Conditions

Foot and ankle pain is quite common and is experienced by many people. A variety of things can cause foot and ankle pain, causing mild discomfort to severe pain that may limit activities. Most often foot and ankle pain can be the result of a direct injury like trauma or a sports injury, resulting in a sprain or fracture.

The physicians at the Hinsdale Orthopaedics Foot and Ankle Center will conduct a thorough and comprehensive evaluation to develop the proper diagnosis to ensure you receive the best treatment option for your situation.

The most common causes for foot and ankle pain are the following:

Achilles Tendon Injuries

Ankle pain is a common complaint for many people and may be caused by a variety of things ranging from mild discomfort to severe pain that may limit activities.  Accurate diagnosis is important to identify the correct treatment plan.  One of the more common injuries seen involves your Achilles tendon.  The Achilles tendon connects your calf muscle to the heel bone and allows you to rise up on your toes and push off when you walk or run.  The Achilles is the strongest and largest tendon in the body and typically bears 2 €“ 3 times more body weight during normal walking.  Regaining the function of an injured Achilles tendon is critical to every day activities.

Acute or chronic conditions of the Achilles tendon include overuse injuries, tears or ruptures, inflammation and typically occur in individuals in the 30s and 40s while performing activities that require sudden changes in direction (basketball, tennis, dancing, etc.), repetitive use or occur after a serious injury.

Acute Tendon Conditions:

A tearing or detachment of your Achilles tendon can occur with a vigorous contraction of the muscle where the tendon tears under stress producing a sudden pain in the back of the calf or behind the ankle.

Acute tendon injuries require immediate attention by a physician and may require surgery.

Chronic Tendon Conditions:

Chronic ankle pain can often linger after repetitive overuse or a serious injury involving the Achilles tendon. When a tendon is subject to repeat micro-tears, chronic conditions such as tendonosis or a state of chronic inflammation can develop.

An injury of the Achilles tendon requires an examination by a physician, diagnostic tests are usually ordered to determine the severity of the injury before it is determined if the injury requires a surgical procedure or can be repaired without surgical intervention.

Acute injuries typically involve complete tearing of the tendon and require surgical intervention and a rigorous rehabilitation program to strengthen the repaired tendon and a return to normal activities. After surgery, a surgeon will put the patient in a cast for a certain period of weeks to immobilize the recovering tendon and promote healing and rejuvenation of the tendon structure. This is followed by physical therapy and rehabilitation.

Chronic inflammation can be treated with common non-operative treatments including rest, ice, anti-inflamation medications followed by physical therapy and rehabilitation after surgery.

Achilles Tendonitis

Ankle pain is a common complaint for many people and may be caused by a variety of things ranging from mild discomfort to severe pain that may limit activities.  Accurate diagnosis is important to identify the correct treatment plan.  One of the more common injuries seen involves your Achilles tendon.  The Achilles tendon connects your calf muscle to the heel bone and allows you to rise up on your toes and push off when you walk or run.  The Achilles is the strongest and largest tendon in the body and typically bears 2 €“ 3 times more body weight during normal walking.  Regaining the function of an injured Achilles tendon is critical to every day activities.

Acute or chronic conditions of the Achilles tendon include overuse injuries, tears or ruptures, inflammation and typically occur in individuals in the 30s and 40s while performing activities that require sudden changes in direction (basketball, tennis, dancing, etc.), repetitive use or occur after a serious injury.

Acute Tendon Conditions:

A tearing or detachment of your Achilles tendon can occur with a vigorous contraction of the muscle where the tendon tears under stress producing a sudden pain in the back of the calf or behind the ankle.

Acute tendon injuries require immediate attention by a physician and may require surgery.

Chronic Tendon Conditions:

Chronic ankle pain can often linger after repetitive overuse or a serious injury involving the Achilles tendon. When a tendon is subject to repeat micro-tears, chronic conditions such as tendonosis or a state of chronic inflammation can develop.

