FAQ Category: Foot

Heel pain as a result of plantar fasciitis affects an estimated two million adults in the United States every year. And over time, at least one in 10 Americans will report this common foot pain problem.

The problem may be more aptly named by calling it “plantar heel pain” because studies show there is no active inflammatory component. The tissue quit trying to self-repair long ago. Sharp pain without swelling, heat, or other signs of inflammation is the only symptom. But that pain can be very disabling affecting quality of life.

As you already know, the standard treatment for plantar fasciitis includes actively stretching the gastrocnemius and soleus (calf) muscles and passively stretching the plantar fascia (connective tissue along the bottom of the foot). Other conservative measures often used include medications and steroid injections. In severe cases that don’t respond to nonoperative treatment, surgery may be an option.

It sounds like you have benefitted from the added treatment of manual therapy. Manual therapy refers several different techniques used to release tension or trigger points in the calf. This technique is done by the therapist’s hands directly over the calf muscles.

Trigger points are irritable areas in the muscle. The area becomes tight and stiff keeping the muscle from moving (and stretching) normally. It’s that stiffness that researchers think might be responding to manual therapy along with stretching. Stretching alone doesn’t always stop the pain or alleviate the problem. In theory, until the trigger point has been released, the heel pain will continue (or come back as soon as the stretching stops).

There’s no problem with continuing to stretch your calf and plantar fascia — it will do no harm and may benefit you in the long-run. At the present time, we don’t have any long-term studies to show what would happen to patients with chronic heel pain if the trigger point is released but they don’t continue stretching.

The standard treatment for plantar fasciitis includes actively stretching the gastrocnemius and soleus (calf) muscles and passively stretching the plantar fascia (connective tissue along the bottom of the foot). Other conservative measures often used include medications and steroid injections.

There is limited evidence that steroid injections really do more than mask the pain for a short period of time. Shockwave therapy has also been studied in the treatment of heel pain associated with this condition. But the studies have come up with conflicting evidence (some say there were good results, others report no significant improvement).

Low-intensity laser (light) therapy has no supporting evidence despite the fact that those who use laser as a modality swear by it. More studies are really needed to research this further. Different intensities and duration of laser might make a difference. Combining laser with other treatments (stretching, manual therapy) might be more effective.

We do know that the stretching helps but doesn’t always completely alleviate the problem. In a recent study, physical therapists from Brazil compared the use of stretching alone with a program of manual therapy combined with stretching. In this instance, manual therapy refers to the release of trigger points in the calf. This technique was done by placing the therapist’s hands directly over the calf muscles and applying pressure and then light stroking of the soft tissues.

Trigger points are irritable areas in the muscle. The area becomes tight and stiff keeping the muscle from moving (and stretching) normally. It’s that stiffness that these researchers thought might respond better to manual therapy along with stretching. In theory, until the trigger point has been released, the heel pain will continue (or come back as soon as the stretching stops).

The technique was very successful. Results showed greater improvement in all measures for the manual therapy plus stretching group compared with the stretching alone treatment group. Patients in both groups got better but the manual therapy group had statistically significant improvements over the stretching only group.

The exact mechanism by which this works isn’t known. It could be that trigger point therapy as described here decreases pressure pain sensitivity. Perhaps it turns off a reflex that is triggering muscle tightness so that the stretching becomes more effective.

More study is needed in the area of treatment for plantar fasciitis. Laser therapy may eventually prove useful but for now, stretching and manual therapy seem to get the best results. Additional study is recommended to see if there are better ways of doing the manual therapy that might be more effective.

This could include comparing Swedish massage, friction massage, myofascial release, acupressure, and other similar techniques with the manual therapy described in this study. Since we don’t know if other types of touch (just placing the hands over the tissue) might also work well, this might be another technique included in the comparisons. And, of course, laser combined with stretching or laser combined with manual therapy might produce good results. We won’t know until it’s tested!

Complex regional pain syndrome or CRPS is a very painful disorder that affects people after major trauma such as you have experienced with multiple fractures and especially a fracture that hasn’t healed quite right. Some people do develop this condition after a seemingly minor injury.

