FAQ Category: Foot

Fusion to treat a severe flatfoot deformity is called arthodesis. The bones are line up in a good position and screws, staples, and/or bone graft are used to hold it in place until fusion takes place.

The exact procedure depends on which bones are affected and how far away they are from the normal position. Bracing with an orthosis is usually designed to keep a joint from moving. With a fusion, the joint is already immobile.

The first thing to do is find out what is the cause of your pain. An X-ray will show the status of your fusion. It’s possible the fusion has failed and motion is occurring at that site. This could lead to arthritis and may be the cause of your painful symptoms.

In that case, you may be a good candidate for medications, activity modification, or even a joint injection. A custom made orthosis to help realign the ankle and prevent motion may also be helpful. Surgery is a final option if conservative care isn’t successful.

Make an appointment with an orthopedic surgeon or podiatrist. The first step is having an evaluation and getting a proper diagnosis. Treatment can be decided on the basis of the underlying problem.

There are many possible causes of heel pain. Some of the more likely choices are obesity, plantar fasciitis, Achilles’ tendinitis, tarsal tunnel syndrome, and neuroma.

Plantar fasciitis is an inflammation of the fascia or connective tissue along the bottom of the foot. There may be no known cause. There may be a hormonal link as it occurs most often in middle-aged obese or overweight women. Tendinitis of the Achilles’ usually causes swelling and tenderness along the tendon.

Tarsal tunnel syndrome is caused by compression of the tibial nerve as it passes under a ligament through a space or tunnel made by the ligament crossing the bones in the ankle. Neuroma is a benign tumor of the calcaneal nerve. All of these conditions are aggravated by obesity and improper shoe wear.

There’s enough overlap or similiarity in symptoms for these conditions that a medical exam and possible testing is needed to find out just what is the problem. An orthopedic surgeon or podiatrist can help guide you through the diagnosis and treatment plan.

You may be describing what’s called a “pump bump” or Haglund’s deformity. It’s caused by repeated friction of the Achilles’ tendon where it attaches to the bone. Usually, patients with Haglund’s deformity report heel pain and swelling.

An X-ray will show bone growth on the back and upper portion of the calcaneus (heel bone). Calcium deposits may be seen in the Achilles tendon at the place where it inserts into the bone.

Treatment is often by conservative means such as a change in shoe wear, using a heel lift, and/or steroid injections. Nonsteroidal antiinflammatory drugs (NSAIDs) are usually prescribed. If the symptoms aren’t changed by these management techniques, then surgery may be needed. The surgeon will remove the bone spur and debride (clean out) the Achilles’ tendon.

There could be other causes for your current symptoms. A medical exam is really needed to know for sure. Even if it is not painful or bothering you, a baseline X-ray to show your current status may be helpful later.

Management of Achilles ruptures has become more complex now that older adults want to remain active in recreational sports. Return to play may require a different approach than just going back to daily activities.

If the two ends of the tendon can be brought back together when the foot is pointed downward slightly, then casting in this position may be all that’s needed. Sometimes ultrasound is used to make sure the gap can be reduced.

Surgery is advised if the surgeon suspects the gap cannot be closed. The rate of re-rupture is higher in patients with more severe tears who treat it nonoperatively. The tendon is also weaker if treated without surgery to repair it.

More surgeons advise active adults in good health with good blood supply to have the surgery. It will increase the chances of returning to previous levels of sports activity. It also reduces the risk of re-rupture. Once healing has occurred, patients are advised to gently stretch the tendon daily to prevent reinjury.

From the description you’ve given, it sounds like you may have ruptured your Achilles tendon. A medical exam is needed to know for sure. Early treatment of Achilles tendon injuries is essential for a good result. Re-injury is common but can be avoided.

The doctor will use your history of what happened along with some special tests to make a diagnosis. The doctor will rule out ankle sprain, blood clot, and tendinitis.