An injury of the Achilles tendon requires an examination by a physician, diagnostic tests are usually ordered to determine the severity of the injury before it is determined if the injury requires a surgical procedure or can be repaired without surgical intervention.

Acute injuries typically involve complete tearing of the tendon and require surgical intervention and a rigorous rehabilitation program to strengthen the repaired tendon and a return to normal activities. After surgery, a surgeon will put the patient in a cast for a certain period of weeks to immobilize the recovering tendon and promote healing and rejuvenation of the tendon structure. This is followed by physical therapy and rehabilitation.

Chronic inflammation can be treated with common non-operative treatments including rest, ice, anti-inflamation medications followed by physical therapy and rehabilitation after surgery.

Arthritis & Total Ankle Replacement

Ankle arthritis can be caused by a prior injury, wear and tear, deformity or actue inflammatory conditions for instance, Rheumatoid arthritis or infection.  When an ankle is injured, it is susceptible to many debilitating conditions such as osteonecrosis.  Osteonecrosis damages blood flow to a portion of the ankle bone and as a result causes increased inflammation in the joint and eventually arthritis. Infections of the ankle joint can cause damage to the cartilage cells, restricting the ability to regenerate and eventually causing permanent damage to the joint.  Genetic pre-disposition to arthritis is not well understood but affects some individuals uniquely, causing their joints to wear out faster than others.

Pain associated with ankle arthritis is one of the most frequent reasons patients seek medical treatment by an orthopaedic specialist.  If you are experiencing severe ankle pain or restricted movement from arthritis in your ankle, you may be a candidate for an ankle replacement. Ankle joint replacement is one of the most successful treatment options for disabling ankle arthritis, as it helps to relieve pain, restore motion and get you back to enjoying normal, everyday activities.  Since its inception over 30 years ago, there have been tremendous advances made in this procedure.

Similar to total hip or knee replacement total ankle replacement surgery removes the damaged cartilage joint and surrounding bone from the ankle joint and then filling the gap with artificial components that restore ankle motion.  After completing ankle replacement surgery and a structured rehabilitation program, patients are able to return to their daily activities pain free.

Broken Ankle

A broken ankle is also known as an ankle €œfracture€.  A fractured ankle can range from simple breaks in one bone, which  may not prevent you from walking, to several fractures in different spots around the ankle which forces your ankle to become very unstable and make it difficult  to walk.

Most often a broken ankles results from a severe twisting injury or fall.  They affect all age categories and can occur due to many lifestyle activities.  Severe and immediate pain, swelling and bruising typically occur, resulting in the patient not being able to stand or walk.

Treatment Options for Ankle Fractures

  • Physical Therapy
  • Cast or Immobilization
  • Anti-inflammatory medications
  • Surgery
Bunion Deformity

A bunion is an abnormal, bony bump that forms at the side of the big toe as the toe angles in and the foot bone angles out.   Over time, the abnormal position enlarges your big toe joint, further crowding your other toes and causing pain and discomfort.

Bunions can occur for a number of reasons but the most common cause is wearing shoes that fit too tightly.  Bunions can also develop as a result of an inherited structural defect or stress on your foot or a medical condition, such as arthritis.

Most people can manage bunions successfully with conservative treatment and simple modifications in show wear but severe, painful bunion conditions require surgical intervention.

Bunion Surgery

Many different surgical interventions may be used to correct bunions.  Bunions can be repaired by removing the damaged €œbump€ or joint, toe bones may be realigned or permanently joined (fused); or a portion of the bone may be removed.

Bunion surgery is a successful treatment options for debilitating bunion, as it helps to relieve pain, improve function and allows patients the opportunity to resume normal show wear everyday activities.  But the goal of all repairs is to realign the big toe, eliminating the bump and taking the pressure off of the other toes.

Treatment Options

  • Shoe Modifications
  • Shoe Inserts
  • Surgery
Chronic Lateral Ankle Pain

Recurring or persistent (chronic) pain on the outer (lateral) side of the ankle often develops after an injury such as a sprained ankle. However, several other conditions may also cause chronic ankle pain.