People with complex regional pain syndrome (CRPS) often experience intense pain, swelling and skin changes (color, texture, hair growth, temperature). The net result is a loss of motion and function along with reduced quality of life. The problem is not understood very well. Doctors don’t know what causes it or why it happens. That makes CRPS a difficult condition to treat effectively.

Although rebreaking a bone and resetting it can be used in some circumstances to relieve pain and correct deformity, it’s not recommended for patients with malunion and CRPS. The additional surgery is another type of trauma that the already compromised nervous system may not be able to handle.

You are more likely to get relief from painful symptoms with antiinflammatory (or other) medications, relaxation techniques, and/or nutritional supplementation. Although experts agree that CRPS cannot be corrected surgically, nerve blocks may be beneficial. There are several different ways to do these blocks. If the procedure works but the painful symptoms come back, a procedure can be done to stop messages

Patients with comnplex regional pain syndrome from any cause seem to respond best to conservative (nonoperative) care. Physical therapy is one approach many patients rely on to gain control over their pain and improve (if not restore) function. The therapist will help you find a treatment or combination of treatments that will be most effective for you. Therapy focuses on improving joint motion, strength, and movement patterns needed for daily activities, work, and recreational activities or hobbies.

Fracture of the calcaneus (heel bone) with malunion means the fracture heals but the bone is not knitted back together properly. With calcaneus malunion, the fracture can separate, the bone widens, and deformity results.

The injury can affect the bone above (the talus) and the supportive soft tissue structures. Recovery is very slow and many times the bone just doesn’t heal. Sometimes, the impact of the talus above the calcaneus down into the calcaneus causes a loss of hindfoot height. Change in the angle between the talus and the calcaneus occurs. As a result of all these changes, the affected person can no longer walk normally.

There may be some treatment that could be effective for you. Your surgeon is really the best one to advise you on this. A thorough physical history and exam (PH&E) is needed to identify all areas that are affected. Information on the location of any pain present, what increases or decreases the pain, and any previous treatment is reviewed.

Motion, strength, and sensation are assessed. X-rays taken in the standing (weight-bearing) position from different angles (side, back, above) show the fractures lines, of course. But the images also give the surgeon an idea of the new shape of the bones, changes in alignment and angles, and deformity or changes in weight-bearing load. CT scans can also be very useful as they provide a three-dimensional (3-D) view of the bones and joints. From the CT scans, surgeons gain a better appreciation of any deformities and joint damage.

These pieces of the puzzle are important when planning treatment because there usually isn’t one simple problem that must be addressed. There are often multiple factors to consider. Besides changes in anatomy, biomechanics, and gait (walking pattern), your lifestyle, goals, expectations, and needs at work, home, and play must all be reviewed. Other health or medical problems may enter the mix as well.

Management may begin with conservative (nonoperative) care. The goals are to decrease pain and improve comfort and function. Nonsurgical treatment can include the special shoes you don’t really want. But it is possible that orthotics (shoe inserts) or some other type of bracing that can be hidden by clothes might be helpful.

Physical therapy is an important part of conservative care. The therapist focuses on improving joint motion, strength, and movement patterns needed for walking, daily activities, work, and recreational activities or hobbies.

For those patients who have severe deformities that cannot be treated conservatively (or for those who do not respond to nonoperative care), there are a variety of surgical techniques that can help. The surgeon chooses the best surgical approach based on the problems present at the time of the evaluation.

The surgeon does everything possible to correct deformities, improve alignment, and decompress (take pressure off) tendons or nerves. Bone may be removed from some areas or built up in other areas to correct alignment or restore calcaneal height. Hardware such as pins or screws may be needed to hold the bones together until fusion is complete. Intra-operative X-rays (taken during surgery) are used to make sure everything is lined up correctly.

Not knowing what’s been tried so far, we can’t say what approach will be best for you. It may be time to make a follow-up appointment with your orthopedic surgeon — get reassessed and find out what options are available to you. Good luck!

You are probably referring to a Lisfranc fracture or injury of the midfoot. Most people have a general idea of what is meant by the midfoot — that area between the base of the toes and the ankle/heel complex.

