Ankle & Foot Conditions


Ankle and Foot Centers of North Georgia seeks to provide the highest level of care to keep our patients healthy and active on their feet. We always strive to cure our patients with conservative methods first, offering minimally-invasive procedures when needed utilizing the latest technologies in surgery to promote healing, shorten recovery times, and return our patients to activity as soon as possible.


Achilles Tendinitis

Achilles Tendinitis is a condition that occurs when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. The heel pain is rarely caused by an injury, and is most often occurs due to overuse of the foot. Tendinitis due to overuse is most common in younger people, walkers, runners or other athletes, and can be more likely to occur if the calf muscles are not stretched, you run on hard surfaces, you do not have shoes with proper support or you suddenly increase the amount or intensity of an activity. Tendinitis from arthritis is more common in middle-aged and elderly people, and a bone spur can sometimes form in the back of the heel one, irritating the Achilles tendon and causing pain or swelling.


Symptoms

  • Symptoms include pain in the heel and along the tendon when walking or running. The area may feel painful and stiff in the morning.
  • The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on one toe.

Treatment:

Changes in activity typically help manage symptoms, such as decreasing the activity that causes you pain, running or walking on smoother or softer surfaces, or switching to activities that put less stress on the Achilles tendon. It is important to remember that it may take at least 2 or 3 months for the pain to go away. Icing the affected area for 15 to 20 minutes two to three times per day, stretching and nonsteroidal anti-inflammatory drugs can also help reduce can also help relieve pain and reduce swelling. Your doctor may suggest changes in your footwear such as a brace or boot to keep the tendon still, heel lifts to place in the shoe, or shoes that are softer in areas over and under the heel cushion. If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue or the bone spur that is irritating the tendon.

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Achilles Tendon Rupture

An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. It can occur from landing hard on your heel, pivoting, sudden accelerations, or from falling or tripping, and is typically seen in middle-aged athletes who participate in sports in their free time.


Symptoms of an Achilles Tendon Rupture Include:

  • Hear a snapping, cracking, or popping sound and feel a sharp pain in the back of your leg or ankle
  • Have trouble moving your foot to walk or go up stairs
  • Have difficulty standing on your toes
  • Have bruising or swelling in your leg or foot

Most injuries can be diagnosed during a physical exam. Your foot and ankle surgeon will ask questions about how and when the injury occurred, examine the site of the injury and evaluate the range of motion and strength compared to the uninjured foot and ankle. You may need an MRI scan to see what type of Achilles tendon tear you have. Treatments can include non-surgical and surgical approaches, and depend on the severity of the injury.


Nonsurgical

For a partial tear, instead of surgery, you may need to wear a cast, leg brace, splint, or boot for about 6 weeks. During this time, your tendon grows back together.

  • If you have a cast, it will cover your foot and go to your knee. Your toes will be pointing downward. The cast will be changed every 2 to 3 weeks to help stretch your tendon.
  • If you have a leg brace, splint, or boot, it will keep you from moving your foot. This will prevent further injury. You can walk once your doctor instructs that you can.

Surgical

Surgery to repair an Achilles tendon is done if the tendon has been completely torn. Numerous techniques are available to repair the ruptured tendon, and the procedure used will be best suited to the patient. After surgery, the foot and ankle will be immobilized in a cast or walking boot until the tendon heals. Your doctor will instruct you when you may bear weight on the injured foot again.


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Ankle Arthroplasty


See Total Ankle Replacement


Bunion

A bunion is when your big toe points toward the second toe. This causes a bump to appear on the outside edge of your toe. Bunions are more common in women and can sometimes run in families. People born with abnormal bones in their feet are more likely to form a bunion.

Bunion Removal
  • Wearing narrow-toed, high-heeled shoes may lead to the development of a bunion.
  • The condition may become painful as the bump gets worse, and extra bone and a fluid-filled sac grow at the base of the big toe.

Symptoms

  • Red, calloused skin along the inside edge of the big toe
  • A bony bump at this site
  • Pain over the joint, which pressure from shoes makes worse
  • Big toe turned toward the other toes

Treatment:
When a bunion first begins to develop, take good care of your feet.