Signs and symptoms

  • Pain, usually on the outer side of the ankle. The pain may be so intense that you have difficulty walking or participating in sports. In some cases, the pain is a constant, dull ache.
  • Difficulty walking on uneven ground or in high heels
  • A feeling of giving way (instability)
  • Swelling
  • Stiffness
  • Tenderness
  • Repeated ankle sprains

Potential Causes

The most common cause for a persistently painful ankle is incomplete healing after an ankle sprain. When you sprain your ankle, the connecting tissue (ligament) between the bones is stretched or torn. Without thorough and complete rehabilitation, the ligament or surrounding muscles may remain weak, resulting in recurrent instability. As a result, you may experience additional ankle injuries. Other causes of chronic ankle pain include:

  • An injury to the nerves that pass through the ankle. The nerves may be stretched, torn, injured by a direct blow, or pinched under pressure (entrapment).
  • A torn or inflamed tendon
  • Arthritis of the ankle joint
  • A break (fracture) in one of the bones that make up the ankle joint
  • An inflammation of the joint lining (synovium)
  • The development of scar tissue in the ankle after a sprain.  The scar tissue takes up space in the joint, thus putting pressure on the ligaments.

Treatment

  • Anti-inflammatory medications such as aspirin or ibuprofen to reduce swelling
  • Physical therapy, including tilt-board exercises, directed at strengthening the muscles, restoring range of motion, and increasing your perception of joint position
  • An ankle brace or other support
  • An injection of a steroid medication
  • In the case of a fracture, immobilization to allow the bone to heal
  • Surgery
Hammer Toes

A hammer toe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. Initially, hammer toes are flexible and can be corrected with simple measures but, if left untreated, they can become fixed and require surgery.

People with hammer toe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.

Cause

Hammer toe results from shoes that don’t fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and cannot stretch out.

Shoes that narrow toward the toe may make your forefoot look smaller. But they also push the smaller toes into a flexed (bent) position. The toes rub against the shoe, leading to the formation of corns and calluses, which further aggravate the condition. A higher heel forces the foot down and squishes the toes against the shoe, increasing the pressure and the bend in the toe. Eventually, the toe muscles become unable to straighten the toe, even when there is no confining shoe.

Treatment

  • Orthotics
  • Corrective Supports
  • Exercises
  • Surgery
Heel Pain

Every mile you walk puts 60 tons of stress on each foot. Your feet can handle a heavy load, but too much stress pushes them over their limits. When you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues, you may develop heel pain, one of the most common problem affecting the foot and ankle. A sore heel will usually get better on its own with rest and modification of offending activity. However, many people try to ignore the early signs of heel pain and keep on doing the activities that caused it. When you continue to use a sore heel, it will only get worse and could become a chronic condition leading to more problems. Surgery is rarely necessary.

Evaluation and treatment

Heel pain can have many causes. If your heel hurts, see your Hinsdale Orthopaedics physician right away to determine why and get treatment. Tell him or her exactly where you have pain and how long you€™ve had it. Your HOA physician will examine your heel, looking and feeling for signs of tenderness and swelling. You may be asked to walk, stand on one foot or do other physical tests that help your HOA physician pinpoint the cause of your sore heel. Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel.

Pain beneath the heel

If it hurts under your heel, you may have one or more conditions that inflame the tissues on the bottom of your foot:

  • Stone bruise: When you step on a hard object such as a rock or stone, you can bruise the fat pad on the underside of your heel. It may or may not look discolored. The pain goes away gradually with rest.
  • Plantar fasciitis (subcalcaneal pain): Doing too much running or jumping can inflame the tissue band (fascia) connecting the heel bone to the base of the toes. The pain is centered under your heel and may be mild at first but flares up when you take your first steps after resting overnight. You may need to do special exercises, take medication to reduce swelling and wear a heel pad in your shoe.
  • Heel spur: When plantar fasciitis continues for a long time, a heel spur (boney extension) may form where the fascia tissue band connects to your heel bone. Your HOA physician may take an X-ray to see the bony protrusion, which can vary in size. Treatment is usually the same as for plantar fasciitis: rest until the pain subsides, do special stretching exercises, splinting and wear heel cushions in shoes.