The proper anatomical term is the tarsometatarsal (TMT) joint. Metatarsals are the long bones of the forefoot. These are the bones of each toe between the ankle (tarsal bones) and the bones we usually refer to as the toes.

Lisfranc injuries describe any injury that occurs at the tarsometatarsal joints. This could be at the base of any of the five metatarsals (toes) or the place where the metatarsals glide against the tarsals (ankle bones). There is also an actual Lisfranc ligament at the base of the second toe. Damage to this ligament can also be called a Lisfranc injury.

Where does the term Lisfranc come from? The French surgeon (Dr. Jacques Lisfranc) who served in Napoleon’s army back in the 1800s. He treated a soldier with this type of injury, named it after himself, and the rest is history.

The bones, ligaments, and connective tissue that form the entire Lisfranc area are important in keeping a strong, stable midfoot with a supportive arch. Injuries to this area can cause collapse of the arch, deformity, pain, and loss of foot function. That’s why an early and accurate diagnosis is important followed by proper treatment.

For true Lisfranc fractures and/or Lisfranc soft tissue injuries, treatment is aimed at restoring alignment and stability. For simple fractures that do not separate or displace and for which there are no soft tissue injuries, a simple cast may be all that’s needed for healing and recovery.

But when the foot is deformed, the patient can’t walk on it, and it isn’t painful — it’s numb, then surgery may be needed to stabilize the joint.. Instability is the big key in deciding the best treatment because as already mentioned, stable fractures and injuries can still be treated nonsurgically with a cast or walking boot.

When the damage is healed and immobilization is no longer needed, your aunt will be guided in finding the right kind of supportive shoe. A special shoe insert called an orthotic is made and worn whenever weight-bearing. Total recovery time of a stable Lisfranc injury treated conservatively is about four months.

Injuries of the midfoot called Lisfranc injuries affect the area of the foot between the base of the toes and the ankle/heel complex. The proper anatomical term is the tarsometatarsal (TMT) joint. Metatarsals are the long bones of the forefoot. These are the bones of each toe between the ankle (tarsal bones) and the bones we usually refer to as the toes.

Lisfranc injuries describe any injury that occurs at the tarsometatarsal joints. This could be at the base of any of the five metatarsals (toes) or the place where the metatarsals glide against the tarsals (ankle bones). There is also an actual Lisfranc ligament at the base of the second toe. Damage to this ligament can also be called a Lisfranc injury.

Recovery depends on quite a few variables. First of all, the severity of the injury — was there a fracture? Did the bones displace (separate, shift, or move)? If so, how much displacement is there? Were the ligaments damaged? Do you use tobacco products or have a poor diet (both are factors in healing)?

If there has been a fracture but it’s not displaced, then immobilization in a cast for four to six weeks may be adequate. Physical therapy after that to regain motion, sensation, stability, and strength will take another four to six weeks. You may be cleared to return to the tennis courts sometime during the rehab phase when you can handle sports-specific activities.

The physician may rely on MRI studies to help determine when it’s safe to return to play status. The midfoot must be in good alignment and stable. Early diagnosis of midfoot instability because of ligamentous damage usually results in surgery to repair the area.

When surgery is involved or when there isn’t a fracture and just ligamentous damage, recovery takes a bit longer (a minimum of four months before therapy begins). The physical therapist helps the patient regain full motion, strength, proprioception (joint awareness), and kinesthia (movement awareness and accuracy).

These are important components of rehab to help prevent future injuries or re-injuries of the same area. This is especially important for the athlete who must make sudden changes in direction on the field or push-off on toes or jump and land on the midfoot.

Turf toe describes damage to the base of the big toe. The medical term for this problem is hyperextension injury to the hallux metatarsophalangeal (MTP) joint. Hyperextension means the toe is bent way back on itself.

It’s called turf toe because most of these injuries occur on artificial turf. The injury can be mild (grade I) to severe (grade III). Treatment and length of time on the bench depend on the severity of the injury.

With a grade I injury, the ligaments around the base of the big toe are stretched and strained but nothing is torn or broken. The player may experience some pain, perhaps a little bruising, and some swelling. He may not even miss a game or practice because of it.

