The Foot & Ankle Center

Achilles

The Achilles tendon, a critical structure for lower limb function, connects the calf muscles – gastrocnemius and soleus – to the heel bone. This tendon is essential for walking, running, and jumping, enabling the heel to lift off the ground.

Injuries to the Achilles tendon range from partial tears and tendinitis to complete ruptures. Partial tears and tendinitis may respond well to conservative treatments, such as physical therapy, immobilization, or bracing, aimed at reducing strain and promoting healing. However, some partial tears may necessitate surgical intervention, especially if conservative measures fail to yield improvement.

Complete ruptures of the Achilles tendon are more severe, often marked by a distinct popping or snapping sound at the time of injury, followed by significant pain and difficulty walking. Patients might also notice the tendon retracting towards the calf, creating a ball or bulge of the muscle. In response to this, advances in surgical techniques over the past decade have led to the development of minimally invasive procedures. These methods aim to reduce the size of the incision, lower the risk of complications, and expedite the healing process.

Postoperative care is pivotal, with immobilization being a cornerstone of recovery. Patients are typically fitted with a VACOped boot, specially designed to support tendon repair by maintaining the leg and foot in an optimal position for healing. Premature stretching or stressing of the tendon is avoided to prevent the development of laxity, ensuring a gradual and controlled return to function. The focus on minimally invasive techniques and proper postoperative care underscores the commitment to enhancing recovery outcomes for Achilles tendon injuries.

Arthritis

Articular cartilage serves as a crucial cushioning material between two bones, facilitating smooth, pain-free movements within joints. This cartilage's integrity ensures the bones can articulate efficiently, contributing to the overall mobility and function of the joint. Osteoarthritis, a common condition, involves the degeneration of this cartilage, often attributed to "wear-and-tear" or the aftermath of an injury. This process can affect any joint in the body, including those in the foot and ankle, leading to pain, stiffness, and reduced range of motion.

The approach to managing osteoarthritis varies based on the condition's severity, as assessed through imaging techniques, and the impact of symptoms on the patient's quality of life. Conservative treatments aim to alleviate symptoms and improve joint function without surgery. These may include:

• Activity modification: Adjusting daily activities to reduce stress on affected joints.

• Bracing and immobilization: Using supportive devices to limit joint movement andprovide stability, reducing pain and preventing further damage.

• Physical therapy: Engaging in targeted exercises to strengthen the muscles around thejoint, enhance flexibility, and maintain or improve range of motion.

• Injections: Administering medications directly into the joint to relieve pain andinflammation.For cases where conservative measures fail to provide sufficient relief, or when the joint damage is extensive, surgical intervention may be considered. Surgical options range from minimally invasive procedures to correct joint abnormalities or remove damaged tissue, to more significant operations like joint replacement, where the damaged joint surfaces are replaced with artificial components.

Fracture

A fracture, or the breaking of a bone, can occur in various parts of the body, including the foot and ankle, often resulting from impacts, overuse, or stress. Among the common foot and ankle fractures, some notable types include:

• Jones Fracture: This specific fracture involves the fifth metatarsal bone in the foot and is particularly prevalent among athletes and physically active individuals. Treatment for a Jones fracture depends on the fracture's displacement. Non-displaced fractures may be managed conservatively through immobilization and physical therapy, while displaced fractures might necessitate surgical intervention to realign and stabilize the bone.

• Stress Fractures: Stress fractures can occur in any foot bone, typically due to repetitive stress or overuse. These fractures are generally treated conservatively, with rest and limited weight-bearing activities to allow the bone to heal naturally. Surgery is rarely required unless the fracture fails to heal with conservative measures.

• Lisfranc Fractures: Lisfranc fractures or injuries involve the midfoot, where the metatarsals connect with the tarsal bones. The treatment approach is dictated by the injury's severity; mild cases may respond well to conservative treatments such as immobilization, whereas more severe injuries, particularly those involving displacement, often require surgical repair to restore proper alignment and function.

• Tib-Fib Fractures (Ankle Fractures): A tib-fib fracture refers to a concurrent fracture of both the tibia and fibula at the ankle. The decision between conservative and surgical treatment is influenced by the extent of displacement. Non-displaced fractures can be treated with immobilization, whereas displaced fractures usually necessitate surgery to realign the bones and ensure proper healing.