  • Wear wide-toed shoes. This can often solve the problem and prevent you from needing more treatment.
  • Wear felt or foam pads on your foot to protect the bunion, or devices called spacers to separate the first and second toes. These are available at drugstores.
  • Try cutting a hole in a pair of old, comfortable shoes to wear around the house.

If the bunion gets worse and more painful, surgery to realign the toe and remove the bony bump (bunionectomy) can be effective. There are more than 100 different surgical procedures to treat this condition. Not every bunion is the same, nor is every bunion surgery the same. We take an individualized approach to each patient’s condition.

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Hammertoe

Hammer toe is a deformity of the toe, in which the end of the toe is bent downward into a claw-like position. The most common cause of hammer toe is wearing short, narrow shoes that are too tight, which force the toe into a bent position. At first, you may be able to move and straighten the toe. Over time, you will no longer be able to move the toe and it will be painful.

Hammertoe

Symptoms:

  • Pain when walking or wearing shoes
  • Corn formation on the top of the toe
  • Calluses present at the sole of the foot

Treatment:
Wearing the right size shoes and avoiding high heels can relieve symptoms associated with hammer toe. For people with severe hammer toe, surgery may be required. This involves cutting of bone and/or moving tendons and ligaments in the foot. Patients are able to go home the same day as surgery.

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Lisfranc Injuries

A Lisfranc injury is characterized as a sprain, dislocation or fracture at the point where the metatarsal bone (long bones that lead up to the toes) and the bones in the arch of the foot connect. The Lisfranc ligament is a band of tissue that joins these two bones, and is important for maintaining proper alignment of the foot. Injuries to this joint typically occur as a result of a direct or indirect force to the foot, and can occur if something falls on the foot, or if the foot twists. Lisfranc injuries are common in runners and participants in contact sports.


There are three types of Lisfranc injuries, and they may sometimes occur together.


  • Sprain
  • Fracture
  • Dislocation

Symptoms:

  • Swelling of the foot
  • Pain throughout the middle of the foot when standing
  • Inability to bear weight
  • Abnormal widening of the foot
  • Bruising or blistering on the arch of the foot or the top of the foot

If you have symptoms of a Lisfranc injury, it is important to see a foot and ankle surgeon as soon as possible. Lisfranc injuries can be mistaken for ankle sprains, making proper diagnosis extremely important. Your foot will be examined, and imaging studies may be necessary to fully evaluate the extent of the injury. In severe cases, surgery may be needed to treat the injury, and the most severe cases may require emergency surgery.


Chronic Ankle Instability

Chronic ankle instability occurs after repeated ankle sprains or following a sprain that has not healed properly. It is characterized as a giving-way of the outer side of the ankle, and can occur while you are walking, or in severe cases, while you are standing still. Repeated ankle sprains often cause greater instability, as each sprain leads to further weakening of the ligaments and greater likelihood of developing additional problems of the ankle. People who suffer from chronic ankle instability typically experience:


  • A repeated turning of the ankle, especially on uneven surfaces or while participating in sports
  • Chronic discomfort and swelling
  • Pain or tenderness of the ankle
  • The ankle feeling unstable

While diagnosing and evaluating chronic ankle instability, your foot and ankle surgeon will ask you about any previous injuries, and will check your ankle for tenderness, swelling and instability. An X ray is somethings used for further evaluation. Treatment depends on the level of severity of the condition, and can include either surgical or nonsurgical treatments.


Nonsurgical treatments typically include:

  • Physical Therapy – treatments and exercises to strengthen the ankle, as well as restore balance and range of motion.
  • Bracing – your doctor may have you wear an ankle brace to support the ankle and keep it from turning
  • Medications – nonsteroidal anti-inflammatory cases may be prescribed to reduce pain and swelling

Surgery:

If your condition does not respond to nonsurgical treatments, or if the injury is severe, surgery may be needed to repair the damaged ligaments. Your surgeon will select the best procedure based on your activity level and severity of the injury.


Ankle Sprain

A sprain occurs when the foot lands awkwardly, causing some ligaments to pull, stretch and tear. When the injury occurs to the middle part of the foot, it is called a foot sprain. Ankle and foot sprains are among the most common types of injuries, especially among athletes.