Grade II injuries are a little more problematic. Some of the soft tissue structures are torn. Swelling and pain limit motion. A walking boot and crutches may be needed. The player will be off the field for up to two weeks. When he does return, the athletic trainer will likely tape the toe to protect it for another two weeks.

In the most severe injuries (grade III), there is significant swelling, bruising, and pain. That’s because the ligaments, joint capsule, and cartilage under the toe have been completely torn or ruptured. As a result, the hallux metatarsophalangeal (big toe) joint is weak and unstable.

At all levels of severity, treatment begins with managing the symptoms using the tried and true formula of R.I.C.E. — rest, ice, compression, and elevation. Anti-inflammatory medications help keep the swelling down.

Accurate diagnosis with physical exam and imaging studies (X-rays, MRIs) help determine whether the athlete will continue with conservative (nonoperative) care or go on to have surgery. With low-grade injuries, a splint, cast, or boot is used to immobilize the foot and protect the soft tissues while healing takes place.

Some cases can be treated with long-term (six to eight weeks or longer) immobilization in a boot or cast. But surgery is often required for grade III turf toe injuries. The surgeon makes every effort to restore the toe to its normal anatomy. Most of the time, the soft tissues can be repaired and stitched back in place.

The player with this level of injury will be off the field for three to four months. The timing of his return-to-play may depend on the position he plays on the team. At a minimum, before being released to full participation (especially running or explosive movements), athletes with turf toe must have 50 to 60-degrees of passive toe flexion without pain. Passive motion means the examiner moves the patient’s toe rather than the player actively bending the toe himself.

But sports fans can relax because orthopedic surgeons have the problem well in hand. Early diagnosis and treatment will ensure that affected athletes will be back in action as quickly as possible. If you find out what “grade” his injury was listed at, you’ll have a better idea of how long he will be off that foot.

Many people suffer from foot pain attributed to plantar fasciitis. But when the pain becomes chronic and lasts months to years, the problem isn’t one of inflammation but rather a failure to heal. The condition is referred to as plantar fasciopathy.

Chronic pain from plantar fasciopathy likely starts out as plantar fasciitis, a true inflammatory process. If caught early, such cases can be cured with conservative care such as stretching exercises. But a failed healing response can lead to continued, unresolved pain.

Shock-wave therapy has been shown effective in other conditions because it gets rid of substance P (P stands for Pain) in the sensory nerve fibers and in the spinal cord (pathway to the brain). Shock-wave therapy also stimulates and speeds up the healing response — at least that’s what other studies have shown when using this tool.

But a recent study from Germany reported that stretching the fascia was much more effective than shock-wave therapy for foot pain attributed to plantar fascia problems. The patients did not have chronic pain — they all had plantar fasciitis for less than six weeks. So future studies are needed to see what effect (if any) this tool might have for folks like you with chronic symptoms.

Many people suffer from foot pain attributed to plantar fasciitis. The plantar fascia is a thick band of connective tissue along the bottom of the foot. It goes from the calcaneus (heel bone) to the metatarsal bones (toes). It supports the arch of the foot and helps carry the load of body weight during standing and walking activities.

The term fasciitis suggests an inflammatory response. Early on, that might be the case but if symptoms persist for months and even years, then there has been a failed healing response.

Biopsy studies of tissue samples from people with chronic plantar fasciitis show no signs of inflammatory cells. The term fasciopathy might be a better descriptor — it just means something’s wrong with the fascia but we don’t know what.

Usually treatment of musculoskeletal conditions depends on the cause of the problem. But with plantar fasciopathy, the cause remains unknown. Or rather, we should say, the cause is poorly understood. For some people (like runners), overuse, training errors, and poor footwear may be contributing factors. Older adults who are overweight or who have problems with foot alignment may be at increased risk for plantar fasciopathy.

So, where does that leave you? Well, if indeed, the symptoms are new and there is active inflammation, then treatment can focus on the standard treatment of antiinflammatory medications, support (perhaps a heel pad in the shoe), and stretching. Many people find this combination curative.

A physical therapist can show you how to apply some manual (hands-on) stretching designed for the plantar fascia. The therapist can apply some additional manual techniques to release tension in the tissues. The therapist can also assess you for posture and shoewear changes that might help.

