Podiatric Surgery & Therapy

The Achilles tendon is a ropelike band of tissue behind the ankle that connects the calf muscle to the heel bone. The tendon allows for movements like pointing the toe and is vital to performing activities like walking, running, and jumping.

A rupture of the Achilles tendon is a debilitating injury that causes pain and weakness in the leg. The treatment of choice for a torn Achilles tendon is surgery to reattach the tendon.

REASONS FOR TREATMENT

Following the rupture of an Achilles tendon, surgery is usually necessary. During Achilles tendon surgery, the ends of the torn tendon are reattached in order to strengthen the tendon. This is the only way to accurately repair the tendon ends and set the correct tension between the muscle and the tendon.

In comparison to other treatment options, including a cast, splint, or brace, Achilles tendon surgery provides the best chance of preventing another rupture of the tendon. It also allows a faster return to normal activities and results in a higher functioning of the tendon with less damage to the muscle.

 HOW ACHILLES SURGERY IS PERFORMED

Achilles surgery is the treatment of choice for athletes and anyone with a high level of physical activity. The goal of the surgery is to reattach the torn Achilles tendon to its normal position. The procedure requires a small incision in the back of the leg near the ankle. The surgeon identifies the torn ends of the tendon and stitches them back together to repair the tendon.

Most surgeons will wait a week to perform surgery after the rupture of the tendon to allow for a reduction in swelling. Following surgery, it is necessary to wear a walking boot or cast for approximately six to eight weeks. Patients will need to undergo physical therapy to strengthen leg muscles and the repaired tendon.

If you feel a sudden pop or snap in your heel followed by pain and weakness, you may have torn your Achilles tendon. Consult a physician immediately to prevent further injury.

Ankle deformities may be the result of injury, a congenital birth defect, degenerative changes brought on by age, or they can result from neuromuscular conditions and diseases like diabetes and rheumatoid arthritis.

Serious ankle deformities can interfere with daily activities, and can make it difficult to enjoy outdoor activities or maintain employment. When conservative methods of treatment fail to relieve ankle pain, ankle surgery is the only solution.

REASONS FOR TREATMENT

Serious ankle deformities often fail to respond to non-surgical treatment. Ankle surgery is the next logical step. Ankle surgery can be used to eliminate the deformity, relieve joint pain and stiffness, and increase activity level.

For many patients, ankle surgery provides the only means of restoring normal function to the foot and ankle.

HOW ANKLE SURGERY IS PERFORMED

Ankle surgery is designed to correct ankle deformities and improve bone structure, allowing for normal movement of the foot and increased function of the ankle joint.

There are several types of ankle surgeries available to correct deformities. Treatment may involve a fusion of the tibia and talus; this is known as an ankle fusion procedure. During this type of ankle fusion, small incisions are made near the front of the ankle, and joint cartilage is removed. Screws or rods are placed in the ankle to allow bones to heal in proper alignment.

Degeneration of the ankle joint from injury or arthritis may necessitate an ankle replacement procedure. During this procedure, the ankle joint is removed and replaced with an artificial joint.

The primary goal of ankle surgery is to address deformities and reconstruct the proper architecture of the foot. Both internal and external fixation devices may be used to support the foot and keep it aligned during the healing process. There is often an extended recovery period associated with these types of ankle procedures and physical therapy might be necessary following surgery to strengthen the ankle joint.

Consult a podiatrist to learn more about the different types of ankle surgery available to treat painful ankle deformities.

Athlete’s foot is a common fungal infection that develops on the feet, usually between the toes. Most cases of athlete’s foot can be treated at home with over-the-counter antifungal medication. However, fungal infections are stubborn and often recur over time. To completely eliminate athlete’s foot, it is necessary to change the environment that is allowing the fungus to grow, and eliminate the infection with antifungal medication.

REASONS FOR TREATMENT

Fungal infections are difficult to treat. They can often persist for years and then abruptly disappear. When athlete’s foot develops, the initial symptoms are itching, burning, redness, and stinging. If left untreated, skin can blister and crack, leading to serious and debilitating skin infections.

