Achilles Tendon Disorders

Treatment of Achilles tendonitis or tendonosis depends on the severity of injury, and degree of damage to the tendon. Immobilization via cast or walking boot, icing for 20 minutes several times per day, and oral medications including NSAID’s may be utilized. A night splint may be recommended to help maintain a stretch in the Achilles tendon during sleep, and custom orthotic devices or physical therapy modalities may be beneficial. In some cases surgery may be needed to repair and restore the tendon, and your foot and ankle specialist can best advise you of options available in your particular case. To prevent recurrence you may be advised to utilize appropriate shoe gear and stretching exercises.

Acute Inflammation

R I C E therapy is the initial treatment for acute inflammation, in order to reduce pain and swelling. This consists of:

• R est - stay off the injured foot or ankle to avoid injury
• I ce - apply ice to the affected area for 20 minutes, several times per day
• C ompression - an elastic type wrap may be utilized to help reduce swelling
• E levation - the injured foot or ankle should be elevated to help reduce pain and swelling

Oral medications including NSAID’s may be utilized for discomfort, and symptoms of inflammation typically resolve in 2- 3 days. If pain persists your foot and ankle specialist can best advise you of treatment options for your particular case.

Ankle Fracture

Treatment for ankle fracture includes the R I C E protocol

• R est - stay off the injured foot or ankle to avoid injury
• I ce - apply ice to the affected area for 20 minutes, several times per day
• C ompression - an elastic type wrap may be utilized to help reduce swelling
• E levation - the injured foot or ankle should be elevated to help reduce pain and swelling

Immobilization via cast will allow the bone to heal, and prescription medications for pain control as well as anti-inflammatory medications may be advised. Some fractures require surgical repair and your foot and ankle specialist will advise you of the most appropriate treatment in your particular case.

Ankle Sprain

Ankle sprain is initially treated via the R I C E protocol:

• R est - stay off the injured foot or ankle to avoid injury
• I ce - apply ice to the affected area for 20 minutes, several times per day
• C ompression - an elastic type wrap may be utilized to help reduce swelling
• E levation - the injured foot or ankle should be elevated to help reduce pain and swelling

NSAID’s may be recommended to help reduce pain and swelling, or prescription medications may be utilized. In severe cases surgery may be needed to repair damaged ligaments. Rehabilitation following surgery is crucial to a successful outcome, and your foot and ankle specialist can best advise you according to your particular case.

Bunions

If bunions are not symptomatic, observation may be all that is needed. To ease the pain of bunions, treatments may include shoe gear changes to include a wide toebox, padding the bunion area, or custom orthotic devices to support and cushion the foot. Oral medications including NSAID’s may be utilized to help reduce pain and inflammation, and corticosteroid injections may be utilized to the inflamed bursa. If relief is not achieved with these treatments, surgery may be recommended to reduce pain. There are a variety of surgical options for treatment of bunions, and your foot and ankle specialist can best advise you of the options in your particular case.

Cavus Foot

Treatment of the cavus foot may include shoe modifications, custom orthotic devices to place in shoes to provide stability, or bracing to help stabilize the foot and ankle. If pain is not resolved utilizing these treatments, surgery may be needed to compensate for weakness, increase stability, and reduce pain. If an underlying neurologic problem is found, further surgery may be needed in the future due to the progression of this condition. Your foot and ankle specialist can advise you on the most appropriate course of treatment in your case.

Charcot Foot

Treatment for Charcot foot includes immobilization via cast or removable boot with crutches, for complete non-weight bearing to keep the foot from further collapse. Custom shoes or bracing may be recommended after bone healing, to help return to normal activities and help prevent recurrence. It is important to avoid repetitive trauma at both feet, as patients with Charcot in one foot often develop it in the other foot.

If Charcot is severe surgery may be advised, and your foot and ankle specialist can advise you of treatments available in your particular case. Daily inspection of feet, avoiding over-use during exercise or activities, and keeping blood sugar levels under good control can all help prevent Charcot foot and the complications associated with this condition.

Chronic Ankle Instability

Treatment for chronic ankle instability may include NSAID’s to reduce pain and inflammation, bracing for ankle support, and physical therapy modalities to strengthen the ankle and improve range of motion. If the instability is severe, or fails to respond to conservative treatment, surgery may be recommended. There are several surgical options available, and your foot and ankle specialist can best advise you of the appropriate treatment for your particular case.