Getting started early is a good idea. If these conservative measures don’t help, then you might be a candidate for other treatment ideas such as shock-wave therapy to the foot, a special splint to wear at night, or special inserts for inside your shoes.

As you suspected, turf toe describes damage to the base of the big toe. The medical term for this problem is hyperextension injury to the hallux metatarsophalangeal (MTP) joint. Hyperextension means the toe is bent way back on itself. You’ve probably seen this occur on TV and not even been aware of it.

Picture this: a football player has the ball. He gets tackled and as he goes down, his foot is in a position with the toes in contact with the ground but the foot with the heel up toward the sky.

The player doing the tackling goes down with his knee on the ball holder’s upended heel. The force of the tackler’s knee pushing down on the ball holder’s heel is enough to injure the soft tissues and even the joint of the big toe still in contact with the ground.

It’s called turf toe because most (83 per cent) of these injuries occur on artificial turf. The injury can be mild (grade I) to severe (grade III). Treatment and length of time on the bench depend on the severity of the injury.

And as you have also discovered, sports radio and TV hosts talk endlessly about athletes’ injuries. With more attention and focus on sports than ever before, it’s only a matter of time before turf toe becomes a well-known problem to players, coaches, and fans alike.

The debate about the most optimal treatment for Achilles tendon ruptures is ongoing. There are so many variables and factors to consider that it’s hard to sort them all out, research them, and then come up with straightforward black and white answers.

For example, there’s the decision to treat initially by repairing the rupture surgically versus the nonsurgical approach of putting the lower leg in a cast for six (plus) weeks. If surgery is done, which technique works best: open incision or arthroscopic percutaneous (through the skin with tiny puncture holes but no incision)?

When the leg is immobilized (whether that’s right away or after surgery), should it be done with an adjustable brace or a rigid cast? How long should the leg be kept immobile so the tendon can heal? And finally, what’s the best course of rehab? There are many decisions to be made in this arena as well.

Many studies show that the long-term results are equal between these two choices. The differences tend to come in the early months of recovery. Patients who have surgery tend to reach their rehab milestones sooner than those who don’t have the tendon repaired. It may be that self-healing just takes longer but the eventual result is the same.

What it boils down to is patient and surgeon preference — at least that’s the approach until more conclusive data can guide treatment. The surgeon will evaluate the severity of the injury, the level of patient activity, and advise you accordingly.

You will, of course, have to evaluate your insurance coverage for surgery and for months of follow-up rehab. In the early phases, direct supervision of a physical therapist is advised but later, a significant portion of the program can be done at home. This might be a factor if you don’t have reimbursement for rehab services.

The large Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel. Along with other tendons, it supports, stabilizes, and helps move the ankle. It is the most important tendon for walking, running, and jumping. It attaches the calf muscles to the calcaneus (heelbone) and allows us to point our toes or raise up on our toes.

In severe cases, the force of a violent strain can rupture the tendon. The classic example is a middle-aged tennis player or weekend warrior who places too much stress on the tendon and experiences a tearing of the tendon. In some instances, the rupture may be preceded by a period of tendonitis, which renders the tendon weaker than normal.

The decision about surgery may depend on your daughter-in-law’s past history and activity level. Does she have a prior history of sprains, strains, or even tears of that same muscle? Of course, standing and walking will be impaired but what was her activity level while off work and during leisure hours? These are factors to consider when making a decision like this.

The personal decision of work versus school is one that might get tipped by an incident like this. In either scenario, she is likely to be restricted in putting any weight on the injured leg. She will likely be using crutches or a little wheeled walker to support her lower leg (knee bent) while using the other leg to move around.

Sometimes young adults with an Achilles rupture are casted for a few weeks, then moved into an adjustable brace. The brace is worn by everyone for another six weeks or so. The position of the foot and ankle can be changed within the brace. The adjustment is made by a physical therapist every two weeks bringing the toes up and less pointed down. That’s what makes it an adjustable brace.

By the end of the six weeks period of time, the foot will be moved from the equinus position (toes down) past neutral (zero degrees of movement) and to a +10 degree position of ankle dorsiflexion (foot pulled up toward the face). At that point, patients often switch to a special shoe with a heel-lift. They can start putting some weight on the foot. It’s a slow but steady process.