Though fungal infections can be treated at home, it is important to see a physician if skin does not clear up within a few weeks. Excessive redness, swelling, fever, and drainage can be a sign that a bacterial infection is also occurring. People with diabetes and medical conditions that compromise the immune system should seek treatment immediately for athlete’s foot.

HOW ATHLETE’S FOOT TREATMENT IS ADMINISTERED

The treatment of athlete’s foot depends on the type of fungal infection and the severity of the infection. The best results are obtained with early treatment before the fungus has taken hold.

At-home Therapy

Treatment usually begins at home with over-the-counter antifungal medications. Antifungal medications may come in cream, spray, or powder form. These products should be applied to the affected area twice daily for a minimum of four weeks. Improvement is usually gradual.

It is also important to keep the infected area clean and dry. Fungus thrives in dark, moist environments. The moisture that develops in shoes and socks combined with the lack of sunlight to the feet provides an ideal environment for fungal growth. The best remedies are to: use medicated powders to keep feet dry, soak feet in a drying solution, change socks periodically throughout the day, and wear open toed shoes or shoes that breathe.

Prescription Medication

When topical medications fail to eliminate athlete’s foot, doctors may recommend prescription antifungal medications. Some prescription antifungal treatments are topical creams; others can be taken in pill form. Athlete’s foot symptoms may disappear shortly after the antifungal medication takes effect, but it is important to continue with the full course of treatment. Recurrence of fungal infection is common, and each time symptoms appear they should be fully treated.

The foot contains 28 bones and more than 30 joints. When arthritis develops in any of the joints of the foot, it can cause pain and create difficulty walking. In some cases, arthritis of the foot and ankle can be managed with orthotics, anti-inflammatory medication, and physical therapy. When conservative treatment fails, surgery to restore movement is necessary.

REASONS FOR TREATMENT

The types of arthritis that typically affect the foot and ankle are osteoarthritis, rheumatoid arthritis, psoriatic arthritis, and gout. Arthritis may affect the ankle joint, the big toe joint, the joints in the midfoot, and the three joints in the hindfoot.

When arthritis progresses to the point where it interferes with walking and other daily activities, surgery becomes necessary to restore the function of the joint. If left untreated, arthritis can weaken foot and ankle joints to the point where fracture is imminent. Chronic deformities may develop along with ulcers and open sores.

HOW ARTHRITIS SURGERY IS PERFORMED

The procedure recommended by your physician will depend on the type of arthritis you have, the location of the arthritis, and the progression of the disease. Three surgical procedures are designed to treat arthritis of the foot and ankle: arthroscopic debridement, joint fusion, and joint replacement.

Arthroscopic Debridement

Arthroscopic surgery is helpful in the treatment of early stage arthritis. During the first part of the procedure, a thin arthroscope with a small camera lens is inserted into the joint, allowing the surgeon to view damage to the joint. During the second stage of surgery, the surgeon clears away any foreign tissue or bony spurs.

Joint Fusion

Another type of surgery used to treat arthritis is joint fusion, or arthrodesis. This procedure eliminates the arthritic joint. The surgeon fuses the affected bones together, making one continuous bone. The bones are held in place by screws or pins until they begin to fuse together.

Joint Replacement

For patients with advanced arthritis, surgeons recommend joint replacement. During a joint replacement procedure, the ankle joint is replaced with an artificial joint. The goal of the procedure is to eliminate pain and improve mobility. However, there is a small risk that the artificial joint will eventually fail and require replacement later in life.

Surgery to treat arthritis of the foot and ankle can be very painful and require a long recovery period. However, when conservative treatments fail, surgery is the only means of restoring movement and improving quality of life.

Arthroscopy is a surgical procedure used to visualize and treat problems inside the ankle joint. The term arthroscopy literally translates to “looking within the joint.” During an arthroscopy procedure, fiber optic cameras and small surgical tools are used to explore the ankle joint and remove debris. The procedure can help treat ankle pain and confirm a diagnosis of damage to bones, cartilage, tendons, and ligaments.