Crossover Toe - Predislocation Syndrome

Early treatment before the second toe begins to drift toward the great to can help avoid need for surgical correction, and may include rest and ice, utilization of NSAID’s to reduce pain and inflammation, and wearing supportive shoes with a stiff sole to help control foot motion and lessen pressure to the ball of the foot. Taping and / or splinting to keep toe in correct position, or custom orthotic devices to help distribute weight away from the affected joint may be beneficial. Once the second toe begins to drift toward the great toe, surgical correction is needed to reposition the toe, and your foot and ankle specialist will advise you of the most appropriate treatment in your particular case.

Diabetic Complications and Amputation Prevention

It is important to have regular foot checkups with your foot and ankle specialist to keep any foot problems from worsening. Daily foot inspection and keeping toenails appropriately trimmed is important, as well as avoiding going barefoot to protect feet. Your should check shoes and socks, and make sure socks are not “bunched up”. Report any leg pain you have at rest to your foot and ankle specialist, as this could be a sign of a blocked artery. Your doctor may advise testing for circulation and feeling to your feet. Sometimes amputation is necessary even with good preventative care, to remove infected tissue, or save limb or life.

Diabetic Foot Care Guidelines

Diabetes may reduce blood flow to feet, or cause nerve damage resulting in reduced feeling to the feet. A blister or injury caused by a foreign object may become infected, possibly resulting in a non-healing wound that could put you at risk for amputation. It is important to inspect your feet daily for any problems, and inspect your shoes for foreign objects. Keep toenails appropriately trimmed, but do not attempt to trim corns or calluses yourself, and avoid walking barefoot to protect your feet. Moisturize feet to keep skin from drying and cracking, but avoid the area in-between toes to keep from fungal infection, and always wear appropriate socks without tight bands that may reduce circulation. See your foot and ankle specialist for regular foot examinations, and keep blood sugar levels under good control. Don’t smoke, as smoking does restrict blood flow to the feet.

Diabetic Periperal Neuropathy

Good blood sugar control is primary in treating diabetic peripheral neuropathy. Medications to help control tingling and burning symptoms are available, and physical therapy modalities may help reduce balance problems or other symptoms. It is important to wear appropriate shoes to avoid pressure sores, and to inspect feet daily for any problems. Regular diabetic foot checkups can help prevent diabetic foot complications, as will regular visits with your primary care physician or endocrinologist

Equinus

There are various treatments for the symptoms of equinus, including heel lifts to wear in shoes to take stress of the Achilles tendon while walking, arch supports or custom orthotic devices to help appropriately distribute weight and provide support, and night splints to help reduce tightness of the calf muscle. Physical therapy modalities to help stretch the calf may be beneficial. If the equinus is caused by a tight tendon or a bone blocking ankle motion, surgery may be recommended. Your foot and ankle specialist can best advise you of the most appropriate course of treatment for your case.

Extracorporeal Shock Wave Therapy

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Flexible Flatfoot

Symptoms of flexible flatfoot are treated with activity modification to avoid prolonged walking and standing, shoe modifications with appropriate arch support, and NSAID’s to help reduce pain and inflammation. Immobilization is sometimes needed to avoid weight bearing, and physical therapy modalities may provide relief. Custom orthotics can provide support to the arches but if pain is not adequately relieved with these modalities, surgery may be recommended to correct the flatfoot. There are several options available to relieve symptoms and improve foot function, and your foot and ankle specialist will advise you of the most appropriate course for your particular case.

Fractures of the Fifth Metatarsal

Fractures of the fifth metatarsal should be treated initially utilizing the R I C E protocol. This includes:

• R est - stay off the injured foot or ankle to avoid injury
• I ce - apply ice to the affected area for 20 minutes, several times per day
• C ompression - an elastic type wrap may be utilized to help reduce swelling
• E levation - the injured foot or ankle should be elevated to help reduce pain and swelling

Your foot and ankle specialist may advise immobilization with crutches for complete non-weight bearing, as well as a bone stimulator to speed healing of some types of fracture, such as a Jones type fracture. If multiple breaks are present, there is displaced bone, or failure to heal appropriately, surgery may be required. Your foot and ankle specialist will advise you of the most appropriate course in your case.