The Thompson test is a reliable way to check for Achilles tendon rupture. The patient lies prone (face down) on the exam table. The doctor squeezes the calf muscle just below its widest point. In a normal response, the foot flexes when the doctor does this. If the tendon is torn, the foot won’t move.

X-rays aren’t usually very helpful unless a piece of bone was pulled off with the tendon during the injury. Ultrasound may be a better way to see what’s happening.

Because there are so many different ways to treat an Achilles, patients are advised to see an orthopedic surgeon. You may not need surgery but even conservative care with casting or splinting must be done properly for the best result.

Tai Chi is a series of slow and smooth movement patterns. They are usually done standing up. Motions are light and steady in all directions. Studies show that Tai Chi is a safe exercise even for patients with rheumatoid arthritis (RA).

It is easily modified if the person can’t stand for long periods of time. Many of the upper body movements can be done sitting forward in a chair with the feet flat on the floor. The person practicing the movements can even shift weight through the feet forward and back or side-to-side while sitting.

It’s possible to start in the standing position and sit down when the person becomes too tired to keep standing. Over time and with practice, the individual may be able to stand for longer periods of time during the exercises.

Classes taught at a senior citizen’s center often take into account physical limitations. The instructor gives ideas how to modify the exercise for those who can’t do the full movement. Any exercise is helpful for patients with RA but especially Tai Chi, which is known for its ability to improve balance, motor control, and strength.

The benefits of walking as an inexpensive but effective form of exercise are well known. Tai Chi is an ancient Chinese martial art that has gained in popularity in recent years. Studies to identify the exact benefits of Tai Chi are also becoming more commonly reported.

A recent study of 16 Tai Chi masters (men and women) showed how the movements differ from walking. A special computerized program was used to measure the pressure through the bottom of the foot both during Tai Chi and during walking.

They found that the center of pressure was different for these two forms of exercise. In Tai Chi, the pressure was more toward and through the big toe compared to walking where the pressure is more toward the middle of the foot. Since the big toe is important in balance, Tai Chi is likely a good exercise to improve balance and posture.

Tai Chi has also been shown to help maintain ankle motion, improve stability, and increase muscle strength. Both Tai Chi and walking have positive effects on the heart, lungs, balance, and strength. Seniors who engage in both are more likely to maintain overall fitness but especially balance and coordination needed to prevent falls.

Conservative care for this common orthopedic disorder includes antiinflammatory drugs, physical therapy, orthotics, or cortisone injection. Orthotics are supports that fit inside your shoe to help support and take pressure off the inflamed tissue.

The goal of treatment is to reduce or eliminate pain and improve function. If conservative treatment fails, then surgery may be the next step. The plantar fascia is cut to release the tension.

Results of conservative or surgical care remain inconsistent. Some patients get better and others don’t. There’s no way to predict who will benefit from what kind of treatment.

A new treatment called extracorporeal shockwave may be another option. It’s done on an out-patient basis with minimal discomfort. A recently published long-term study reports the results are much better for shockwave treatment compared to conservative care.

Most patients receiving shockwave treatment had no heel pain with improved function. Many of the athletes returned to full participation in sports. Symptoms came back in 11 percent of the shockwave group compared to 55 percent for those patients receiving antiinflammatory drugs, exercise, or local steroid injection.

There’s some debate on the topic of plantar fasciitis, running, and bone spurs. If running caused bone spurs then more people who run long distances would have bone spurs. And some people who don’t run at all get bone spurs so running isn’t the only cause of bone spurs.

There is a delicate balance between the bones in your feet and the ligaments, tendons, and nerves. Aging and postural components may be a part of the problem, too. People over 40 and especially women seem prone to plantar fasciitis and bone spurs. Running style and run down shoes may be risk factors for anyone prone to plantar fasciitis.

Tight soft tissues along the bottom of the foot causing friction and irritation to the bone from running may contribute to the problem. Heel spurs related to plantar fasciitis occur after calcium deposits build up on the underside of the heel bone. Heel spurs can take months to form. A proper warm-up with stretching of the plantar fascia (band of tissue on the bottom of the foot) may help prevent these problems.