REASONS FOR TREATMENT

Arthroscopy aids in the diagnosis of numerous diseases and injuries affecting the ankle. Conditions treated with arthroscopy include:

• Bone spurs: Bone spurs can develop in the front of the ankle joint, causing restricted mobility of the ankle and foot. With arthroscopy, surgeons can shave down the bone spur to increase movement of the joint.
• Cartilage damage: Cartilage damage is common in people who have suffered an injury to the ankle joint (like a sprained ankle). If left untreated, cartilage damage can eventually lead to arthritis of the ankle joint.
• Scar tissue: Certain conditions and injuries can cause an accumulation of scar tissue or loose debris in the ankle joint. Removing scar tissue via arthroscopy can help reduce pain and swelling inside the joint.
• Undiagnosed ankle pain: Arthroscopy can be used to make a final diagnosis in cases of unexplained ankle pain. Arthroscopy is considered more accurate than x-rays and other imaging methods.

Arthroscopy is the preferred method of diagnosis and treatment of ankle problems because it produces little scarring and carries less risk of infection.

HOW ARTHROSCOPY IS PERFORMED

Ankle arthroscopy procedures can be performed using general or local anesthesia. The surgeon will make several small incisions near the ankle joint and begin by inserting the arthroscope. The arthroscope is a pen-shaped instrument with a small camera and light source attached at the end. The images from the arthroscope are transferred to a TV monitor, providing a clear view of the inside of the ankle joint.

If the surgeon detects damage to the joint, they can use small surgical tools to begin removing debris and repairing the joint. Recovery from an arthroscopy procedure is much faster than recovery from open ankle surgery; however, some patients may have to be immobilized with a splint or cast for up to six weeks after surgery.

A bunion is a painful foot deformity caused by enlargement of the joint at the base of the big toe. Bunions often require surgical intervention to reduce pain, improve mobility of the toe, and correct related foot deformities.

There are countless variations of bunion surgery. In general, bunion surgery involves the removal or realignment of soft tissue and bone near the toe joint. If the joint is severely deformed, it can be stabilized with wires, stitches, screws, or plates.

REASONS FOR TREATMENT

Studies have shown that the majority of people who have undergone bunion surgery are satisfied with their results. However, there is no guarantee that bunion surgery will completely relieve pain.

Surgery should only be a consideration if conservative treatment fails. The following is a list of reasons that people choose to undergo bunion surgery:

• To address chronic toe inflammation and swelling.
• To address toe deformities, like a drifting of the big toe toward the inside toes.
• To improve the mobility of stiff toe joints.
• To relieve severe foot pain that interferes with everyday activities.

If anti-inflammatory medications fail to reduce the pain associated with a bunion and the deformity begins to affect movement, bunion surgery is the next logical treatment.

HOW BUNION SURGERY IS PERFORMED

There are more than 100 different types of surgery that can be used to treat bunions. It is also common for surgeons to combine multiple procedures in order to treat the additional foot deformities that occur alongside bunions. Bunion surgery is performed as an outpatient procedure. The surgery usually lasts an hour or longer; the length of the procedure depends on the complexity of the deformity. Surgery begins with an incision on the top or side of the big toe joint. The procedure may include any of the following:

• Fusion of the big toe joint.
• Fusion of the joint between the metatarsal bone and midfoot.
• Insertion of an artificial joint.
• Insertion of wires, screws, or plates to stabilize the joint.
• Realignment of soft tissue near the joint.
• Removal of bone from the foot or toe.
• Removal of the bony outgrowth (this is referred to as a bunionectomy).

The length of recovery time following bunion surgery depends on the amount of tissue and bone affected. You may or may not have to use crutches. Complete recovery can take up to a year.

A corn is a small, rough mound of thick, hardened skin. Corns can develop wherever skin rubs together. They usually occur at pressure points on the foot, such as the top of the toe “knuckle” or in between toes.

Corns are caused by one thing - friction. They can be trimmed away with a small knife during a visit to a podiatrist; however, to permanently remove corns, it is necessary to address the source of pressure that is causing the corns to develop.

REASONS FOR TREATMENT

Corns will not simply disappear without treatment. They are a symptom of an underlying problem with the structure of the foot. Unless the source of friction causing the corns is removed, they will continue to become thicker and more painful.

