs. If the fracture is more severe where displacement has occurred, the ankle joint is unstable, dislocation of the ankle joint is present, multiple bones are involved or ligamentous injury is present, surgical intervention with hardware placement may be required (see “Ankle ORIF” for more information)

Ankle Sprains - Treatment and Surgery in Wayne & Paramus, NJ

Ankle sprains are the most commonly seen sports injuries; however, ankle sprains can happen among people of all ages and activity levels.

Ankle sprains are the most commonly seen sports injuries; however, ankle sprains can happen among people of all ages and activity levels. When the term “sprain” is used, it refers to an injury to a ligament, the tough fibrous connective tissue found between two bones. There are many ligaments around the ankle joint that help with motion and stability. When one of these ligaments around the ankle are injured, bleeding and swelling occur. This is the body’s response to heal an injured area. Ankle ligaments often do heal on their own due to the increased blood that travels to the area. Swelling and bruising are usually more pronounced at the ankles due to this response, and the distance of the ankles from the heart can cause the ankles to remain swollen for prolonged periods following the injury. Most mild to moderate ankle sprains (Grade 1 and Grade 2 respectively) can be treated at home with the RICE protocol (rest, ice, compression and elevation) and NSAIDs (nonsteroidal anti-inflammatory drugs). You should see your doctor if the sprain is severe (Grade 3), the pain is severe when bearing weight or you can’t walk at all. Nonsurgical treatment is commonly implemented first, often using a brace or a CAM boot to immobilize the joint appropriately and allow for adequate healing. If extensive tearing of the ligament(s) is expected after a clinical exam, an MRI may be ordered. The American Academy of Orthopaedic Surgeons suggests a three-phase program for all ankle sprains when treated conservatively:

- Phase 1: resting, protecting the ankle and reducing the swelling.

- Phase 2: restoring range of motion, strength and flexibility. Physical therapy is often utilized here to prevent stiffness and increase ankle strength.

- Phase 3: maintenance exercises and the gradual return to activities that do not require turning or twisting the ankle. Eventually, activities that require more intense activities that require sharp, sudden turns (i.e. tennis, basketball) can be reintroduced.

The length of this treatment program may take just two weeks to complete for minor sprains, or up to six to 12 weeks for more severe sprains. Surgical treatment for ankle sprains is rare; however, it is sometimes necessary for severe injuries that fail to respond to nonsurgical treatment. High ankle sprains (also known as syndesmotic injuries) sometimes require surgical intervention with a “tightrope” or a screw if the syndesmotic joint (joint found between the tibia and fibula) is found to be unstable. As with many other conditions, prevention is the best way to avoid ankle sprains. This includes using caution when walking or running on uneven surfaces, wearing proper footwear, and implementing a thorough warm up and stretching regimen before and after physical activity.

Arthritis of the Foot and Ankle - Treatment and Surgery in Wayne & Paramus, NJ

Rheumatoid arthritis is a type of autoimmune disease that tends to effect multiple joints in the body simultaneously but often starts in the foot and ankle and usually affects both sides of the body (symmetrical presentation)

There are 28 bones in the foot and ankle and more than 30 joints that provide a wide range of movement, support and shock absorption. Arthritis of any one or many of these joints can cause pain, stiffness and difficulty performing physical and daily activities if these symptoms become severe. The most common type of arthritis seen is osteoarthritis, or a degeneration (wear and tear) of joint. This condition occurs gradually and certain risk factors can increase your risk of developing osteoarthritis: advanced age, obesity, laborious occupations, a high level of physical activity or previous trauma to the joint (also known as posttraumatic arthritis). Rheumatoid arthritis is a type of autoimmune disease that tends to effect multiple joints in the body simultaneously but often starts in the foot and ankle and often effects both sides of the body (symmetrical presentation). Symptoms of foot and ankle arthritis are pain with motion, flare ups with activity, swelling and/or redness over the affected joint, difficulty walking due to pain, and tenderness with applied pressure to the area. X-rays are often used by your doctor to help visualize the joint(s) involved. Joint space narrowing and bone spurs are common findings on x-rays. Sometimes blood tests, specifically in rheumatoid arthritis cases, are required to help confirm a diagnosis. While there isn’t any cure for arthritis, there are some treatment options that our doctors may recommend: lifestyle modifications, physical therapy and NSAIDs are often first-line therapy options. Sometimes supportive braces are utilized as well. If a patient’s arthritis is severe and symptoms effect daily activity, surgery may be recommended. Arthroscopic debridements can be performed to remove loose cartilage, inflamed synovial tissue and bone spurs from the affected joint space. More invasive surgical options include an arthrodesis (complete fusion of the joint with hardware or screws) or a joint arthroplasty (replacement of the affected joint with prosthetics). While surgery can be very effective in relieving arthritis pain, it is usually reserved only for more severe cases.