Pain behind the heel

If you have pain behind your heel, you may have inflamed the area where the Achilles tendon attaches into the heel bone (insertional tendonitis), the soft tissue behind the tendon can also inflame and swell (retrocalcaneal bursitis) People often get this by running too much or wearing shoes that rub or cut into the back of the heel. Pain behind the heel may build slowly over time, causing the skin to thicken, get red and swell. You might develop a bump on the back of your heel that feels tender and warm to the touch. The pain flares up when you first start an activity after resting. It often hurts too much to wear normal shoes. You may need an X-ray to see if you also have a bone spur.

Treatment includes resting from the activities that caused the problem, doing certain stretching exercises, using pain medication and wearing open back shoes and lifts to alleviate the stress placed on the tendon.

Treatment Options

  • Your HOA physician may start you with heel insert/lifts.
  • Stretch your Achilles tendon by leaning forward against a wall with your foot flat on the floor and heel elevated with the insert.
  • Use nonsteroidal anti-inflammatory medications for pain and swelling.
  • Icing the back of the heel after use.
Osteoarthritis of the Foot or Ankle

Osteoarthritis (OA) also known as Degenerative Joint Disease (DJD), is perhaps the most common cause for foot and ankle pain in the older individual.  Depending on factors like cause, age, weight, joint function and activity, people with this type of arthritis experience increasing pain, stiffness and deformity to varying degree and require an individual treatment plan.

Primary Osteoarthritis occurs more frequently as we age.  Before 45, osteoarthritis occurs more frequently in males.  After age 55, it occurs more frequently in females.  In the United States, all races appear equally affected.

Secondary osteoarthritis is caused by another disease or condition such as obesity, repeat trauma or surgery to the joint, congenital abnormalities, gout, diabetes and other hormone related disorders.  Obesity causes osteoarthritis by increasing the mechanical stress on the cartilage.  Hormone disturbances, such as Diabetes and growth hormone disorders, are also associated with early cartilage wear and secondary osteoarthritis.

Repetitive use of worn joints over the years can irritate and inflame the cartilage, causing joint pain and swelling.  Loss of cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility.  Inflammation of the cartilage can also stimulate new bone outgrowths or spurs which form around the joints.

Treatment options can include conservative care to limit or modify activities, including bracing, inserts, nonsteroidal anti-inflammatory medications, minimally invasive surgical procedures to clear out the joint or remove spurs to decrease inflammation and pain, or more invasive procedures such as fusion of the ankle, uniting the bone together to stiffen the joint and eliminate bone-to-bone rubbing with movement or total ankle replacement, removing bad/diseased cartilage or bone and implanting artificial components made of metal and heavy plastic, acting as a new ankle hinge.

Treatment Options

  • Braces
  • Non-steroidal Anti-Inflammatory Medications
  • Surgery
Peroneal Tendon Injury

The peroneal tendon is a band of tissues which connects the leg to the foot at the ankle area.  There are two peroneal tendons in each foot which run side-by-side behind the outer ankle bone.  One peroneal tendon attaches the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of your arch area.  The main function of the peroneal tendon is to stabilize the foot and ankle and protect it from foot sprains.  When the foot is exposed to repetitive forces during standing and walking, the peroneal tendon become irritated and inflamed.  Athletes participating in such sports as soccer, running, tennis, etc. may experience an increase in peroneal tendon injury.  Certain foot shapes such as higher arched feet tend to increase the force that peroneal tendons are exposed to and may thereby predispose to the development of peroneal tendonitis.