Corns can eventually bore down into the skin and press on underlying nerves, causing extreme pain. At a certain point, the body begins to treat corns as a foreign object and an ulcer can develop. Ulcers present a serious complication for those with diabetes and poor circulation.

HOW CORN REMOVAL IS PERFORMED

Corns are merely a symptom of an underlying foot problem. It is important to treat the corn and the problem causing the corn. Self-treatment is possible, but if you have persistent corns you should see a doctor.

To remove corns, your physician may begin by recommending a change in footwear. To reduce pain, protective padding can be used to cushion the corn and give it time to heal. Your doctor can remove a corn in a single office visit by using a small knife to trim down the corn. Part of your treatment plan may also include surgery to correct foot deformities that might cause corns to continue developing.

People with diabetes, peripheral neuropathy, and poor circulation should never try to treat a corn themselves; the risk of infection is too great.

Warts that refuse to go away without treatment may need to be removed by a physician. One of the most popular methods of removing warts is cryotherapy.

Cryotherapy eliminates warts by freezing them with a very cold substance, usually liquid nitrogen. Icy crystals form inside the skin cells and as they multiply, they push through cell walls, destroying the live tissue. Freezing the wart kills the skin cells so they cannot continue to spread. With cryotherapy, it is possible to destroy both the wart and the virus that causes it to grow.

REASONS FOR TREATMENT

It is not necessary to treat warts; however, warts pose a cosmetic concern and can lead to unsightly skin conditions. When they are located in a crevice of the skin, they can also cause irritation and limit range of motion.

Over-the-counter medications are sometimes successful at treating warts, but most people prefer aggressive treatment. Cryotherapy is a standard treatment for warts and can be performed in a brief office visit.

HOW CRYOTHERAPY (WART REMOVAL) IS PERFORMED

Cryotherapy is a noninvasive treatment. The doctor begins by cleaning the wart and the skin around it; a numbing agent can be used to reduce pain. The liquid nitrogen can be applied with a cotton swab, a spray, or through a tube. The freezing is uncomfortable and might cause a stinging sensation, but it is not unbearable, and the paint is brief. The wart will begin to turn white; this is a sign that the skin cells are dying. A blister may also form at the site of the wart. It is important to leave the blister alone; it will heal within a week.

The entire process lasts about 15-20 minutes and recovery is rapid. Cryotherapy does not leave any scars; however, there may be some slight discoloration in the treated area. It may be necessary to repeat treatment to ensure that the wart does not return.

It is important to follow-up with your physician to monitor regrowth of the wart and address any complications that may arise from treatment.

A ganglion cyst is a benign soft-tissue tumor filled with a jelly-like fluid. Ganglion cysts can occur anywhere on the body but are especially prevalent on the feet.

Ganglion cyst removal, or ganglionectomy, is a procedure designed to permanently remove a cyst from the foot. During the procedure, the cyst is separated from surrounding tissue and removed with the fluid sac intact. An alternative to surgical removal of ganglion cysts is drainage of the cyst with a needle or syringe.

REASONS FOR TREATMENT

For some people, the only symptom of a ganglion cyst may be the noticeable lump of fluid beneath the skin. Aside from cosmetic concerns, cysts may cause mild pain due to irritation between the cyst and the shoe.

Most ganglion cysts are located under the skin. In some cases, it is possible for ganglion cysts to connect to a tendon or joint. If the cyst begins to press on a tendon or joint it can cause a dull but persistent ache. If the cyst presses on a nerve, it can cause sharp pain, tingling, and burning. When cysts are connected to soft tissue, it is best to surgically remove them to prevent recurrence.

HOW CYST REMOVAL IS PERFORMED

If a mass is diagnosed as a ganglion cyst, it can be left alone, drained with a needle, or surgically removed.

Needle Aspiration

When cysts fail to disappear on their own, one of the simplest methods of treatment is aspiration. This technique involves draining the fluid from the cyst and injecting a steroid into the mass. A large needle is inserted into the cyst to drain the growth, followed by a cortisone injection to reduce inflammation and prevent refilling of the cyst.