Lisfranc Injury - Treatment and Surgery in Wayne & Paramus, NJ

A Lisfranc injury is an injury of the midfoot that involves either a break to the bones and/or a strain to the ligaments that connect the midfoot to the forefoot.

A Lisfranc injury is an injury of the midfoot that involves either a break to the bones and/or a strain to the ligaments that connect the midfoot to the forefoot. Lisfranc injuries can result from direct trauma (i.e. a fall from a height) or from a twist-and-fall scenario, often seen when someone stumbles over the top of a foot that is flexed downward. Symptoms include swelling and pain to the top of the foot, bruising to the top and bottom of the foot, and pain worse with standing, walking or pushing off the affected foot. These injuries can be easily confused as a simple sprain, but given the location, these injuries are considered severe and must be treated appropriately. If a Lisfranc injury is suspected, your doctor may order advanced imaging to evaluate for any fractures or ligament tears. Nonsurgical treatment is always the goal and can sometimes be achieved if the injury is not severe and no fractures, joint dislocations or complete ligamentous tears are present. A cast or boot would be applied and a strict non-weight bearing regimen for six weeks (or longer) would be enacted to allow proper healing. However, in most cases this injury requires surgical repair, often with screws and plates which would later need to be removed once the injury has fully healed.

Morton’s Neuroma - Treatment and Surgery in Wayne & Paramus, NJ

A Morton’s neuroma is a thickening of the tissue that surrounds the digital nerve that goes to the toes.

A Morton’s neuroma is a thickening of the tissue that surrounds the digital nerve that goes to the toes. This condition creates a persistent pain at the ball of the foot and is often described as a “walking on a marble” sensation. The most frequent location is between the third and fourth toes. Women are more likely to develop the condition than men. This diagnosis can be made easily in the office setting and treatment is often nonsurgical with proper footwear recommendations or orthotics; sometimes cortisone injections can help relieve the symptoms.

Plantar Fasciitis Treatment and Surgery in Wayne & Paramus, NJ

Inflammation of the plantar fascia, a long ligament found at the bottom of the foot which connects your heel to the front of your foot and helps support the foot’s arch.

The plantar fascia is a long ligament found at the bottom of the foot which connects your heel to the front of your foot and helps support the foot’s arch. The foot is made to withstand high amounts of pressure and movement, however sometimes too much pressure on the plantar fascia can cause damage and tears resulting in an inflamed and irritated plantar fascia or “fasciitis.” This usually develops over time and many factors can contribute to this progressive condition: obesity, high foot arches, repetitive impact activities or tight calf muscles to name a few. Patients usually complain of pain at the bottom of the foot, especially the first few steps after getting out of bed in the morning and after exercise. This is a clinical diagnosis, however if x-rays are obtained it is common for your clinician to see a bone spur at the heel bone (calcaneus). Treatment is almost always conservative with rest, ice, NSAIDs, stretching exercises, and wearing proper footwear or orthotics. Sometimes cortisone injections may be used to reduce inflammation and pain. Electrocorporeal shockwave therapy (ESWT) has been used to help stimulate the healing process of the damaged fascia (See “Electrocorporeal shockwave therapy” for more information).

Toe and Forefoot Fractures - Treatment and Surgery in Wayne & Paramus, NJ

A break in one or more of the 29 bones found in the foot.

The foot is comprised of many bones: the forefoot alone has 29 bones — five metatarsal bones and 14 phalanges (toe bones). A break in any of these bones can be very painful and make walking a difficult task. Most acute fractures in the foot occur from direct force (like dropping a heavy object onto the foot) or trauma (like kicking a hard object). “Stress” fractures are small fractures that can also develop over time due to repetitive activity. Fractures in the foot usually cause bruising to the top and bottom of the foot, swelling and pain, especially when walking or bearing weight. An x-ray is used to evaluate the injury and determine the location, type and severity of the fracture. Fractures of the toe (phalangeal bones) are the most likely bones of the foot to fracture. Toe fractures, while painful, often do not need any surgical treatment. Allowing the fracture to heal with rest and supportive shoes are usually appropriate first-line care for most toe fractures. Metatarsal fractures are breaks in the long bones found in the middle of the foot. Like toe fractures, these fractures can be treated with a period of rest, ice, elevation, and supportive shoe wear or a brace. However, if there are several metatarsal fractures involved, concurrent ligamentous injury, and the foot is deformed or unstable, an open reduction with internal fixation (ORIF) with plates and/or screws may be necessary to regain proper function and mobility of the foot (Please visit out Treatments section for more information of toe and forefoot fracture treatment). Your doctor will monitor the fracture closely with serial x-rays during your treatment course to ensure proper alignment of the bone is maintained throughout the healing process.