 ARTHRITS OF THE FOOT AND ANKLE
Arthritis or joint pain can come from a wide variety of causes. These include trauma such as a fracture involving the joint, overuse and stress on a joint such as in running or other sports, or systemic causes such as gout or rheumatoid arthritis. Each has a unique effect and we will evaluate every cause of joint pain to ensure optimal treatment both on a local and systemic level. This may include x-rays and advanced imaging, blood test evaluation and consult with another specialist. We will employ bracing, strapping , physical therapy, and orthotic techniques to relieve pain and improve function and be involved with the systemic treatment process to minimize further damage and recurrence. When necessary we will utelize the latest techniques in joint and bone reconstruction as well as foot implant surgery. The overall goal of treating foot arthritis is to eliminate pain while maintaining maximal joint function whenever possible, limit compensation elsewhere and prevent progression.
PAIN IN THE BALL OF THE FOOT
A common condition known as metatarsalgia can result in pain along the ball of the foot. This may be the result of abnormal metatarsal length and alignment, the presence of ligament and tendon tears, and local micro-trauma from shoes and/or overuse activities. We will assess the cause of your pain and prescribe an appropriate treatment plan. In some cases of chronic metatarsal pain, we offer realignment utilizing one of several surgical procedures, most commonly the Weil Metatarsal Osteotomy.
ANKLE SPRAINS AND STRAINS
A common injury, which we often treat, is sprained ankles. This may occur during sport activities or just simply while walking on an uneven surface. When your ankle ligaments stretch beyond their normal range, a sprain occurs. If the force is very strong, the ligaments can actually tear or your bone may break (fracture). Pain and swelling occur after an ankle sprain or fracture. Ankle instability may develop if there is complete tearing of the ligaments. Therefore, it is important to seek immediate care to make a correct diagnosis and avoid poor healing of these sensitive ligaments.
Possible long term complications of ankle sprains include, more frequently recurring ankle sprains, imbalance and muscle weakness. This can also happen if you return to regular activities without allowing the ankle to heal appropriately.
If you have had previous ankle sprains, you may have repeat sprains if the ligaments have not had a chance to heal completely. If the sprain recurs often and pain continues for an extended period of time, you may develop a chronic ankle sprain, which may lead to ankle instability and persistent pain.
Rehabilitation and bracing is used to help to decrease pain and swelling and to prevent chronic ankle problems. Surgical treatment, in the form of ankle arthroscopy or tendon repair, is reserved for injuries that do not to respond to conservative treatment and rehabilitation.
FLATFOOT IN CHILDREN AND ADULTS
Most children have flexible flatfeet, where an arch is visible when the child is sitting, but not when the child is standing. As one gets older, the tendons that attach to the bones of the foot grow stronger and tighten, forming the arch. In many instances, the arch can "fall," creating a flatfoot. This may be due to ligamentous laxity, injury, or familial predisposition. Flatfoot in children may cause pain in the arch, tripping, and lack of desire to participate in sports and activities. Custom molded orthotics to alleviate these symptoms with great predictability and will provide a quick return to function.
There are situations where the flatfoot may become rigid over time, such as in tarsal coalition. This is a process whereby the ligaments or bones of the hindfoot become locked causing progressive stiffness. It is important to differentiate a rigid from flexible flatfoot.
If a flexible flatfoot continues into adulthood, it can contribute to lower back, knee or hip pain. The most severe complications of flatfoot in adults is weakness or tear of the posterior tibial tendon, which is commonly referred to as Posterior Tibial Tendon Dysfunction (PTTD). This may lead to chronic arch and ankle pain as well as arthritis. Systemic arthritic conditions, such as rheumatoid arthritis, may also be a primary cause of PTTD, or exacerbate the condition. Common symptoms associated with progressive flatfoot are: pain in the arch with prolonged standing, difficulty standing on one’s toes, swelling along the inner side of the arch, pain in one’s feet that reduces their ability to participate in activities of daily living, or arthritis conditions.
Treatment options for painful flatfoot may include: custom-molded foot orthotics, ankle-foot orthotics (AFOs) for more rigid bracing, anti-inflammatory medication and physical therapy.
In cases where pain and function are not improved, surgery may be needed to correct the problem. Surgical procedures can help reduce pain and improve bone alignment. The different types of surgery your physician may discuss with you may include: fusing one or more of the bones in the foot together, cutting and reshaping a bone to correct alignment, removing a bone or bone spur, cleaning the sheath covering a tendon, or using a piece of one tendon to lengthen or replace another damages tendon.
FOR RUNNERS
Athletic shoes increase traction and protect your feet from specific stresses encountered in a given sport. The differences in design and characteristics between sneakers reflect the activities that the wearer is engaged in. That means that a running shoe will differ from a tennis shoe, because they are inherently built to encounter different stress (forward motion vs. lateral motion). Additionally, foot structure varies from person to person, and therefore, not every sneaker is good for every person. For example, over-pronators, under-pronators, and high arched feet all need different support. We will evaluate your feet and recommend the appropriate shoe gear for your activity. It is important to note, that even the best-made sneakers cannot replace the stability and function of a custom-molded orthotic.
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Heel pain is one of the most common complaints which draw patients to our office. We have combined our collective experience and developed a systematic approach to heel pain. You will be introduced to this protocol on your first visit to our office. A majority of our patients will have a full resolution of their symptoms soon after initiation of our treatment plan. For those patients who do not respond to our protocol or have had