Surgical Removal

Cysts may need to be removed surgically if other treatment methods fail. The recurrence rate of ganglion cysts is much lower with surgical removal than with needle aspiration. Patients are given a local anesthetic during the procedure. The surgeon makes incisions around the cyst; the goal is to remove the sac of fluid still intact. Recovery time is brief.

Adult acquired flatfoot, or posterior tibial tendon dysfunction, is a complex disorder that results in a gradual loss of the foot arch.

The posterior tibial muscle is the muscle responsible for stabilizing the arch. If injury or illness damages the tendon connected to the posterior tibial muscle, the arch can fall, resulting in a flatfoot. Surgery can be performed to repair the tendon and improve bone alignment, which gives patients more stability when running and walking.

REASONS FOR TREATMENT

Flatfoot may not be a problem in itself, but it can contribute to more serious conditions throughout the body, most commonly the legs, hips, ankles, and lower back. A painful flatfoot is a sign of injury to the tendons and muscles of the foot. Flatfoot does not necessarily get worse over time, but it can lead to the following:

• Arthritis of the foot and ankle.
• Bunions and hammertoes.
• Corns and calluses.
• Difficulty walking and running.
• Knee pain.
• Lower back pain.
• Pain and swelling in the heel and arch.
• Stiffness and limited mobility.

The symptoms of flatfoot can be managed with anti-inflammatory drugs, but these medications fail to address the underlying cause of flatfoot. The best long-term solution is surgery that repairs the tendon.

HOW FLATFOOT CORRECTION IS PERFORMED

Flatfoot can be treated with shoe modifications, custom orthotics, physical therapy, and steroid injections. When the pain associated with flatfoot becomes severe, surgery is required.

Surgical correction of flatfoot may include any of the following procedures:

• Fusion of the bones in the foot and ankle.
• Osteotomy (cutting and reshaping bone to improve alignment).
• Removal of bone spurs.
• Repair of the tibial tendon.
• Synovectomy (cleaning the tendon sheath).
• Tendon transfer.

Most flatfoot procedures involve cleaning and repairing damaged tendons. In rare cases, joint fusion is required. Fusion helps improve the alignment and stability of the foot.

Surgery can reduce the pain associated with flatfoot, but it may not work for everyone. There is also a risk of infection following surgery. The earlier flatfoot is treated, the better chance there is of repairing the damage to the tendon.

Pain and discomfort in your lower legs and feet can make it difficult for you to stand, walk, and complete many other activities essential to daily life. Thankfully, podiatric medicine provides various treatment methods to alleviate this pain.

REASONS FOR PROCEDURES

There are numerous issues that can lead to surgical treatment or other therapeutic procedures for the feet and lower legs, including:

• Achilles tendinitis.
• Arthritis.
• Bone fracture.
• Bunions.
• Cysts.
• Fungal infections, including athlete's foot.
• Gout.
• Neuropathy.
• Plantar fasciitis.
• Tear of Achilles tendon.
• Toe and foot deformities.
• Various diseases.

TYPES OF CORRECTIVE TREATMENTS

Depending on the specific issue, there are several surgical procedures and non-surgical therapies to treat disorders of the feet and lower legs.

Surgery

Surgical procedures will depend on the specific problem; however, some general surgeries for the feet and lower leg include:

• Arthroscopy (diagnostic tool and treatment method to see inside joints).
• Bone fusion.
• Open-reduction fracture setting.
• Surgical removal (i.e. of bunions, cysts, nail, etc.).
• Tendon repair.

Non-surgical treatments

Like surgical procedures, there are numerous non-surgical therapies that can be used to treat problems with feet and lower legs. These treatments will vary based on the condition; some common therapies include:

• Anti-inflammatory medication.
• Change in footwear.
• Closed-reduction fracture setting.
• Cryotherapy (wart removal).
• Drainage or needle aspiration.
• Extracorporeal shock wave therapy (ESWT).
• Heat and cold treatments.
• Oral medication.
• Orthotics.
• Physical therapy.
• Protective pads.
• Shoe modifications.
• Steroid injections.
• Topical medication.

