Foot & Ankle Surgery

Overview

It is estimated that the average person will walk over 100,000 miles in their lifetime. Therefore it is important that everyone’s ankles and feet be strong and stable since constant impact of walking and running can really take its toll. It is also not surprising that the feet and ankles are some of the most frequently injured areas of the human body. Ankle and foot pain and injuries are very common.

Anatomy

The ankle of is made up of a convergence of three major bones, the talus, fibula, and tibia. The center bone of the ankle is called the talus. The talus bone has a large cartilage covering which allows the ankle to glide effortlessly across the cartilage of the large leg bone called the tibia. When these two bones meet they form the ankle joint. On the outside of the ankle is a smaller, thinner bone called the fibula. This bone helps prevent the tibia from shifting outward for stability and helps to keep your ankle at length.

*The stability of the ankle joint is dependent upon the ability of these bones to keep the central (talus) bone in place while the ankle moves back and forth. The joint is more stable when the foot is flat on the floor. However, when the toes are pointed down, the ankle becomes unstable because the distance between the bony stabilizers of the ankle becomes larger. Thus, the ankle relies more and more on the ligaments to provide stability. Since the ligaments are “softer” than bones, the ankle becomes more vulnerable to a sprain when the toes are pointed.

When an ankle twists, it is usually when the toes are pointed down. However, the ankle can be twisted while in any position. There are six major soft tissue structures that hold the ankle in place. Four of these are located on the outside part of the ankle and all attach to the fibula. Thus, all four of these ligaments have the word fibula in them. The most commonly injured ligament of the ankle is called the Anterior (meaning front) Talo-Fibular Ligament, or ATFL for short. This is the ligament that is most commonly torn in ankle sprains. The second most commonly torn ligament is the ligament connecting the heel bone to the fibula called the Calcaneo-Fibular Ligament. The third ligament again attaches the fibula to the back of talus called the Posterior (meaning back) Talo-Fibular Ligament. The fourth ligament connected to the fibula is the Tibiofibular Syndesmotic Ligament, which connects the fibula to the tibia. The soft tissue just in front of the ankle is the capsule of the ankle joint and helps keep the ankle from sliding forward along with the other ligaments. The final stabilizing ligament is on the inside part of the ankle. As this ligament forms a triangle shape like the Greek letter delta, it is called the
Deltoid Ligament. The deltoid ligament attaches the inner tibia to the talus.*

*Adapted from https://www.rothmaninstitute.com/specialties/foot-and-ankle

Conditions

Achilles Tendon Rupture

The Achilles tendon is the long tendon that connects the calf to the ankle. It also helps to move the foot up and down. When an Achilles tendon rupture occurs, it can be either partially torn or completely torn. Prompt evaluation should be sought out.

Ankle Sprains and Fractures

An ankle sprain usually occurs when one or more of the ligaments gets injured in the ankle. Ligaments in the ankle are bands of tissue, like rubber bands, that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement. The severity of an ankle sprain depends on whether the ligament is partially or completely torn and on the number of ligaments involved. Most ankle sprains occur on the outer aspect of the ankle. Some ankle sprains are worse than others.

Ankle Fractures

Common injuries and most often occur when the ankle rolls inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and require an accurate and early diagnosis. However, both can occur simultaneously. The ankle can have a wide array of injuries and the severity of the fracture can range from the small pieces of bone that have been pulled off (less-severe avulsion injuries) to more severe, shattering-type breaks of the tibia, fibula, or both.

Arthritis

Osteoarthritis of the ankle and foot usually occurs when the cartilage in the ankle joint wears away. This leaves the irregular bone and cartilage to rub against bone and causing pain. This condition is common in people over the age of 50, but can start at younger ages. Several diseases can result in arthritis, but trauma and rheumatoid disease are the most common causes in the ankle. Other inflammatory types of arthritis that can affect the foot and ankle are rheumatoid, inflammatory, gout, psoriasis, lupus (SLE), ankylosing spondylitis (AS), and Reiter’s syndrome.

Bunions

A condition where there is a malalignment of the first toe. Bunions are a common problem that most individuals experience as a painful swelling or a bony protuberance at the inner base of the big toe. These can also be hereditary or secondary to wearing high-heeled or
narrow toe-box shoes.