There is one other thing to consider. It is clear that treatment with a cast will allow the vast majority of tendon ruptures to heal, but the incidence of rerupture is increased. Patients who are treated with casting for eight weeks compared with those undergoing surgery have a higher rate or reruptures. In addition, the strength of the healed tendon is significantly less in patients who choose cast treatment. For these reasons, many orthopedists feel that Achilles tendon ruptures in younger, active patients should be surgically repaired.

Osteochondral lesions refer to defects in the joint surface, specifically the articular cartilage that lines the joint. Chondral refers to cartilage. Osteo- tells us that the damage goes clear down to the first layer of bone.

You have an osteochondral lesion of the talus. The talus is a bone in the ankle that is sandwiched between the lower leg bone (tibia) above and the calcaneus (heel bone) below. Treatment for this problem ranges from rest and immobilization to surgery.

Surgeons have been grappling for years how to repair painful, debilitating osteochondral lesions of the knee. Now the same techniques (debridement, microfracture, osteochondral autograft transfer or OAT, autologous chondrocyte implantation or ACI) are being used on the ankle.

But osteochondral repair on the ankle is more difficult than on the knee because there is limited access to the ankle joint. The surgeon must do a thorough and extensive work-up in order to make sure the real underlying problem is determined. Accurate diagnosis is important in planning treatment as well.

The first step is to perform a diagnostic injection. It sounds like you may have already gotten a diagnosis. When using an injection of a numbing agent like Novocaine, relief of symptoms points to an osteochonral defect and requires a CT scan to stage the lesion.

Staging is a way of determining the location, extent, depth, and overall severity of the defect. With mild (early stage) disease, it may be possible to treat the patient conservatively with nonoperative care (rest, immobilization in cast or splint). Deep fissures or displaced fragments require more extensive surgical procedures.

If the OLT is free of cysts, then a simple debridement (smooth the area, remove frayed edges) may be all that’s needed. Another treatment option early on is called microfracture — after debridement, the surgeon drills tiny holes in the area of the defect down into the bone. This stimulates bleeding and a healing response.

For larger defects (or for any size defect that doesn’t respond to a more conservative approach), the lesion is filled with graft material. The donor graft may come from a bank (allograft) or from the patient (autograft).

Many of these procedures can be done arthroscopically, which avoids an open incision and disruption of the soft tissues around the ankle. Another advantage of an arthroscopic approach is the pre-procedure diagnostic information it provides.

Before setting to work with the osteochondral repair or reconstruction, the surgeon uses the scope to look the joint over carefully. Every aspect of the lesion is reviewed and measured in preparation for the surgery. In fact, the diagnostic arthroscopic exam really helps the surgeon make the final treatment decision as to which procedure should be used.

You may be experiencing the start of a tendinitis. Because we use our feet continuously, tendoinitis in the foot is a common problem. One of the most frequently affected tendons is the posterior tibial tendon (PTT).

The posterior tibial tendon (PTT) runs behind the inside bump on the ankle (the medial malleolus or “ankle bone”), across the instep, and into the bottom of the foot. The tendon is important in supporting the arch of the foot and helps turn the foot inward during walking.

Tendon pathology may begin with an acute injury from a traumatic fall, an ankle fracture or dislocation, or even laceration (cut) of the tendon.

Other factors that seem to put people at risk of PTT deficiency and even rupture include female gender, obesity, diabetes, high blood pressure, taking steroids, or previous trauma or surgery to the mid-foot.

If it doesn’t clear up quickly, call your medical doctor and get an appointment. You may need something as simple as a shoe modification or arch support. Antiinflammatories are often used in the acute phase when there are symptoms such as you describe. Early treatment is advised to avoid having a simple problem progress into something more chronic and resistant to treatment.

The posterior tibial tendon (PTT) is important in supporting the arch of the foot and helps turn the foot inward during walking. As we age, our tendons can degenerate, or wear down and weaken over time. Degeneration in a tendon usually shows up as a loss of the normal arrangement of the fibers of the tendon.

As the tendon heals itself from wear and tear, scar tissue forms, thickening the tendon. This process can continue to the extent that a nodule, or knot, forms within the tendon. This condition is called tendonosis.