Ganglion Cyst

Treatment for ganglion cyst depends on the symptoms present. If a cyst causes no pain or difficulty with shoe gear or ambulation, observation may be all that is needed, to monitor growth or change. Shoe gear modification including padding to relieve pressure on the cyst is often beneficial, and aspiration and corticosteroid injection can help relieve pain and may provide resolution, although ganglion cysts can always recur. If these treatments do not provide adequate relief, surgery may be recommended to excise the cyst. Your foot and ankle specialist will advise you of the options available for your particular case.

Gout

Treatment of gout may initially include prescription medications to treat pain, swelling, and inflammation, and immobilization of the affected foot. Patients with gout should avoid foods high in purine, and following the gout diet as well as staying adequately hydrated is important in treating the symptoms of gout. Recurrent or frequent gout attacks often require maintenance treatment, and you should consult with your primary care physician regarding ongoing treatment for gout.

Haglund’s Deformity

Treatment for symptoms of Haglund’s deformity may include medications including NSAID’s to help reduce pain and inflammation, icing the heel for 20 minutes several times per day to help reduce swelling, and utilizing backless or shoes with a soft back to avoid irritation of the inflamed bursa. Stretching exercises for the tendo-Achilles may be beneficial, and heel lifts placed in shoes may help decrease pressure on the affected heel. Custom orthotic devices or physical therapy modalities may be recommended. If pain is not relieved with conservative treatments, surgery may be advised to provide adequate pain relief. Your foot and ankle specialist can advise you on the most appropriate course of treatment in your particular case.

Hallux Rigidus

Treatment for mild hallux rigidus may include utilizing shoes with a large toebox or stiff soled shoes, custom orthotics to place in shoes to improve foot function, and medications including NSAID’s to reduce pain and inflammation. Corticosteroid injection may be administered to reduce inflammation, and physical therapy modalities including ultrasound may provide relief. With severe hallux rigidus surgery may be needed to eliminate or reduce pain, and there are several surgical options available for this condition. Your foot and ankle specialist will advise you of the options available for your particular case.

Hammertoes

Treatment for hammertoes may include padding to protect areas of corns or calluses, use of medications such as NSAID’s for reduction in inflammation and pain, and splinting or strapping to realign the affected toe. Custom orthotics may help control muscle / tendon imbalance, and corticosteroid injection therapy may be beneficial to reduce pain and inflammation. In severe cases surgery may be advised to correct the hammertoe (s) and your foot and ankle specialist can best advise you of the appropriate procedures available for your particular case.

Heel Pain

There are several treatments you can utilize for heel pain, including icing the painful heel for 20 minutes several times per day, using NSAID’s to help reduce pain and inflammation, and wearing supportive shoes with a slightly raised heel to reduce stress on the plantar fascia. Your should avoid walking barefoot as this puts strain and stress on the plantar fascia, and reduce activities to rest the painful heel. If pain is not resolved utilizing these treatments, your foot and ankle specialist may recommend padding or strapping, custom orthotic devices, or corticosteroid injection to held reduce inflammation and pain. Wearing a night splint to maintain stretch to the plantar fascia while sleeping as well as physical therapy modalities may provide pain relief. If these treatments do not afford adequate pain relief, surgery may be recommended, and your foot and ankle specialist can best advise you of treatment options in your particular case.

Ingrown Toenail

You may treat an ingrown toenail at home with warm water / Epsom Salts soaks and gentle massage to the affected nail fold to help reduce inflammation. An infected ingrown toenail should be treated by your foot and ankle specialist, and self-treatment is not recommended. Your foot and ankle specialist may perform a minor procedure utilizing local anesthetic to remove the offending nail border, and you may be prescribed antibiotics. You can help prevent ingrown toenails with proper nail trimming, trimming toenails straight across, and avoiding over-the-counter medications, which don’t correct the cause of ingrown toenail. Avoid repeated nail trimming and never utilize cotton under a toenail, as bacteria could collect and infection develop.

Lisfranc Injuries

Lisfranc injuries should be treated by a foot and ankle specialist, and initial treatment includes icing and elevation to help control pain and swelling. Your foot and ankle specialist may recommend immobilization via casting and crutches, use of NSAID’s to help reduce pain and inflammation, as well as ice and elevation.

Some Lisfranc’s injuries require corrective surgery, and is should be noted that a possible complication following Lisfranc’s surgery is compartment syndrome, which could require further surgery to prevent tissue damage. Arthritis and / or alignment problems are likely following a Lisfranc’s injury, and additional treatment may be needed.

