Welcome to Advanced Ankle & Foot
Before and After Gallery
Left Ankle Fracture Repair
Bunion and Hammertoe Surgery
Bilateral Pediatric Clubfoot Surgery
Medical Terminology for Ankle and Feet
• Trauma, as in a foot or ankle sprain
• Chronic irritation from shoes or other footwear rubbing against the extra bone
• Excessive activity or overuse
Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular.
Achilles tendon ruptures are most often seen in “weekend warriors” – typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.
• Increased warmth and redness of the skin
Inflammation can be acute or chronic. When it is acute, it occurs as an immediate response to trauma (an injury or surgery), usually within two hours. When it is chronic, the inflammation reflects an ongoing response to a longer-term medical condition, such as arthritis.
The most common form of ankle arthritis is osteoarthritis.
Similar symptoms may be caused by another form of arthritis, rheumatoid arthritis.
Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.
Initial treatment may consist of rest, ice, elevation, and immobilization, but may also include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, physical therapy, and cortisone injection. A foot and ankle surgeon can best determine the cause of the ankle pain and appropriate treatment options.
Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.
Pain across the bottom of the foot at any point between the heel and the ball of the foot is often referred to as “arch pain.” Although this description is non-specific, most arch pain is due to strain or inflammation of the plantar fascia (a long ligament on the bottom of the foot). This condition is known as plantar fasciitis and is sometimes associated with a heel spur.
In most cases, arch pain develops from overuse, unsupportive shoes, weight gain, or acute injury. If arch pain persists beyond a few days, see a foot and ankle surgeon for treatment to prevent this condition from becoming worse.
Fungal infections are more common in warm weather when feet tend to sweat more. Fungus thrives in damp areas such as swimming pools, showers, and locker rooms. Athletes commonly have sweaty feet and use the facilities where fungus is commonly found, thus the term “athlete’s foot.”
Although it is very rare, a more serious cause of black toenails is malignant melanoma. Since early diagnosis and treatment of melanoma improves the chances for a good outcome, it is important that all black toenails be evaluated by a qualified foot and ankle surgeon to rule out this cause.
Bone generally takes 6 to 8 weeks to heal to a significant degree. In general, children’s bones heal faster than those of adults. The foot and ankle surgeon will determine when the patient is ready to bear weight on the area. This will depend on the location and severity of the fracture, the type of surgical procedure performed, and other considerations.
Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.
Calcaneal apophysitis is also called Sever’s disease, although it is not a true “disease.” It is the most common cause of heel pain in children, and can occur in one or both feet.
Calf pain can result from many different causes. Sometimes something as simple as over-activity causes muscle strain in the calf. Or, dietary imbalances may cause cramping in the calf.
However, calf pain may be a symptom of more serious problems as well. Poor blood flow to the legs (peripheral vascular disease, or PVD) may cause cramping in the calf while walking or when sitting with the legs elevated. A blood clot in the calf (deep vein thrombosis or DVT), a very serious problem, also produces pain in the c
There are a number of treatments for painful calluses. People who have calluses are cautioned against performing “bathroom surgery,” as this can lead to cuts and infection. A foot and ankle surgeon can evaluate the cause of the calluses and recommend the treatment most appropriate for your condition. However, if the underlying cause of the callus is not treated or removed, the callus may return.
Although capsulitis can also occur in the joints of the third or fourth toes, it most commonly affects the second toe. This inflammation causes considerable discomfort and, if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe. Capsulitis—also referred to as predislocation syndrome—is a common condition that can occur at any age.
Charcot foot is a very serious condition that can lead to severe deformity, disability, and even amputation. Because of its seriousness, it is important that patients with diabetes—a disease often associated with neuropathy—take preventive measures and seek immediate care if signs or symptoms appear.
When the skin of the foot comes into contact with the substance, an allergic response is initiated. Symptoms, including redness, itchiness, and small blisters, usually occur within 24 hours of exposure to the irritant. The symptoms should be evaluated by a foot and ankle surgeon for proper diagnosis and treatment.
People with foot deformities, such as hammertoes, often suffer from corns because the tops of the bent toes rub against the tops of shoes.
Heels should be kept well moisturized with a cream to help reduce the cracking. If an open sore is noted, make an appointment with a foot and ankle surgeon for evaluation and treatment.
Having diabetes increases the risk of developing a wide range of foot problems. Furthermore, with diabetes, small foot problems can turn into serious complications.
The foot and ankle surgeon may measure the diabetic patient’s foot and have the shoes made at a specialty laboratory. In some cases he/she will give the patient a prescription to have the shoes custom-made.
