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Foot & Ankle

According to the Greek myth, Achilles was vulnerable only at his heel. It's a trait that he must have passed down to all other humans when he gave his name to the Achilles tendon, which connects the calf muscles to the heel bone.

The Achilles tendon is the largest tendon in the human body and can withstand forces of 1,000 pounds or more. But it is also the most frequently ruptured tendon, and both professional and weekend athletes can suffer from Achilles tendinitis, a common overuse injury and inflammation of the tendon.

Any number of events may trigger an attack of Achilles tendinitis, including:

Symptoms of Achilles tendinitis fall into a common pattern.

Because several conditions such as a partial tendon tear and heel bursitis have similar symptoms, you need to see your orthopaedic surgeon for a proper diagnosis.

Treatment depends on the degree of injury to the tendon, but usually involves

 

Surgery is often an option of last resort. If friction between the tendon and its covering sheath makes the sheath thick and fibrous, surgery to remove the fibrous tissue and repair any tears may be the best treatment option. Recovery is slow, may require a temporary cast and includes a rehabilitation program to avoid weakness.

You may not be able to prevent Achilles tendinitis, but here are six steps to reduce your risk of incurring an attack:


ACHILLES TENDON RUPTURE

Side View of Ruptured Achilles' Tendon. Notice depression at site of rupture

TREATMENT

The treatment options for a complete rupture of the tendon include surgery followed by casting, or casting alone. There are advantages and disadvantages to each technique and the options should be discussed with your physician. With surgery, the tendon is either reattached to the calcaneal bone (if it has been pulled off or avulsed) or the two ends are sewn together is the tendon has been torn in two.In most people, a cast is applied after surgery until healing is complete. Each patient must be considered individually. There are many reasons why a person may not be a suitable candidate for a surgical repair of the injury. These include, but are not limited to: poor circulation, presence of skin problems at the site of the injury, age, a sedentary lifestyle, other medical conditions that make the person a poor candidate for surgery (such as heart or lung problems). If the injury is treated non-operatively, then a cast is applied until healing is complete. The length of time required for healing is highly variable. Often it may take as long as six months for complete healing to occur.

Arthritis of the Foot and Ankle

There are more than 100 different types of arthritis. But when most people talk about arthritis, they are usually referring to the most common form, osteoarthritis ("osteo" means bone). Osteoarthritis develops as we age and is often called "wear-and-tear" arthritis. Over the years, the thin covering (cartilage) on the ends of bones becomes worn and frayed. This results in inflammation, swelling, and pain in the joint.

An injury to a joint, even if treated properly, can cause osteoarthritis to develop in the future. This is often referred to as traumatic arthritis. It may develop months or years after a severe sprain, torn ligament or broken bone.

Anatomy

There are 28 bones and over 30 joints in the foot. Tough bands of tissue, called ligaments, hold the bones and joints in place. If arthritis develops in one or more of these joints, your balance and walk may be affected. The foot joints most commonly affected by arthritis include:

Signs and symptoms
Signs and symptoms of arthritis of the foot vary, depending on which joint is affected. Common symptoms include pain or tenderness, stiffness or reduced motion, and swelling. Walking may be difficult.

Diagnosing arthritis of the foot and ankle

Your doctor will begin by getting your medical history and giving you a physical exam. Among the questions you may be asked are:

 

Your doctor may do a gait analysis. This shows how the bones in your leg and foot line up as you walk, measures your stride, and tests the strength of your ankles and feet. You may also need some diagnostic tests. X-rays can show changes in the spacing between bones or in the shape of the bones themselves. A bone scan, computed tomography (CT) scan, or magnetic resonance image (MRI) may also be used in the evaluation.