Malignant Melanoma of the Foot

Any lesion of the foot with an irregular border, mixed color, asymmetric shape, or size larger than the size of a pencil eraser should be evaluated by your foot and ankle specialist, who may perform a biopsy to determine presence of melanoma. Early detection of malignant melanoma is crucial, and precautions include using adequate sunscreen on feet, utilizing water shoes or socks, daily inspection of both feet, and reporting any discoloration underneath a toenail to your foot and ankle specialist.

Morton’s Neuroma

Treatment for Morton’s neuroma include padding the decrease pressure on the affected nerve, icing to reduce swelling, and use of NSAID’s to help reduce pain and inflammation. Custom orthotics may be utilized to help reduce pressure and compression to the nerve, and injection therapy utilizing corticosteroid may provide relief. If adequate relief is not achieved with conservative treatments, surgery may be recommended to excise the lesion and provide relief. Your foot and ankle specialist will advise you of the most appropriate course of treatment for your particular case.

Osteoarthritis of the Foot and Ankle

Treatments for symptoms of osteoarthritis include oral medications including NSAID’s to help reduce pain and inflammation, custom orthotics to improve foot mechanics and help relieve pain, as well as corticosteroid injection to the affected joint. Immobilization via cast or removable cast boot may be utilized to allow inflammation to resolve, and bracing to restrict motion and reduce pain on ambulation may be beneficial. Some patients benefit from physical therapy to strengthen muscles and increase stability. Surgery may be recommended in severe or advanced cases, with the goal of increasing function and decreasing pain, and your foot and ankle specialist can advise you on the various surgical procedures available for your particular case.

Pediatric Flatfoot

If no symptoms are present in the child with flatfoot, only periodic observation and re-evaluation may be needed. If symptoms are present, your foot and ankle specialist may recommend modifying activities that cause pain, utilize medications including NSAID’s to help reduce pain and swelling, or custom orthotics to support foot structures and improve function. Physical therapy modalities including stretching may be utilized for relief of pain. In some cases surgery is needed to improve function and reduce pain, and your foot and ankle specialist can advise you of the most appropriate treatment for the child with flatfoot.

Pediatric Heel Pain - Sever’s Disease

The child with heel pain may be treated via NSAID’s to reduce pain and inflammation, shoe inserts or custom orthotics to support the heel, or physical therapy modalities such as stretching. The child should refrain from activities that cause heel pain, and in severe cases your foot and ankle specialist may recommend immobilization via casting to promote healing. As the heel bone is still growing in a child, heel pain may recur, and should be evaluated by your foot and ankle specialist. Wearing well fitting supportive shoes, keeping fit and avoiding obesity, and avoiding use of cleated athletic shoes can help prevent instances of heel pain.

Peroneal Tendon Injuries

Treatment for peroneal tendon injuries depends on the type and severity of injury. Your foot and ankle specialist may advise immobilization via cast or splint, bracing, oral medications including NSAID’s to relieve pain and inflammation, or physical therapy modalities such as ice, heat, or ultrasound therapy. In some cases surgical repair of the tendon is needed, and your foot and ankle specialist can advise you of the most appropriate procedure in your case.

Plantar Fasciitis (Heel Pain)

Treatment for plantar Fasciitis may include stretching exercises for the calf muscles and plantar fascia, icing for 20 minutes several times per day, and oral medications including NSAID’s to help reduce pain and inflammation. You should avoid walking barefoot which puts strain and stress on the plantar fascia, and wear supportive shoes with good arch support and a slightly raised heel. If pain persists after several weeks, your foot and ankle specialist may recommend padding or strapping, utilizing a night splint to maintain stretch while sleeping, or custom orthotic to help correct structural abnormalities which may cause heel pain. Corticosteroid injection to the painful heel may be utilized to help reduce pain and inflammation. If pain persists after utilizing these conservative treatments for several weeks, surgery may be recommended to afford pain relief. Your foot and ankle specialist will advise you of the most appropriate course in your case.

Plantar Wart

Plantar warts or verruca can be treated with topical chemical treatment, laser therapy, freezing, or surgical excision. Warts can always recur, and it is important to follow the advice of your foot and ankle specialist to insure complete resolution of your wart. It is important to refrain from self-treatment as warts can always return, requiring further treatment.