Eczema can occur on any part of the body including the foot. It occurs in both children and adults and is not contagious. There is no known cause for eczema, but it often affects people with a family history of allergies.
People with equinus develop ways to “compensate” for their limited ankle motion, and this often leads to other foot, leg, or back problems. The most common methods of compensation are flattening of the arch or picking up the heel early when walking, placing increased pressure on the ball of the foot. Other patients compensate by “toe walking,” while a smaller number take steps by bending abnormally at the hip or knee.
Most cases of “fallen arches” develop when the main arch-supporting tendon (the posterior tibial tendon) becomes weakened or injured, causing the arch to gradually become lower. With time, the shape of the foot changes and secondary symptoms start to appear.
Hygiene is very important to help prevent smelly feet. Feet should be washed daily with soap and water and clean dry socks worn. Some synthetic materials used in shoes, when mixed with sweat and bacteria, can produce smelly feet.
The foot and ankle surgeon will recommend one of a variety of treatments for this condition.
The calcaneus is often compared to a hard boiled egg, because it has a thin, hard shell on the outside and softer, spongy bone on the inside. When the outer shell is broken, the bone tends to collapse and become fragmented. For this reason, calcaneal fractures are severe injuries. Furthermore, if the fracture involves the joints, there is the potential for long-term consequences such as arthritis and chronic pain.
• Avulsion fracture
In an avulsion fracture, a small piece of bone is pulled off the main portion of the bone by a tendon or ligament. This type of fracture is the result of an injury in which the ankle rolls. Avulsion fractures are often overlooked when they occur with an ankle sprain.
• Jones fracture
Jones fractures occur in a small area of the fifth metatarsal that receives less blood and is therefore more prone to difficulties in healing. A Jones fracture can be either a stress fracture (a tiny hairline break that occurs over time) or an acute (sudden) break. Jones fractures are caused by overuse, repetitive stress, or trauma. They are less common and more difficult to treat than avulsion fractures.
A ganglion cyst is a sac filled with a jellylike fluid that originates from a tendon sheath or joint capsule. The word “ganglion” means “knot” and is used to describe the knot-like mass or lump that forms below the surface of the skin.
GanglionGanglion cysts are among the most common benign soft-tissue masses. Although they most often occur on the wrist, they also frequently develop on the foot – usually on the top, but elsewhere as well. Ganglion cysts vary in size, may get smaller and larger, and may even disappear completely, only to return later.
This disorder can be very troubling and even disabling, since we use the big toe whenever we walk, stoop down, climb up, or even stand. Many patients confuse hallux rigidus with a bunion, which affects the same joint, but they are very different conditions requiring different treatment.
Hammertoe2Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.
Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is able to distinguish between all the possibilities and determine the underlying source of your heel pain.
If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if the toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.
• Crutch pad distance from armpits:
The crutch pads (tops of crutches) should be 1½” to 2″ (about two finger widths) below the armpits, with the shoulders relaxed.
Place it so your elbow is slightly bent – enough so you can fully extend your elbow when you take a step.
• Crutch length (top to bottom):
The total crutch length should equal the distance from your armpit to about 6″ in front of a shoe.
Joint pain may be caused by trauma, infection, inflammation, arthritis, bursitis, gout, or structural foot problems. It is initially treated with rest, elevation and limitation of walking/weight bearing on the painful foot. Use of non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and ice can help to reduce local inflammation and pain. Custom orothotic devices may also be prescribed to support the foot and reduce pain.
A foot and ankle surgeon can best determine the cause of joint pain and recommend the appropriate treatment.
Joint swelling may also result from inflammatory, degenerative, traumatic, infective, or crystal-forming joint diseases, such as gout. If joint swelling persists, a foot and ankle surgeon can best determine the cause and recommend the appropriate treatment.
The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.
Toenail fungus often begins as an infection in the skin called tinea pedis (also known as athlete’s foot). The fungus often starts under the nail fold at the end of the nail. Over time it grows underneath the nail and causes changes to its appearance, such as a yellow or brownish discoloration. It can also cause thickening and deformity of the toenail.
Many people have difficulty with their toenails and need assistance in caring for them. A foot and ankle surgeon can diagnose the cause of toenail problems and recommend treatments.
Os trigonum syndrome is usually triggered by an injury, such as an ankle sprain. The syndrome is also frequently caused by repeated downward pointing of the toes, which is common among ballet dancers, soccer players and other athletes.
Osteoarthritis is also known as degenerative arthritis, reflecting its nature to develop as part of the aging process. As the most common form of arthritis, osteoarthritis affects millions of Americans. Some people refer to osteoarthritis simply as arthritis, even though there are many different types of arthritis.
