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 The ankle is a hinged joint capable of moving in two directions: away from the body (plantar flexion), and toward the body (dorsiflexion). It is formed by the meeting of three bones, the end of the shin bone of the leg (tibia) and a small bone in the leg (fibula) meet a large bone in the foot to form the ankle. The hard bony knobs on each side of the ankle are called the malleoli. These provide stability to the ankle, which function as the weight-bearing joints of the foot. The ankle joint is surrounded by fibrous tissue; tendons are attached to the large muscles of the leg and foot and wrap around the ankle both front and back. The normal ankle has the ability to move the foot in a flex-and-relax motion during use.
There are a myriad of conditions that might require treatment and/or surgery of the foot and ankle, such as sport injuries, degenerative disorders, and birth defects. After examination and review of your medical history, a physician will discuss possible methods of treatment for your problem, and let you know if surgery is necessary.
The information below highlights some of the most common procedures surgeons perform and is intended for informational purposes only.
Diabetic Foot Problems
Diabetes can be the cause of many foot-related problems. In general, nerve damage, which causes loss of feeling in the feet and legs, and/or vascular insufficiency, which delays or inhibits the diabetic’s ability to heal wounds are the two most typical causes for complications.
Fractures
A fracture is a broken bone. If not treated properly, a fracture can lead to long term disability. The bone may fail to heal (non-union) or it may heal in a poor alignment (mal-union). If a non-union or mal-union occurs, often times a surgical reconstruction is necessary.
The complex anatomical relationships of the multiple bones of the foot and ankle allow for pain free walking, running, jumping, etc. When a fracture of one of these 30 bones of the foot and ankle occurs it is essential to obtain a prompt evaluation for proper diagnosis and treatment. Some treatment methods may be non-operative and/or involved physical therapy. If surgical reconstruction of the fractured bone(s) of the foot and ankle is required, a rehabilitation program may also be included in your treatment plan.
Hammertoes
Hammertoe syndrome is a general term used to describe a series of symptoms and joint changes involving the lesser toes of the foot. Hammertoes most frequently involve the second toe; however, multiple toes can be involved. Hammertoes can be congenital (from birth), but usually are precipitated by improperly fitted shoes and/or hosiery; pressure or deforming force from adjacent toes, e.g., bunions, trauma, arthritis; or a neuromuscular disorder. Surgery becomes necessary when adequate pain relief and an acceptable level of comfort is not attained through non-surgical means.
Neuromas
A neuroma is an irritative process of a nerve branch. An inflamed, irritated nerve that supplies sensation to the third and fourth toes is called a Morton’s neuroma and is the most common neuroma. Numbness and burning are generally consistent findings and pain may vary from mild to severe. After examination and analysis of your situation, our surgeon will discuss possible methods of treatment and let you know if surgery is necessary based on the severity of your condition.
Tendinitis
Tendons attach the muscle to the bone in our bodies. It is through tendons that the muscles of the foot and ankle react to allow us to perform the motions necessary for walking.
Injuries to tendons usually start with an inflammation of the lining of the tendon that lead to inflammation within the tendon (tendinitis). Typically, both of these conditions are initiated by overuse of the secondary tendons or over-activity or increased stress on the tendon. If left untreated, tendinitis can lead to a tearing within the tendon or a complete rupture of the tendon. If properly treated early with rest, activity modifications, directed physical therapy and proper medication, the problem can be resolved completely. If untreated, long term structural abnormalities, such as flat foot, can result. Surgery may be necessary in order to regain the normal pain free function of the foot and ankle in these cases.
Surgery
When possible, arthroscopic surgery is preferred by surgeons because traditional inpatient surgical techniques tend to produce significant loss of motion after the recovery, as well as a longer recovery period. In contrast, arthroscopic surgery is usually successful in restoring almost all motion in the surgical area and producing a shorter recovery period. Depending on your situation and diagnoses by your physician, surgery performed arthroscopically may be an option for you. If surgery is required your doctor will discuss surgical expectations and recovery based on your particular situation.
If non-surgical methods cannot correct you condition, your doctor may suggest surgery. The type of surgery you have, and your doctor’s recommendations, will determine how soon you can begin moving and walking again after the surgery. Arthroscopic surgical patients may go home in a few hours after surgery, but will need to arrange to have someone drive them home because the pain medications and anesthesia are likely to make them sleepy.
Physical therapy is an extremely important part of the success of any surgery and full participation by the patient is necessary for optimal outcome. Some degree of pain, discomfort, and stiffness can be expected during the early days of physical therapy. Patients will start walking using a walker and/or crutches depending on the type of surgery they have had.
A number of home exercises are given to strengthen the muscles. The medical staff and therapist will teach you proper movements and exercises to do so that your foot and ankle heals properly. Whether you’re recovering at home or in a rehabilitation facility, sit and move the way you were taught by the physical therapist. Return to activity slowly. Practice walking a little every day and soon you’ll be able to walk without aid. Don’t be surprised if you feel a little stiff at first, it may take a few months for complete recovery. It is very important to keep all your scheduled follow-up visits with your surgeon.
For information on Chesapeake Orthopaedic & Sports Medicine Center physicians that specialize in the treatment of the foot and ankle, click below.
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