Posterior Tibial Tendon Dysfunction PTTD (Ankle Pain)

Early treatment is advised due to the progressive nature of PTTD. If untreated PTTD could result in an extremely flat foot, limitations in walking or running, or painful arthritis of the foot or ankle. Treatment may include immobilization via cast or boot to allow tendons to heal, orthotics or bracing to support the arch, or physical therapy modalities including therapeutic ultrasound. Medications including NSAID’s may be utilized to help reduce pain and inflammation. If PTTD has progressed substantially, or fails to respond to conservative therapy, surgery may be needed, and your foot and ankle specialist can advise you of the appropriate treatment options in your particular case.

Puncture Wounds

It is important for puncture wounds to be appropriately cleaned and monitored during the healing process to avoid complications. Your foot and ankle specialist may anesthetize the area of injury in order to appropriately clean the wound. The wound must be properly cleaned and examined for presence of foreign objects or bone damage, and antibiotics may be prescribed. A common complication of puncture wounds is infection, and this can lead to serious problems involving bones or joints. Cyst formation is also a common complication, and may occur if a foreign body is left in the wound. Your foot and ankle specialist will advise you of the appropriate treatment for your particular case.

Rheumatoid Arthritis in the Foot and Ankle

Your foot and ankle specialist may treat rheumatoid arthritis of the foot via orthotic devices to support the mechanics of the foot, or accommodative shoes to help relieve pressure and pain, and assist with ambulation. Aspiration and corticosteroid injection may be utilized when inflammation flares up in a joint, and your foot and ankle specialist will advise you of the most appropriate treatments in your case. If pain and deformity caused by RA is not relieved with conservative treatments, surgery may be advised.

Sesamoid Injuries in the Foot

Treatment for sesamoid injuries of the foot may include padding, strapping, or taping to relieve tension, immobilization via cast or walking boot with crutches, and oral medications including NSAID’s to help reduce pain and inflammation. Custom orthotics may be prescribed for long-term treatment of sesamoiditis, and physical therapy modalities including stretching exercises and ultrasound may be beneficial. Surgery may be needed when sesamoid injuries fail to respond to conservative treatment, and your foot and ankle specialist can advise you on the most appropriate procedure for your particular case.

Tailor’s Bunion

Initial treatment for tailor’s bunion includes utilizing shoes with a wide toebox and low heels, padding the painful area, and icing the affected area for 20 minutes several times per day. Oral medications including NSAID’s may be utilized to help reduce pain and inflammation, custom orthotic devices to place in shoes, or corticosteroid injection to the inflamed tissue around the joint. Surgery may be recommended if these treatments do not adequately relieve pain, and your foot and ankle specialist can advise you of the most appropriate options available for you.

Tarsal Coalition

To reduce pain and motion at the affected joint, your foot and ankle specialist may advised NSAID’s to relieve pain and inflammation, custom orthotics to distribute weight away from the affected joint, or physical therapy modalities including therapeutic ultrasound. Injection with corticosteroid may be recommended to reduce inflammation and pain, or immobilization via cast or boot with crutches, to avoid any weight bearing on the affected foot. If symptoms persist, surgery may be needed, and your foot and ankle specialist can advise you of the most appropriate treatment for your particular case.

Tarsal Tunnel Syndrome

Treatment for tarsal tunnel syndrome may include rest, icing the affected area for 20 minutes several times per day, utilizing NSAID’s for reducing pain and inflammation, and support shoe gear. Your foot and ankle specialist may recommend immobilization via cast or boot to enable the nerve and tissues to heal, bracing to reduce pressure, or physical therapy modalities including therapeutic ultrasound. If pain persists surgery may be needed, and your foot and ankle specialist will advise you of the most appropriate treatments available for your particular case.

Toe and Metatarsal Fractures

Traumatic fracture of toe bones are treated with rest, splinting or “buddy taping” into correct position, and wearing stiff soled shoes to protect the toe and keep it in proper position. A displaced break, or break at the joint may need surgical correction to properly fixate the toe.

Traumatic or stress fractures of the metatarsal bones are treated via rest and immobilization via casting or utilizing a stiff soled shoe, to protect the fractured bone while healing. As repetitive stress inducing act ivies are the cause of stress fracture, it is important to refrain from these activities to appropriately heal. Some traumatic fractures require surgical correction, and physical therapy modalities may be utilized during the postoperative phase.

There are different types of fractures, and your foot and ankle specialist is trained to correctly identify the type of break and the appropriate treatment for the injury. Some fractures can lead to arthritis, or may be misdiagnosed as sprain or other problem, and your foot and ankle specialist can advise you of the treatment most appropriate to your particular injury.