Claw and Hammer Toe

These deformities are common conditions that are primarily caused by the wearing of footwear that is too tight and fits poorly. Often, these deformities can be congenital or due to other problems.

Claw toes appear exactly as their name would suggest, like a closed fist. Because of the joint variations of the toes (big toes have two bones, the other toes have three), claw toes cannot occur in the big toe. Claw toes are usually the result of an imbalance in the your toe muscles and thus cause the tendons and ligaments to become tight. The cause of this imbalance can include neuromuscular disorders, rheumatoid arthritis, or other conditions. Because of this deformity, a rigid claw toe is very painful and has limited mobility.

There are two types of hammer toes and are classified on the degree of mobility found in the joint itself, flexible and rigid. A rigid hammer toe has minimal movement and can be painful. In contrast, a flexible hammer toe, does have the ability to move and can be straightened manually.

Flat Foot

Flat foot or “Flat feet” is a condition where the arch of the foot has collapsed along with your entire sole of the foot coming into direct contact with the ground. Causes of flat feet include tendon failure, bone structure, genetics, or a combination of these.

Usually there is no pain associated with flat feet. However, the condition may lead to misalignment to other structures of the feet. Pain may start to develop in the calf, lower back, and arch. In occurrences of severe flat feet, patients may have pain that makes moving and/or standing difficult. Prolonged standing or strenuous athletic activity usually worsens this pain.

Fracture Care

A fracture anywhere in the foot or ankle can be extremely painful. However, the talus is a bone that is an important part of the ankle joint. It helps to transfer weight and pressure forces across the ankle point. It is located between the tibia and fibula of the lower leg and the calcaneus or heel bone. The tibia and fibula are situated on top and around the sides of the talus and thus form the ankle joint. At the point where the talus meets the calcaneus, it forms the subtalar joint. This joint is essential for individuals walking on uneven ground.

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 your feet pound on hard surfaces from sports or shoes that irritate sensitive tissues, heel pain may develop, the most common problem affecting the foot and ankle. A sore heel will usually get better on its own without surgery given enough rest. However, many people try to ignore the early signs of heel pain and continue doing the activities that caused it. A sore heel will only get worse and could become a chronic condition leading to more problems.

Lisfranc Fracture

This injury is both a fracture and dislocation to the middle of the foot. This is a very important area of the foot as there are a group of small bones that form the arch shape of the foot. These bones are connected to each other in this arch shape by a group of ligaments called the Lisfranc ligaments. Injuries to these bones and Lisfranc ligaments are often caused by falls, twisting injuries, or heavy objects dropping on the foot. The most common problem that can develop in the long-term after these injuries is arthritis in the middle of the foot.

Posterior Tibial Tendonitis

This becomes a fairly common problem for the foot as we enter middle age. The posterior tibial tendon (PTT) itself runs along the inner aspect of the leg and ankle. It helps support the arch of the foot. Posterior tibial tendonitis occurs when this tendon becomes inflamed through overuse. In more severe cases, the inflammation can cause the tendon to tear. Most patients with this problem complain of pain at the inner ankle and arch. Some people may feel unsteady when walking. Without treatment, this condition can cause collapse of the arch and development of arthritis.

Tarsal Tunnel Syndrome

TTS is caused by a compression or squeezing on the posterior tibial nerve at the inner aspect of the ankle. This painful condition is often due to inflammation or injury. TTS is similar to carpal tunnel syndrome, where tarsal tunnel refers to the compression of a nerve in a confined space. The tarsal tunnel is an area created by the very strong ligament that covers a bony canal through which pass the major nerve, artery, vein, and tendons of the foot. Individuals who suffer from tarsal tunnel syndrome exhibit symptoms that include tingling, burning sensations, numbness, and shooting pain. These symptoms occur most often at rest or just before sleeping at night.

Treatments

Ankle & Foot

Achilles Tendon Repair Surgery
Ankle Sprain and Fracture Surgeries
Arthritis Surgery
Bunionectomy
Cheilectomy
Foot and Ankle Surgeries
Heel Pain Treatments
Non-Operative Ankle and Foot Treatments
Posterior Tibial Tendonitis Surgery
Total Ankle Replacement

 

Physicians