Rearfoot Conditions


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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Ankle 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

Ankle arthroplasty is surgery to replace the damaged parts of the three bones that make up the ankle joint. Your symptoms may be pain and loss of movement of the ankle, and the causes of the damage may include osteoarthritis, rheumatoid arthritis, infection, bone fracture or arthritis caused by ankle surgery in the past. Artificial joint parts are used to replace your own bones, and they come in different sizes for different sized people.

Ankle Arthroscopy

Treatment

  • Your surgeon will remove the damaged bone and will reshape three of your bones that will remain in place
    • The lower end of your shin bone (tibia)
    • The lower end of your smaller lower leg bone (fibula)
    • The top of your foot bone (talus) that the leg bones rest on
  • The parts of the new artificial joint are then attached to the cut bony surfaces. A special glue/bone cement may be used to hold them in place. Often, screws are also placed through the two leg bones (fibula and tibia) to help support the artificial ankle. A bone graft is created between the ends of the fibula and tibia. This makes your new ankle more stable.
  • After putting the tendons back into place, the surgeon closes the wound with sutures (stitches). You may need to wear a brace for a while to keep the ankle from moving.

After surgery, you will go home the same day. Your ankle will be in a cast or a splint after surgery. To keep swelling down, keep your foot raised higher than your heart while you are sleeping or resting. Your doctor may recommend physical therapy to teach you exercises that will help you move more easily.


A successful ankle replacement will get rid of your pain and allow you to move your ankle up and down. Usually, total ankle replacements last 10 or more years. How long yours lasts will depend on your activity level, overall health, and the amount of damage to your ankle joint before surgery.

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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.


Broken Ankle

Ankle fractures are partial or complete breaks in the bone, and can occur in tibia, fibula or both. They are most often caused by rolling the ankle inward or outward, and are commonly mistaken for an ankle sprain. Ankle fractures may include one or all of the following symptoms:


Symptoms

  • Pain at the site of the fracture
  • Significant swelling, sometimes occurring along the length of the leg
  • Blisters over the fracture site
  • Bruising that develops soon after the injury
  • Change in the appearance of the ankle

After an ankle injury, it is important for an evaluation by a foot and ankle surgeon for proper diagnosis. The limb will be examined by the foot and ankle surgeon, and xrays and other imaging studies may be ordered as well. Treatment depends on the severity of the injury.

Immobilization: Certain fractures can be treated by restricting the ankle and foot in a cast or splint to protect it and allow the bone to heal

Surgery: In severe cases, surgery may be needed to repair the fracture and any injuries to the soft tissue. Your surgeon will use a procedure most appropriate for your injury.



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