Treating your arthritis

Depending on the type, location and severity of your arthritis, there are many types of treatment available. Nonsurgical treatment options include:

If your arthritis doesn't respond to such conservative treatments, surgical options are available. The type of surgery that's best for you will depend on the type of arthritis you have, the impact of the disease on your joints, and the location of the arthritis. Sometimes more than one type of surgery will be needed. The primary surgeries performed for arthritis of the foot and ankle are:

Outcomes and rehabilitation

Initially, foot and ankle surgery can be quite painful, so you will be given pain relievers both in the hospital and after you are released. After surgery, you will have to restrict activities for a time. You may have to wear a cast and use crutches, a walker, or a wheelchair, depending on the type of surgery you had. Keeping your foot elevated above the level of your heart will be very important for the first week or so.

You will not be able to put any weight on your foot for at least four to six weeks, and full recovery takes four to nine months. You may also need to participate in a physical therapy program for several months to regain strength in the foot and restore range of motion. Usually, you can return to ordinary daily activities in three to four months, although you may have to wear special shoes or braces. In the vast majority of cases, surgery brings pain relief and makes it easier for you to do daily activities.

Bunions

If the joint that connects your big toe to your foot has a swollen, sore bump, you may have a bunion. More than half the women in America have bunions, a common deformity often blamed on wearing tight, narrow shoes, and high heels. Bunions may occur in families, but many are from wearing tight shoes. Nine out of ten bunions happen to women. Nine out of ten women wear shoes that are too small. Too-tight shoes can also cause other disabling foot problems like corns, calluses and hammertoes.

With a bunion, the base of your big toe (metatarsophalangeal joint) gets larger and sticks out. The skin over it may be red and tender. Wearing any type of shoe may be painful. This joint flexes with every step you take. The bigger your bunion gets, the more it hurts to walk. Bursitis may set in. Your big toe may angle toward your second toe, or even move all the way under it. The skin on the bottom of your foot may become thicker and painful. Pressure from your big toe may force your second toe out of alignment, sometimes overlapping your third toe. An advanced bunion may make your foot look grotesque. If your bunion gets too severe, it may be difficult to walk. Your pain may become chronic and you may develop arthritis.

Relief from bunions

Most bunions are treatable without surgery. Prevention is always best. To minimize your chances of developing a bunion, never force your foot into a shoe that doesn't fit. Choose shoes that conform to the shape of your feet. Go for shoes with wide insteps, broad toes and soft soles. Avoid shoes that are short, tight or sharply pointed, and those with heels higher than 2 1/4 inches. If you already have a bunion, wear shoes that are roomy enough to not put pressure on it. This should relieve most of your pain. You may want to have your shoes stretched out professionally. You may also try protective pads to cushion the painful area.

If your bunion has progressed to the point where you have difficulty walking, or experience pain despite accomodative shoes, you may need surgery. Bunion surgery realigns bone, ligaments, tendons and nerves so your big toe can be brought back to its correct position. Orthopaedic surgeons have several techniques to ease your pain. Many bunion surgeries are done on a same-day basis (no hospital stay) using an ankle-block anesthesia. A long recovery is common and may include persistent swelling and stiffness.

Adolescent Bunion

Your young teenager (especially girls aged 10-15) may develop an adolescent bunion at the base of his or her big toe. Unlike adults with bunions, a young person can normally move the affected joint. Your teenager may have pain and trouble wearing shoes. Try having your child's shoes stretched and/or getting wider shoes. Surgery to remove an adolescent bunion is not recommended unless your child is in extreme pain and the problem does not get better with changes in shoe wear. If your adolescent has bunion surgery, particularly before they are fully grown, there is a strong chance his or her problem will return.

Bunionette

If you have a painful swollen lump on the outside of your foot near the base of your little toe, it may be a bunionette (tailor's bunion). You may also have a hard corn and painful bursitis in the same spot. A bunionette is very much like a bunion. Wearing shoes that are too tight may cause it. Get shoes that fit comfortably with a soft upper and a roomy toe box. In cases of persistent pain or severe deformity, surgical correction is possible.

Chronic Lateral Ankle Pain

Recurring or persistent (chronic) pain on the outer (lateral) side of the ankle often develops after an injury such as a sprained ankle. However, several other conditions may also cause chronic ankle pain.

Signs and symptoms

 

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