Pediatric flatfoot can be classified as symptomatic or asymptomatic. Symptomatic flatfeet exhibit symptoms such as pain and limitation of activity, while asymptomatic flatfeet show no symptoms. These classifications can assist your foot and ankle surgeon in determining an appropriate treatment plan.
The presence of P.A.D. may be an indication of more widespread arterial disease in the body that can affect the brain, causing stroke, or the heart, causing a heart attack.
The main function of the peroneal tendons is to stabilize the foot and ankle and protect them from sp
Definitive causes for this condition have not been clearly identified.
PTTD is often called “adult acquired flatfoot” because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn’t treated early.
Puncture wounds are common in the foot, especially in warm weather when people go barefoot. But even though they occur frequently, puncture wounds of the foot are often inadequately treated. If not properly treated, infection or other complications can develop
There is no known test to diagnose the problem; instead, the foot and ankle surgeon considers the individual’s history to determine possible causes of the symptoms.
RA causes inflammation in the lining (synovium) of joints, most often the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness, and a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity, and disability.
Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe “pushes off” during walking and running. The sesamoids also serve as a weight-bearing surface for the first metatarsal bone (the long bone connected to the big toe), absorbing the weight placed on the ball of the foot when walking, running, and jumping.
This condition usually occurs bilaterally (both legs) and can be alleviated by rest, use of non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, icing, a change in training habits, stretching exercises, and properly fitted shoes. A foot and ankle surgeon can treat the condition, recommend proper shoe gear, and evaluate whether orthotics are needed. If not treated, shin splints may eventually result in a stress fracture of the shin bone.
These devices can range from generic over-the-counter inserts to prescription devices custom made for the individual’s foot and/or foot problem.
Pain, swelling, redness, and possibly bruising can be signs of a stress fracture. The fracture can occur almost anywhere in the foot. X-rays and other studies are used to diagnose the stress fracture. A foot and ankle surgeon should be seen as early as possible to start treatment and possibly shorten the recovery time.
Possible treatments include rest and possible immobilization of the foot. In some cases, surgery may be required to stabilize the stress fracture or to repair a stress fracture that has progressed to a fracture.
Athlete’s foot or smelly feet may accompany sweaty feet. The foot and ankle surgeon can recommend one of a variety of treatments for this condition.
The foot and ankle surgeon will recommend treatment based on examination and diagnosis of the cause of the swelling.
The foot and ankle surgeon will recommend treatment based on examination and diagnosis of the cause of the swelling.
Tailor’s bunions are not as common as bunions, which occur on the inside of the foot, but they are similar in symptoms and causes.
The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). “Osteo” means bone and “chondral” refers to cartilage.
Talar dome lesions are usually caused by an injury, such as an ankle sprain. If the cartilage doesn’t heal properly following the injury, it softens and begins to break off. Sometimes a broken piece of the damaged cartilage and bone will “float” in the ankle.
The tarsal bones include the calcaneus (heel bone), talus, navicular, cuboid, and cuneiform bones. These bones work together to provide the motion necessary for normal foot function.
Thick toenails can also be seen in individuals with nail fungus (onychomycosis), psoriasis, and hypothyroidism. Those who have problems with the thickness of their toenails should consult a foot and ankle surgeon for proper diagnosis and treatment.
Diabetes is one of the most common medical conditions with which “tingly feet” can be associated. A thorough evaluation by a foot and ankle surgeon is advised to determine the cause of “tingly feet.”
A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room.
Although this injury is most commonly reported in football players, participants in soccer, basketball, wrestling, gymnastics and dance also are at risk.
The condition can cause swelling of the legs, ankles, and feet. The skin may become discolored due to leakage of blood into the surrounding tissues, and ulcers may form on the skin. The foot and ankle surgeon may advise use of compression stockings or other treatments.
When an ankle is injured, it may take a few weeks to many months to fully heal. Often, the injured ankle remains weaker and less stable than the uninjured one. A foot and ankle surgeon can assess ankle stability and may obtain medical imaging studies to evaluate the ankle for further damage.
Treatment for weak ankles usually includes physical therapy and bracing. Surgery may be recommended depending on the degree of instability and the response to non-surgical approaches.
Trauma, such as when an object is dropped on a toenail, often causes bleeding under the nail because of blood vessels being broken. This would cause a black toenail. If the trauma does not cause broken blood vessels, a white spot may appear under the nail. The spot will slowly grow out with the normal growth of the toenail.
Other potential causes for yellow discoloration of the nail include diabetes mellitus and lymphedema (chronic leg swelling). Yellow staining of the nails can also occur in individuals who use nail polish. A stained nail may take several months to grow out.