Symtpoms of peroneal tendonitis include pain and discomfort of the ankle area and occasional swelling on the outside and back part of the ankle.  Since not all bodies are alike, slight variations in ankle anatomy can leave some people predisposed to this condition.

Treatment Options

  • Bracing
  • Physical Therapy
  • Anti-Inflammatory Medications
  • Ice Therapy
  • Surgery
Plantar Fasciitis

When your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis (fashee-EYE-tiss). It€™s an overuse injury affecting the sole or flexor surface (plantar) of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.

You€™re more likely to get the condition if you€™re a woman, if you€™re overweight, or if you have a job that requires a lot of walking or standing on hard surfaces. You€™re also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches are also more prone to plantar fasciitis.

The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You€™re more likely to feel it after (not during) exercise. The pain classically occurs again after arising from a midday lunch break.

If you don€™t treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity and you may also develop symptoms of foot, knee, hip and back problems because of the way plantar fasciitis changes the way you walk.

Treatments

Rest is the first treatment for plantar fasciitis. Try to keep weight off your foot until the inflammation goes away. You can also apply ice to the sore area for 20 minutes three or four times a day to relieve your symptoms. Often a doctor will prescribe nonsteroidal anti-inflammatory medication such as ibuprofen. A program of home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treating the condition and lessening the chance of recurrence.

In one exercise, you lean forward against a wall with one knee straight and heel on the ground.  Your other knee is bent.  Your heel cord and foot arch stretch as you lean.  Holds for 10 seconds, relax and straighten up.  Repeat 20 times for each sore heel.

In the second exercise, you lean forward onto a countertop, spreading your feet apart with one foot in front of the other. Flex your knees and squat down, keeping your heels on the ground as long as possible. Your heel cords and foot arches will stretch as the heels come up in the stretch. Hold for 10 seconds, relax and straighten up. Repeat 20 times.

About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with a standard orthotic device like a rubber heel pad. Your foot may be taped into a specific position.

If your plantar fasciitis continues after a few months of conservative treatment, your Hinsdale Orthopaedics physician may add additional treatments, including non-steroidal anti-inflammatory drugs, night splinting, injections or casting.

In a few cases, you might need surgery to release your ligament.

Treatment Options

  • Non-steroidal Anti-Inflammatory Medications
  • Night Splinting
  • Injections
  • Casting
Posterior Tibial Tendon Dysfunction or Adult Acquire Flatfoot

Posterior tibial tendon dysfunction (PTTD), also known as Adult Acquired Flatfoot, is a most common cause of foot pain and dysfunction in adult patients. The posterior tendon helps to hold the arch of your foot in proper form (curve) and provides support as you step off on your toes when walking.  When this tendon become inflamed, over-stretched or torn, patients begin to experience pain in the inner ankle area and gradually lose the inner arch on the bottom of the foot, leaving patients flatfooted.

Posterior tibial tendon dysfunction often occurs in women over 50 and may be due to inherent abnormalities of the tendon.  Several additional risk factors may contribute to this condition, such as obesity, diabetes, hypertension, steroid injections in the foot, rheumatoid arthritis, and athletic repetitive injury, which can cause tearing of this specific tendon area.

Patients can often be successfully treated with conservative measures, such as foot orthotics, arch supports, bracing and physical therapy.

If conservative treatment options do not remedy the foot condition, your orthoapedic specialist may recommend surgery and the following procedures can be performed to repair or provide relief from PTTD:

Tenosynovectomy. In this procedure, the surgeon will clean away (debride) and remove (excise) any inflamed tissue surrounding the tendon.

Osteotomy: This procedure changes the alignment of the hindfoot by cutting heel bone (calcaneus), sometimes multiple cuts are required.

Tendon transfer: This procedure uses a healthy tendon usually the FDL (flexor digitorum longus which helps bend the toes) to replace the damaged posterior tibial tendon.

Arthrodesis: This procedure welds (fuses) one or more bones together in a corrected position, recreating the arch. This stabilizes the hindfoot and prevents the condition from progressing further.