The area of tendonosis in the tendon is weaker than normal tendon. The weakened tendon sets the stage for the possibility of rupture of the tendon. Tendonosis may develop into tendonitis if the weakened area becomes inflamed.

Treatment depends on the severity of the PTT disorder and can include conservative (nonoperative) care or surgery. Conservative care consists of adapting shoes, using an insert called an orthotic) inside the shoe, and sometimes, immobilization in a cast or boot.

Physical therapy may be helpful in regaining alignment through postural adjustments, strengthening exercises, and manual therapy to restore tissue tensegrity (balance of tension and compression). Other nonoperative forms of treatment may include a rigid (nonflexible) ankle-foot-orthosis or AFO. Some patients will end up wearing the AFO permanently to support the foot and ankle.

you may be wondering about surgery? When is that appropriate and what does the surgeon do? This is an area of considerable debate and an area for continued study. Transferring another tendon to take the place of the torn, ruptured, or degenerated PTT is one option.

One of the goals of surgery is to stabilize the joint and improve alignment. Procedures to accomplish this goal can be quite complex with lengthening of some muscles, repair of damaged ligaments, and/or fusion of certain ankle bones.

All surgical procedures are followed by immobilization, a period of non-weight bearing, and then rehab with a physical therapist. Full recovery can take 12 weeks or more. But before you see yourself in this situation, talk with your surgeon about what’s best for you. Your age, general health, physical condition, and severity of the PTT disorder are all factors in planning the best care for you.

You may be experiencing a problem referred to as metatarsalgia. Metatarsals refer to the long bones of the toe. The term -algia always indicates pain. So in metatarsalgia, the pain occurs at the base of the toes where the metatarsals join the phalanges (end of the toes). This area is also known more commonly as the “ball” of the foot.

If you look up the treatment for metatarsalgia, you won’t find a “one-size-fits-all” recipe. Every patient who presents to the surgeon with this problem has a different reason why it developed. And in order to get the best results, treatment must be individualized for each person.

Some of the most common causes of metatarsalgia include congenitalfoot problems (deformities). Congenital means they are present at birth. This can include pes cavus (excessively high arch), equinovarus (clubfoot), or abnormal differences in the length of the toes.

Acquired problems such as neuromas, malignant tumors, infection, arthritis, or fractures (especially fractures that don’t heal properly) can contribute to metatarsalgia. Basically, anything that alters the way the foot hits the ground or changes the contact points for pressure and load through the foot can lead to metatarsalgia.

There are still other potential causes such as trauma, failed foot surgery, or nerve entrapment. In order to get to the bottom of the problem, the surgeon will conduct a careful exam and look at the wear pattern of the shoes. X-rays or other imaging studies (e.g., MRIs) may be helpful.

Often calluses on the bottom of the foot point right to the area of abnormal weight bearing and overload. The problem can be severe enough for the bones to form spurs or shift out of alignment. The end-result can be even more deformities such as hallux valgus (bunions).

The examiner will check out the motion of each individual joint (ankle, forefoot, toes) and assess muscle strength and function. Pulses will be palpated (felt) to assess circulation to the foot and any skin changes (e.g., ulcers) or swelling will be noted.

Most cases of metatarsalgia are treated conservatively (nonoperative care) first. Physical therapy may be a good idea. The therapist will help find the right shoe modifications, work on correcting postures that might be contributing to the problem, and address any muscle imbalances.

Stretching and strengthening may be needed as well. The therapist’s evaluation will guide the specifics of which muscles need additional training in either direction (flexibility or endurance training). Other noninvasive approaches may include corticosteroid injections into the painful area. This treatment technique is used carefully as there are often more side effects than benefits.

If conservative care is unsuccessful in changing the pressure distribution along the bottom of the foot, then it may be time to try something else. Just what that “something else” is depends on the underlying pathology. An orthopedic surgeon or podiatrist can help you with this.

Calluses form on the bottom of the foot when there is excess pressure on the bones inside the foot at that spot. Shoe correction is often the first step in correcting the problem.