Post-treatment/recovery information

Some foot and lower-leg treatments, especially non-surgical therapies, have little or no recovery time. More invasive treatments will require a longer recovery period. Depending on the extent treatment needed, following the procedure a patient may be required to:

• Complete physical therapy.
• Follow the R.I.C.E. therapy method of rest, ice, compress, elevate.
• Keep foot/leg elevated.
• Use crutches.

Because treatment methods vary so greatly, it is important for you to visit a skilled podiatrist to determine the most effective procedure or therapy for your foot or lower-leg problem.

A fracture setting is performed after a bone is broken and involves putting the bone fragments back in correct alignment. There are two types of fracture setting procedures: closed reduction and open reduction. Closed reduction does not involve surgery and is usually performed when a bone is broken in one place. An open reduction procedure involves a surgical incision and is typically performed when there are multiple breaks in the bone, or the bone has shattered into several small pieces.

REASONS FOR A FRACTURE SETTING

A fracture setting is performed to properly align a broken bone so that it can heal properly. Setting a fracture is important in preventing a deformity that could occur if the bones are left to heal on their own where they may not be properly aligned. It can also help alleviate pain associated with the break and allow the individual to regain use of that part of the body.

HOW A FRACTURE SETTING IS PERFORMED?

A fracture setting is performed through either an open reduction procedure or a closed reduction procedure. A closed reduction is usually attempted first, but an open reduction may be necessary if there are multiple breaks in the bone or if a closed reduction is not possible due to a wound.

During a closed reduction procedure, the doctor will apply traction to lengthen the muscles near the fracture and then manipulate the bone fragments into proper alignment either strictly by feel or by using an imaging machine called a fluoroscope. A splint or cast must then be worn to hold the bone fragments in place and prevent them from moving while they heal.

An open reduction is a surgical procedure in which an incision must be made in order to access the bone fragments and align them properly. Plates, rods, and screws are then used to hold the bone fragments in place.

It typically takes at least three to six weeks for a bone to heal following a fracture setting.

Fungal nail treatment is used to clear up fungal infections affecting the nails. Treatment may involve using a topical medication, taking an oral medication, or undergoing surgery. Topical medications can treat minor fungal infections of the nail where only part of the nail is infected. However, once the fungus covers the whole nail or spreads to other nails, it becomes more difficult to treat and topical medication alone may not suffice. Oral medications are often effective, but they are also expensive and can have serious side effects. Oral medications are often more effective when combined with surgery, as this can treat the infection more quickly thereby reducing side effects. However, surgery is usually performed as a last resort when topical and oral medications have proven unsuccessful.

REASONS FOR FUNGAL NAIL TREATMENT

Fungal nail treatment is important in order to:

• Get rid of the fungal infection.
• Prevent the infection from spreading to other nails.
• Reclaim clear, healthy nails.

HOW FUNGAL NAIL TREATMENT IS ADMINISTERED

Fungal nail treatment may involve topical medications, oral medications, surgery, or a combination of these.

Topical Medications

Over-the-counter and prescription topical medications usually need to be applied to the affected nails once or twice a day for at least six weeks. It is important to keep using the topical solution until the infection has cleared completely to keep it from coming back.

Oral Medication

If topical medication isn’t effective, your doctor may prescribe an oral medication to be taken once a day for three months. However, the medication is expensive and can have serious side effects including liver damage, so it should not be taken longer than necessary.

Surgical Correction

Surgery is usually only considered in severe cases when topical and oral treatments haven’t been successful. However, it may also be recommended for those who can benefit from oral medication but are at a higher risk of suffering side effects such as liver damage. For such individuals, surgery can help minimize the length of time one needs to take medication and thereby limit the side effects.

Surgery is usually performed under local anesthetic and involves removing the affected nail completely. This means that the nail won’t grow back. Instead, the skin will harden and form a protective layer where the nail once was. Following surgery, topical or oral medication is usually prescribed for a few weeks to destroy any remaining fungus and prevent the infection from recurring. Recovery typically takes two to three weeks.