The underlying principle in treating fractures is assessing whether the fracture is displaced. Non-displaced fractures can often be managed without surgery, focusing on immobilization and rehabilitation. In contrast, displaced fractures typically require surgical intervention to realign the bone fragments, followed by a period of immobilization and physical therapy to recover strength and mobility.

Sprain

An ankle sprain refers to the injury of the ligaments surrounding the ankle, rather than the muscles or tendons, and is categorized based on the severity of ligament damage. This common injury varies widely in severity and the approach to treatment:

• First-Degree Sprain: This is the mildest form of an ankle sprain, involving slight stretching and microscopic tears of the ligament fibers. Symptoms may include mild pain, swelling, and tenderness around the ankle, but stability is largely maintained. First-degree sprains are typically managed with conservative treatments, such as rest, ice, compression, and elevation (RICE), along with possible use of an ankle support or brace to protect the ligament as it heals.

• Second-Degree Sprain: A more severe injury, a second-degree sprain involves partial tearing of the ligament. This results in more significant pain, swelling, bruising, and tenderness, along with some loss of function and ankle stability. Treatment often still leans towards conservative methods, including RICE, physical therapy to strengthen the surrounding muscles and restore range of motion, and a longer period of bracing. However, the decision between conservative and surgical treatment can depend on the specific ligament involved and the extent of the injury.

• Third-Degree Sprain: This is the most severe form of an ankle sprain, characterized by a complete tear of the ligament, leading to considerable pain, swelling, instability, and inability to bear weight on the affected ankle. Third-degree sprains usually require surgical intervention to repair the torn ligament, followed by a comprehensive rehabilitation program to recover strength, flexibility, and stability of the ankle joint.

Given the varying degrees of ankle sprains, a thorough evaluation, often including physical examination and imaging tests like X-rays or MRI, is crucial in determining the appropriate treatment plan. This ensures that each individual receives tailored care suited to the severity of their sprain, optimizing recovery, and minimizing the risk of future ankle problems.

Plantar Fasciitis

Plantar fasciitis is a common condition resulting from inflammation of the plantar fascia, a thick band of tissue on the bottom of the foot. This condition is often marked by sharp pain in the heel and along the foot, especially noticeable first thing in the morning. The inflammation can be attributed to factors like excessive standing, walking, heightened activity levels, or weight gain. The tissue's overnight contracture, a typical position during sleep, exacerbates the discomfort. Conservative treatment, including physical therapy and the use of a night splint to maintain the foot at a right angle and prevent overnight contracture, is commonly effective. Surgical intervention is rarely necessary for plantar fasciitis.

Bunion

A bunion involves a bony protrusion of the big toe, resulting from the big toe being pushed towards the other toes, causing the first metatarsal bone to stick out. This condition is often due to prolonged pressure and stress on the big toe joint. Over time, this can lead to additional bone growth and a significant angle between the bones. Treatment typically involves surgery to remove the bony prominence and realign the toe for a straighter position. While conservative management exists, it is less common and mainly focuses on symptom relief rather than correcting the deformity.

High Ankle Sprain (Syndesmosis Sprain)

High ankle sprains affect the ligaments above the ankle joint, including the anterior inferior tibiofibular ligament, the interosseous membrane between the tibia and fibula, and the posterior inferior tibiofibular ligament. These sprains are more complex than traditional ankle sprains and can result from specific twisting injuries or impacts. Treatment options range from conservative approaches like bracing, immobilization, and physical therapy to surgical repair, depending on the severity of the ligament damage. The choice of treatment is tailored to the patient's specific condition and needs, following a thorough evaluation by an orthopaedic surgeon.

At BBJI, our expertise in orthopedics allows us to provide comprehensive care tailored to each patient's unique needs, ensuring a swift and effective recovery from injuries and other orthopedic issues. Our dedicated team is committed to guiding you through the entire healing process, prioritizing open communication and collaboration with all parties involved. Our ultimate goal is to restore your quality of life, helping you return to daily activities with confidence and without pain.