Ledderhose disease of the feet is the same as Dupuytren’s disease of the hands. There’s an abnormal increase in the amount of fibrous tissue on the bottom of the foot. It replaces the normal connective tissue and causes the fascia to become like scar tissue.

You may see some bumps or nodules on the bottom of your feet. Most patients find it painful to walk when these are present. Treatment to keep the tissue stretched and as soft and pliant as possible is advised. Physical therapy may still be appropriate but you’ll probably also need a shoe insert or orthosis to keep the tissues from tightening up even more when walking.

Surgery may be advised but the problem comes back in more than half the cases. At the present time there is no cure and no effective treatment for everyone.

Splayfoot is an abnormal width of the forefoot. Splayfoot may develop slowly over 10 or 20 years, sometimes longer. The forefoot looks quite large for the size of the foot and for the width of the heel. Usually the big toe (first metatarsal) and second metatarsal are affected. The angles between the toes are larger than they should be.

As the bones drift apart the soft tissues are stretched allowing the bones to drift even more. If the bones spread too far, then subluxation or partial dislocation can occur. Joint sprains are less common when the ligaments and capsule are injured.

Splayfoot can cause pain as the deformity gets worse. The muscles become unstable and no longer support the foot or move the toes the way they are supposed to. Walking can become more difficult as the big toe is no longer able to push off from the ground normally.

There are some simple exercises that can help. You may want to see an orthopedic surgeon or physical therapist to help you with some conservative measures. Surgery may be needed if the problem progresses too far.

Yes, exercises and the right kind of shoe can make a difference. Let’s talk about shoe wear first. Try to avoid a narrow toe in a shoe. This just pushes the toes together and forces the joint into a position that’s prime for a bunion. If you’re a woman, avoid high heels, which have the same effect only worse because they jam the foot even further down into the narrow space.

Shoes with a deep and wide box, sandals, or even going barefoot can make a difference. If a woman must wear heels then select a shoe with a round toe and low heel. Walking shoes, sports shoes, or tennis shoes should also be purchased with an eye to the size and shape of the toe box.

Some doctors advise passive exercises to help stretch the great toe. The affected individual pulls the big toe away from the second toe and holds it for four seconds. A second exercise is to pull the toe up off the floor and hold it for four seconds. Both of these exercises must be done every day for six weeks to see a difference. Ten to 15 repetitions are advised, twice daily.

Bunions affect the base of the big toe (metatarsal). Because of abnormal forces on the joint the bone starts to deform forming an angle instead of a straight line. This is called hallux valgus.

The exact cause of bunions isn’t really known. There may be some heredity involved. Some conditions linked with hallux valgus include flatfeet, arthritis, stroke, and cerebral palsy.

Improper footwear with a narrow space (or toe box) for the toes is a contributing factor. Adding a high heel forces the toes further forward into the toe box adding to the problem. The bone may even grow larger at that point because of the pressure.

Women are affected nine times more often than men. Sandal wearers and people who go barefoot have a much lower rate of bunions. Ballet dancers in pointed shoes are at risk for both
hallux valgus and the resulting bunions.

Studies show that foot fracture is a condition that has put an end to many athletic careers. There are far fewer reports on the results of military recruits.

The best advice on record suggests cast immobilization without putting any weight on the foot for six weeks is the treatment of choice for navicular stress reactions or fractures. If the bone is reacting to stress but an actual fracture line doesn’t show on X-ray, then more advanced studies are needed.

CT scans show more fractures than MRIs. When a bone fracture or stress to the bone starts to heal, fluid and blood around the damaged area starts to get absorbed. The new bone being layed down at the fracture site may prevent the MRI signal from showing a fracture line. CT scans are better able to show subtle fracture lines.

A recent study was done of athletes with navicular fractures. There were more re-fractures and fewer patients returning to sports who didn’t have the cast treatment. It’s probably a good idea to ask for more testing. Early diagnosis is always the key to the most effective treatment.