Symptoms:

  • Pain and difficulty when walking
  • Swelling and bruising of affected part of the foot or ankle.
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Treatment:
Treatment for mild sprains is conservative and usually just involves resting, compressing, elevating and icing the affected area. Oral medications, such as ibuprofen, may also be used to help reduce inflammation. For more serious sprains, temporary bracing may be used to help reduce inflammation and help hold ligaments in place to heal properly. A brief course of physical therapy has also been shown to help in recovery. More serious injuries such as fractures of the foot and ankle can often be mistaken as common sprains. If your condition does not improve or you begin to experience increased pain, swelling, bruising, and difficulty walking, it is important to seek out care immediately.


Tendon Repair

Tendon repair is surgery to repair damaged or torn tendons to bring back normal function of joints or surrounding tissues. The surgeon makes a cut on the skin over the injured tendon. The damaged or torn ends of the tendon are sewn together.


If the tendon has been severely injured, a tendon graft may be needed.

  • In this case, a piece of tendon from the foot, toe, or another part of the body is often used.
  • If needed, tendons are reattached to the surrounding tissue.
  • The surgeon examines the area to see if there any injuries to nerves and blood vessels. When complete, the wound is closed.

Tendon repairs can often be done in an outpatient setting. Hospital stays, if any, are short.

  • Healing may take 6 - 12 weeks. During that time the injured part may need to be kept still in a splint or cast. Typically, movement is returned gradually with therapy to protect the tendon as it heals.
  • Treatment after surgery is often needed to minimize scar tissue and maximize the use of the injured area.

If the tendon damage is too severe, the repair and reconstruction may have to be done at different times. The surgeon will perform one operation to repair part of the injury, and then allow the hand to heal for a few weeks. Another surgery will be later done to complete the reconstruction and repair the tendon.

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Plantar Fasciitis

Plantar Fasciitis is a condition that occurs when the thick band of tissue on the bottom of the foot is overstretched or overused, causing pain and making walking more difficult. It is seen in both men and women, and can be caused by foot arch problems, long distance running, a tight Achilles tendon, or shoes with poor arch support. The most common symptom is pain and stiffness in the bottom of the heel, and the pain can be worse in the morning when you take your first steps, after standing or sitting, while climbing stairs or after intense activity. The pain may develop slowly over time, or suddenly after intense activity.


Treatment:

Your health care provider will usually first recommend heel and foot stretching exercises, anti-inflammatories, night splints and wearing a different shoes. Steps to relieve pain may include icing the affected area and a heel cup or shoe inserts.


If these treatments do not work, your provider may recommend:

  • Wearing a boot cast
  • Custom-made shoe inserts (orthotics)
  • Steroid shots or injections into the heal
  • In severe cases, foot surgery may be needed to relieve pain.

While nonsurgical treatments almost always help improve the pain, treatment can last for several months before symptoms get better. Because some patients may need surgery to relieve pain, it is important to talk to your doctor about the best treatment options for you.


Flat Feet

Flat feet is a common condition in which the foot does not have a normal arch when standing. While normal in infants and toddlers until the joints and tissue develops, adults with flat feet may experience aches or become tired after standing for a long period of time. To diagnose, your health care provider will ask you to stand on your toes, the flat foot is called “flexible”. If the arch does not form with toe-standing, or there is pain, other tests may be needed such as CT scans to observe the bones in the foot, MRI scans for the tendons or an E-ray of the foot.


Treatment:

In older children and adults, flexible flat feet that are painless and do not cause problems do not need further treatment once a health care provider has evaluated them. If you have pain due to flexible flat feet, orthotics and arch-supporting shoes can help.


For tarsal coalition, treatment starts with rest and possibly a cast. If this does not help, surgery may be needed.


In the most severe cases, surgery may be needed to clean or repair the tendon, or fuse some of the joints into the correct position. This is the last option is some cases, however.



High Arch

A high arch is an arch in the foot that is raised more than normal. Much less common than flat feet, it is more likely to be caused by a bone or nerve condition. Unlike flat feet, highly arched feet tend to be more painful because more stress is placed on the section of the foot between the ankle and toes (metatarsals). Symptoms of this condition can include shortened foot length, difficulty fitting shoes, and foot pain when walking, standing and running, although not everyone has this symptom.


Your health care provider will check to see if the high arch is flexible, and tests may include:

  • Electromyography
  • Xray of the Feet

While corrective shoes may help relieve pain and include walking, surgery may be needed in severe cases.