Hammertoe surgery corrects a foot deformity in which the first joint on one or more of the four small toes is bent. During surgery, the first joint of the toe is straightened to correct the deformity and relieve the symptoms commonly associated with hammertoe including pain and inflammation.

REASONS FOR HAMMERTOE SURGERY

Hammertoe surgery may be performed when other treatments are unable to provide sufficient relief of symptoms. Surgery is usually offered to individuals whose hammertoe causes them severe pain and leaves them unable to fit into shoes. By straightening the toe, surgery can correct the deformity and relieve pain and swelling that is often associated with the condition.

HOW HAMMERTOE SURGERY IS PERFORMED

There are a few different surgical procedures that can be performed to correct hammertoe depending on the severity of the condition and the needs of the patient. These include tendon transfer, digital arthroplasty, and digital arthrodesis. Each procedure is usually performed under local anesthesia.

Tendon transfer surgery involves rerouting the tendon. In this procedure, the tendon underneath the toe is moved on top of the toe so that it pulls the toe down.

Digital arthroplasty involves removing part of the bone in the first joint of the affected toe. This procedure will reduce the prominence of the joint, but will still allow the toe to move.

Digital arthrodesis involves removing the whole joint and fusing the two bones together. In some cases, a pin is used to hold the toe in place while it heals. Once it has healed, the toe will remain rigid and will not bend.

In some cases, a tendon that is too short might be contributing to the deformity. When this occurs, an additional procedure can be performed in conjunction with one of the surgeries mentioned above in order to lengthen the tendon and loosen the joint behind the affected toe so the toe can lie flat.

If you suffer from plantar fasciitis, a foot problem characterized by inflammation of the plantar fascia (the tissue that connects the heel bone to the toes), you know the discomfort the condition can cause. The condition causes pain under the heel bone and foot arch, especially after prolonged walking or standing. When conventional treatments are ineffective at minimizing symptoms and healing the plantar fascia, extracorporeal shock wave therapy (ESWT) can be an excellent solution.

ESWT delivers shock waves to the plantar fascia tissue, causing micro-trauma in the tissue. The micro-trauma prompts the body’s natural healing response, replacing the damaged plantar fascia tissue with new, healthy tissue. As a result, the ESWT procedure can reduce or eliminate the symptoms of plantar fasciitis and improve the foot’s functioning.

REASONS FOR ESWT

Generally speaking, ESWT is recommended for individuals with plantar fasciitis whose symptoms have become unmanageable. It is also recommended when conventional plantar fasciitis treatments (i.e. anti-inflammatory medications, heat and cold treatments, shoe inserts, and physical therapy) have been ineffective. In addition, many patients choose ESWT as a less-invasive alternative to heel surgery.

THE ESWT PROCEDURE

ESWT is administered in low- and high-wave treatments. The low-wave treatments are administered first, in a series of three or more sessions. Low-wave ESWT treatments typically cause little or no discomfort. If the low-wave treatments do not provide the desired effect, the high-wave treatments are administered (in one session). The high-wave treatments can cause significant discomfort, so general or regional anesthesia is usually necessary.

If you have been diagnosed with plantar fasciitis or are suffering from chronic arch or heel pain, contact your doctor to obtain more information on your treatment options, including extracorporeal shock wave therapy. With the help of a skilled foot care specialist, you can enjoy improved foot functionality.

An injury or deformity of one of the five metatarsal bones (the long bones behind each toe) can cause debilitating pain, difficulty walking, and other symptoms. When the problem does not respond to non-invasive treatments (i.e. physical therapy or therapeutic foot supports), metatarsal surgery may be an excellent treatment option.

The surgery involves re-setting the metatarsal bone, pinning the bone in place, and allowing the surgical site to heal. Once the foot heals from metatarsal surgery, patients typically experience relief from pain and improved foot functionality.

REASONS FOR METATARSAL SURGERY

Metatarsal surgery can be used to correct a number of foot problems, including:

• Bunion deformities.
• Calluses on the bottom of the foot or ball of the foot.
• Foot problems caused by rheumatoid arthritis, diabetes, and certain other diseases.
• Metatarsal fractures.

