FEET/ANKLE
The pain and discomfort you experience in your feet and ankles can be very uncomfortable. The team at Washington Sports Medicine Institute can diagnose and treat your foot issues and ankle injuries so you can gain back the use and mobility of your feet and ankles.
CONDITIONS WE TREAT
ACHILLES TENDON RUPTURE
Tendons are the soft tissues connecting muscles to the bones. The achilles tendon is the longest tendon in the body and is present behind the ankle, joining the calf muscles with the heel bone. Contraction of the calf muscles tightens the achilles tendon and pulls the heel, enabling foot and toe movements necessary for walking, running and jumping.
The achilles tendon is often injured during sports resulting in an inflammatory condition called tendonitis which is characterized by swelling and pain. In some cases, severe injury results in a tear or rupture of the Achilles tendon requiring immediate medical attention.
The main objective of treatment is to restore the normal physiology of the Achilles tendon so the patient can perform activities as before the injury. Immediately following a torn or ruptured Achilles tendon you should employ the RICE method as follows:
- Rest of the injured part
- Ice packs application at the site of injury to prevent swelling
- Compress the injured area to prevent swelling
- Elevate the injured part to reduce swelling
ANKLE SPRAIN
Ankle Sprains are a common injury that occurs from over stretching or tearing of the ligaments that support the ankle. In fact, it has been estimated that 25,000 ankle sprains occur each day in the US. The ankle is composed of bones forming a joint and ligaments are the elastic structures which are responsible for holding these bones in their proper place. Ligaments and other soft tissues function to prevent abnormal movement such as twisting, turning, and rolling of the foot beyond the normal range. Sprains occur when the strong bands of tissue that hold our joints together, called ligaments, stretch or tear. This happens when we twist or roll our ankle suddenly and exceed a ligament’s normal length. In the ankle, this typically involves the ligaments on the outside of our ankle.
TREATMENT FOR ANKLE SPRAINS
If you think you have sprained your ankle the first thing to do is remove yourself from any activity that may create further injury. Elevate the ankle and apply ice and a compressive wrap – like an ace bandage or an ankle brace that can be picked up in many pharmacies. For less severe sprains, it is best to start moving as soon as possible and place weight on the ankle with a light wrap or brace. More severe sprains may require a period of immobilization and potential use of crutches. It may take days, weeks or even months to return to normal. Throughout this time, even if the pain is improved, the ankle may continue to swell with activities, but should improve over night. If you seem to stop improving, make sure you see an orthopedic surgeon for further evaluation. Treatment and healing time of an ankle sprain will depend on the grade of the sprain. All sprains will be treated with the R.I.C.E. method: Rest, Ice, Compression, and Elevation. You may return to activities without restrictions once you have regained full, pain free range of motion, have no pain with activities and demonstrate normal strength. Your physician may also order the following treatment measures if the sprain is a grade 2 or 3.
- Immobilization
- Medications
- Physical Therapy
ORTHOPEDIC SURGERY
Surgery for ankle sprains is rarely needed but may be necessary if the sprain is a grade 3 with complete tearing of the ligament and the patient does not improve with conservative treatment measures and months of adequate healing time.
TOE DEFORMITIES
COMMON TOE DEFORMITIES – Anatomically the foot is divided into the forefoot, mid foot and hind foot. The Forefoot has 4 small toes called phalanges and 1 large toe called the hallux or big toe. Phalanges have 3 bones and 3 joints, while the big toe has 2 bones and 2 joints. The mid foot and hind foot have different structures, which are responsible for bearing body weight and performing activities such as walking and running.
Toe deformities are common problems that occur due to abnormal positioning of the foot bones, inadequate biomechanics, and diseases such as arthritis affecting bones and tissues of the foot. Toe deformities not only affect the alignment of the bones, joints and tissues in the foot, but may also affect alignment of the weight bearing joints such as the hips or knees resulting in further problems. The most common toe deformities are hammertoes, claw toes, and mallet toes.
TREATMENT FOR COMMON TOE DEFORMITIES
Initially, toe deformities are treated by conservative treatment measures to restore or maintain walking ability, relieve pain, and also to delay progression of the deformity. Conservative treatment includes wearing specially designed shoes with cushions or pads with an enlarged toe box area to prevent skin breakdown. You will be instructed to avoid wearing tight, narrow, or high heeled shoes. Splints or tape may be applied to reposition the toes, and regular toe stretching exercises are also recommended.
ORTHOPEDIC SURGERY
Surgical treatment is recommended if conservative treatment fails to relieve symptoms, or the deformed toes become rigid and immovable. The main objective of the surgery is to restore normal toe alignment and return the foot to normal pain-free function.
PLANTAR FASCIITIS
The plantar fascia is a long, thin ligament present along the bottom of the foot that creates the arch of the foot. It extends from the heel bone, and then splits and fans out to attach itself to the toes. Plantar fasciitis is a condition where the plantar fascia becomes inflamed from overstretching or overuse, causing pain in the heel and bottom of the foot. It can occur in one or both feet due to excessive standing and is one of the most common orthopaedic complaints, especially in active men between 40 and 70 years of age.
TREATMENT FOR PLANTAR FASCIITIS
Treatment involves conservative measures to resolve the condition. Conservative treatment measures include:
- Rest
- Ice
- Medications
- Steroid injections
- Supportive shoes and orthotics
- Night splints
- Physical therapy
- Extracorporeal shockwave therapy (ESWT)
- Gastrocnemius recession: Tight calf muscles or gastrocnemius muscles can strain the plantar fascia. To release this stress, a surgeon will surgically lengthen the calf muscle and increase the motion of the ankle. The surgery can be performed by open incision or endoscopically with a small incision using an endoscope, which is a long instrument with a small camera attached
- Plantar fascia release:If you have normal range of ankle motion, but continue to have heel pain, a partial release procedure is recommended. Your surgeon will partially cut the plantar fascia ligament to relieve the tension. The surgery can be performed endoscopically but open incision is easier to perform and is associated with lower risk of nerve damage
ORTHOPEDIC SURGERY
Surgical treatment is considered only if conservative therapy does not provide effective relief after 12 months. There are two surgeries your surgeon may perform and will depend on your particular situation.