Surgery can be a successful treatment option to provide relief from posterior tibial tendon dysfunction by relieving pain, improving function and allowing patients the opportunity to resume normal, everyday activities.

Flatfoot is a condition in which the ligaments of the long part of the arch in the foot are loose and allow the arch to collapse or flatten out.  Flatfoot may be an inherited condition or may be caused by injury or physical conditions, such as severe tendonitis, Rheumatoid arthritis, or diabetes.

Adults, as well as children, may be affected by a flat-footed condition.  Most often adults can take advantage of conservative treatment options, such as orthotic shoe devices, arch supports, or bracing prior to considering more invasive measures such as a surgical procedure.

In severe cases, symptoms may not be controlled with conservative care options, and patients may need to consult with their orthopaedic specialist to discuss surgical options to correct a flat foot condition .

Although recovery can take up to 6 months, flat feet surgery is a successful treatment option for debilitating arch conditions as it helps to relieve pain, improve function and allows patients the opportunity to resume normal, everyday activities.

Children€™s Flatfoot

Flatfoot can occur in children from birth to adulthood, but normally will correct itself as the child grows and therefore goes untreated.  Children typically wear inserts to treat persistent symptoms while their feet are maturing.  Surgery is not a common treatment for children with flatfoot.

Treatments

  • Medications
  • Physical Therapy
  • Orthotics
  • Surgery
Rheumatoid Arthritis of the Foot & Ankle

Rheumatoid arthritis (RA) is a common rheumatic disease that affects approximately 1.3 million people in the United States.  Rheumatoid arthritis is an autoimmune disease that cases chronic inflammation of the joints and the tissue around the joints, as well as in the organs in the body.

Autoimmune diseases are illnesses that occur when the body€™s tissues are mistakenly attacked by their own immune system (a complex organization of cells and antibodies designed normally to €œseek and destroy€ invaders of the body, particularly infections).  Patients with autoimmune disease have antibodies in their blood that target their own body tissues, where they can be associated with inflammation.  Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.

While rheumatoid arthritis is a chronic illness that is not curable, meaning it can last for years, patients may experience long periods without symptoms.  Never the less, rheumatoid arthritis is typically a progressive illness that has the potential over time to be quite destructive, resulting in functional disability.

In Rheumatoid arthritis, the lining which covers the joint called the synovium, can become damaged and overactive. During the overactive phase, swelling and inflammation begins destroying the joint, as well as ligaments and other tissues supporting the foot or ankle finally eroding into the bone.  Weakened ligaments can cause joint deformities involving the ankle all the way to the toes.  The most common deformities are flatfoot, bunions, hammer toes or claw toes.

The most common symptoms are pain, swelling and stiffness.  Unlike osteoarthritis, which typically affects one specific joint, symptoms of Rheumatoid arthritis usually appear in both feet, affecting the same joints on each foot.

Pain associated with ankle Rheumatoid arthritis is one of the most frequent reasons patients seek medical treatment by a foot and ankle specialist.

Treatment options for patients experiencing Rheumatoid arthritis in the foot and/or ankle could include minimally invasive treatments, such as arthroscopy to wash out inflamed cells and tissues to reduce swelling and relieve pain.  Important to note, patients with Rheumatoid arthritis can typically manage their arthritic pain, but can€™t cur their arthritis.  Additionally, some patients may require fusion of the ankle, uniting the bones together to stiffen the joint to eliminate the bone-to-bone rubbing with movement, thereby and pain.  It can also correct mal-alignment.  Or total ankle replacement may be required, removing bad or diseased cartilage or bone and implanting artificial components made of metal and heavy plastic to act as the ankle hinge.

If you suffer from ankle pain come see one of our foot and ankle specialists to get started.  Keeping the patient with Rheumatoid arthritis moving is vital for their overall health and wellbeing.

Treatment Options

  • Bracing
  • Injection Treatment
  • Minimally Invasive Surgical Procedures

 

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