The goal is to find a shoe that fits correctly and helps distribute pressure evenly across the ball of the foot. The first thing to look for in a good shoe is a wide toe box (where your toes are in the shoe).

Many of today’s fashions still dictate a shoe with a narrow box and pointed toe. That can get you in trouble as the toes are all pressed together inside the toe box. With no room to spread, the pressure during weight bearing gets directed to one area. Calluses develop to help cushion the foot where there is too much pressure or load.

You’ll need a shoe with a toe box long enough as well as wide enough. A soft sole and low heel (one-half inch up to one inch) are important. Look for a shoe that has an arch support that matches the placement and heighth of your natural arch.

Depending on the cause of your problem, you may need some shoe modifications that are specific to your foot. An orthopedic surgeon, podiatrist, or physical therapist can help you with this. If changing your shoe wear does not solve the problem quickly, don’t wait to get an expert’s help. Early intervention can help prevent worse problems later.

Front-end collisions resulting in airbag release can cause significant physical injuries. The force of the bag inflating against the body protects the person from smashing into the dashboard or going out the front window.

But as Newton’s third law of motion states, For every action, there is an equal and opposite reaction. This means that for every force there is a reaction force that is equal in size but in the opposite direction.

The transfer of force during the car crash and air bag release can result in a traumatic injury to the otherwise unprotected body. The most common airbag-related injuries are to the hip, thigh, and knee. In fact almost half (49.5 per cent) of airbag injuries affect these areas. More than one-third of the injuries (38.4 per cent) are to the foot and ankle.

Fractures, dislocations, and torn ligaments affecting the midfoot are common. And height is a factor. Being short (usually less than four feet, six inches) does increase the number of ankle and foot injuries. If the foot is not planted firmly on the car floor, the unprotected, unstabilized area takes a significant hit.

It sounds like the midfoot or tarsometatarsal joint (TMT) joint is affected. This is where the bones and connecting joints between the heel and the base of the toes are located. Pain from midfoot arthritis can cause limping when walking and an inability to navigate uneven surfaces or move faster than a slow walk. Going up and down stairs can be next to impossible.

The first goal is to reduce the painful symptoms and any destructive inflammation that might be present. Nonsteroidal antiinflammatory drugs (NSAIDs) are used at first to accomplish this.

Next, an attempt is made to stabilize the midfoot. This may be done with special shoes, shoe modifications, or orthotics (inserts placed inside the shoe). The orthotics help off-load the midfoot and protect the already damaged joint. Special plastic braces that fit inside the shoe (called polypropylene ankle-foot clamshell orthosis) can reduce pressure on the bottom of the foot by 30 per cent.

When nonsurgical measures such as these just described are not successful in reducing pain and stabilizing the joints, then surgery may be needed. The surgeon fuses the bones of the midfoot together. The procedure is called an arthrodesis. The specific bones that get fused depend on where the damage is located. Surgeons rely on imaging studies (X-rays, CT scans) taken before surgery to plan the type of procedure needed.

Often, the base of the metatarsal bones (long bones in the forefoot) must be fused to the bones in the midfoot to achieve the rigid stabilization needed. Metal plates and screws are used to hold everything together.

Patients are often warned that arthrodesis of the midfoot helps reduce but doesn’t always eliminate foot pain. The procedure provides stability to improve function but the patient should not expect to regain full or normal motion. Recovery includes rehab and final results aren’t known until at least 12 months after the surgery (longer if a second surgery is required).

It used to be thought that hallux valgus, or bunions, were caused by wearing shoes that didn’t fit properly or had high heels. The theory was the more the heels were worn or the more pressure there was on the foot, joint would move, causing the bunion. However, research is starting to show that this isn’t necessarily the case. In fact, family history may play a larger role.

If your daughter does develop bunions, it is entirely possible that she does because you have them, although the shoes could contribute. In a recent study, by Daniel Wu and Lobo Louie, data from over 1,000 women showed that most of them who had a family history of bunions also had them, while those who wore high heels but had no family history of bunion, didn’t often develop them.

This isn’t to say that high heels aren’t a problem. They do cause other issues with the body, by throwing it off balance. For example, the heels place a larger amount of pressure on the ankles, knees, and lower back, than they are used to.