THE METATARSAL SURGERY PROCEDURE

Metatarsal surgery is an outpatient procedure performed while the patient is anesthetized (usually via intravenous sedation or general anesthesia). After the patient is completely anesthetized, the surgeon begins the procedure by incising into the skin just behind the toe, thereby accessing the metatarsal bone. He then incises the bone, places it in its proper position, and pins it in place with a metal pin or screw. Finally, he stitches the incision. (The doctor may also remove any foot calluses and correct any other problems if necessary.)

After the metatarsal surgery procedure, most patients wear a cast and use crutches for approximately six to eight weeks, while the bone and skin tissues heal. Patients may resume normal activities once the surgical site heals completely.

If you have been diagnosed with a metatarsal injury or condition, or if you are experiencing foot pain, contact an experienced podiatrist for more information on your treatment options. Your doctor can provide the information you need to make an informed decision for your health.

Toe ailments cause pain and can be disabling. With the proper surgical procedure, your doctor can correct the condition and relieve symptoms. Toe surgery may involve removing or smoothing bones, repositioning ligaments and tendons, removing nerve tissue, or reducing pressure on a compressed nerve.

REASONS FOR TOE SURGERY

Toe surgery is usually performed to correct a deformity or treat a compressed nerve between the toes. Typically, surgery is only considered if the condition is debilitating or other treatments have been unable to provide sufficient relief of symptoms such as pain and inflammation. Some deformities that can be corrected through toe surgery include:

• Bone spurs (overgrowth of bone).
• Bunions (enlarged bone and tissue near the big toe joint).
• Claw toes (abnormal positions of all three toe joints).
• Hammertoes (toes bend at the middle joint).
• Mallet toes (toes bend at the joint near the tip of the toe).
• Neuromas (swelling of the nerve between toes).

HOW TOE SURGERY IS PERFORMED

There are several different surgical procedures that can be performed depending on the toe disorder that needs to be treated. Surgery to treat a bunion may involve removing excess bone while surgery for a bone spur may involve smoothing the bone. Surgery to correct toe joints that are bent in abnormal positions may involve removing bone, fusing bones together, repositioning tendons and ligaments, or a combination of these. Surgery performed to treat a neuroma, or swollen nerve, may involve either reducing pressure on the affected nerve or removing the nerve tissue.

Depending on the procedure, recovery may take a few weeks or several months.

If you are suffering with toe pain, be sure to visit your doctor for proper treatment.

Compressed nerves can become enlarged and be very painful, but neurolysis, or nerve surgery, can treat the condition and relieve any pain or discomfort. Inflamed nerve tissues are referred to as neuromas and commonly form on the ball of the foot between the third and fourth or the second and third toes as a result of injury or trauma. Your doctor can perform either neurolysis or nerve surgery to treat a neuroma. Neurolysis involves hardening the nerve while surgery involves either removing the affected nerve tissue or reducing pressure on the nerve.

REASONS FOR NERVE SURGERY

Nerve surgery is performed to relieve the pain and discomfort associated with a neuroma. In most cases, these procedures are considered only if other treatments have been unable to provide sufficient relief of the symptoms.

HOW NEUROLYSIS IS PERFORMED

Neurolysis involves injecting a mixture of ethanol and anesthetic into the nerve to harden it. Injections may need to be administered once a week, for a month or two, to destroy the nerve and relieve symptoms.

Nerve surgery can be performed using either the plantar approach to remove the nerve tissue or the dorsal approach to relieve pressure on the nerve.

Plantar Approach

In the plantar approach, the nerve tissue is removed through incisions on the sole of the foot. This allows direct access to the neuroma. Crutches will be needed for at least three weeks following surgery to allow for proper healing, as weight should not be placed directly on the surgical site. In some cases, a scar may still form on the bottom of the foot which can make walking uncomfortable.

Dorsal Approach

In the dorsal approach, the metatarsal ligament is released through an incision on the top of the foot in order to reduce pressure on the nerve. Recovery is relatively quick since the incision is on top of the foot. However, with the metatarsal ligament released, the forefoot may gradually become unstable and require treatment in the future.