Let’s look at what’s the same about these two problems. The key thing they have in common is that the injury occurs in response to repetitive overloading of the bone. This is most common in athletes involved in sports activity. Long-distance runners, military recruits, track and field athletes, and gymnasts are the most likely to suffer a navicular fracture.

The navicular bone is located in the midfoot. The tarsal bone rests on top of the calcaneal (heel) bone. The navicular bone is just in front of the tarsal bone on the same side as the big toe.

The difference between a ‘reaction’ and ‘fracture’ is a matter of degree. Both suggest a disruption of the bone metabolism. Fracture can be seen on most imaging studies (X-ray, MRI, CT scan), whereas a stress reaction only shows up as increased bone activity on a bone scan.

Both injuries cause midfoot pain and swelling. Weight-bearing (walking, running) make it worse; resting makes it better. Both should be treated with six weeks of casting with nonweightbearing.

Studies using low energy sound waves to treat tendinitis have reported a variety of possible problems from time to time. These have included pain during and right after the treatment. Sweating, dizziness, and tremor can occur.

Some patients had a skin reaction at the site of the treatment. Reddening and bruising may occur because the blood vessels dilate (open wide) for a little while in response to the treatment. Any skin changes are mild and short-term.

Muscle soreness, cramps, and spasms or joint stiffness near the treated area have also been reported. All of these side effects are mild and don’t last more than 24 to 48 hours.

Shoe inserts come in all sizes, shapes, and materials. They can be soft and flexible or rigid. They can come in standard shoe sizes or made and adjusted for each person.

Knowing if the orthotic is having the desired effect depends on the underlying problem. Inserts, sometimes called orthotics, can be used to correct foot, ankle, or knee problems.

The usual measure of success is relief of pain. Some doctors suggest at least a 50
percent reduction of pain to be considered a success. Some patients are happy if they can do more with the orthotics in place, such as running farther or walking longer without
pain.

Try the shoe inserts for three weeks and see if your symptoms improve, get worse, or change in any way. If you need further help, see a podiatrist or physical therapist. Sometimes an orthotic is the right treatment, but a custom designed insert may be needed.
The off-the-shelf type doesn’t work for everyone.

Shoe inserts, also called orthotics, aren’t made for use in an open-shoe design. They are best used in Oxfords, tennis shoes, or loafers. They can also be slipped inside a boot or other lace up or high top shoe wear.

If you can’t walk pain free without the orthotics, you may have to put the sandals and clogs aside for a time. Some people can go without the inserts and wear these more stylish shoes for an hour or two. It may be possible to go without orthotics when the occasion doesn’t call for long periods of walking or standing.

The use of steroid injections for tendonitis has come under fire many times. Some studies show it helps the tendon heal faster. Others report problems with soft tissue thinning
and even rupture. Sometimes the area gets infected, too.

Steroid injections can be very safe if performed carefully. Doctors can use an imaging tool called fluoroscopy to guide the injection to the right spot. This also allows the doctor to inject just the right amount of steroid. The drug goes into the space around the Achilles tendon.

A recent study from the University of Virginia reported low-volume steroid injections for Achilles tendonitis are safe. The needle must be carefully inserted into the correct space. Fluoroscopy makes it possible for the doctor to see exactly where the needle and injection are going.

You may be referring to the navicular drop test (NDT). In this test the person stands with the feet about shoulder width apart. The navicular tuberosity is felt and
marked. This is a boney projection along the side of the navicular bone. The navicular bone is the bone on top of your foot above your arch.

With the ankle joint in the middle (neutral), the distance from the navicular bone to the floor is measured. The person with a flat foot then relaxes the foot and the same measurement is taken again. The difference between these two measures is called the
navicular drop.

Movement of 10 mm or less is considered “normal.” More than 10 mm suggests too much rolling in of the ankle and drop of the arch called pronation. Pronation isn’t really divided into degrees except perhaps mild, moderate, or severe.