Frequently Asked Ankle Questions
Who should I see for my broken ankle?
A broken ankle, also know as a fractured ankle, is an urgent time sensitive condition. Not all broken ankles require surgery, but some do. Often X-ray (radiographs) are used to diagnose and guide treatment. Broken ankles should be treated by a board certified Orthopaedic Surgeon (ABOS). Preferably one who specializes in Foot and Ankle Surgery. They can help you decide on treatment. If surgery is required normally plates, screws, and nails are used to fix the broken bone.
What should I do for a sprained ankle?
Sprained ankles are initially treated with rest, ice, compression, elevation and immobilization. This can be initiated by most primary care providers. An ASO brace or a CAM Boot are often used to immobilize for a short period of time. If pain and swelling has not improved after 3-4 weeks then a referral to an Orthopedic Surgeon should be made. They will use XR and an exam to guide treatment options.
Repetitive ankle sprains can lead to chronic instability and chronic ankle rolling.
What is ankle arthritis?
Arthritis is inflammation of the joint. A joint is where 2 or more bones meet. Joints are meant to move, so any inflammation of the joint leads to pain, swelling, and difficulty moving the joint.
At the joint the bones are lined with cartilage. Any damage to the cartilage can lead to inflammation and arthritis. This damage can be from repetitive use or an injury.
A less common but well know cause is an autoimmune arthritis such as Psoriatic or Rheumatoid arthritis.
What is this painful bump on the back of my ankle? What can I do about the bump?
This is a common physical finding in Insertional Achilles Tendonitis. The Achilles Tendon attaches to the calcaneus heel bone at back of the ankle. At this spot the tendon is known to become inflamed, swell and painful. On a microscopic level the tendon can begin to tear which results in more pain and more swelling. Shoes can rub this area too which only increases the symptoms.
Non Surgical treatment in successful in 70% of patients. This includes bracing, medications, heel lifts, and physical therapy. If this fails then surgery is an option. Fortunately there are minimally invasive surgical options such as a Zadek Osteotomy.
What is a Zadek Osteotomy? Why would I choose it?
It is intended to treat Achilles Tendon pain, specifically insertional Achilles pain. A minimally invasive surgery where the calcaneus heel bone is cut, moved and placed in position that allows the Achilles Tendon to not hurt. Small 1 cm incision are used which leads to less pain and quicker recovery when compared to classic open Achilles surgery. Unlike classic larger incision surgeries, this minimally invasive surgery is even safe for higher risk individuals.
The Achilles Tendon itself is not cut leading to quicker recovery.
Patient often endorse this surgery as they have low need for pain medication, can begin walking at 3 weeks after surgery, and has a low complication rate.
Frequently Asked Toe Questions
What is the bump on my big toe?
Bumps on the big toe can be from multiple sources. Often these bumps are referred to as bunions. A bunion is more complex than a bone bump, it actually involves the bones moving out of alignment. This can result in pain in the big toe, as well as potential arthritis. There are many treatments, braces, spacers and online marketing that would make you believe the bunion can be removed. Although these treatments may temporarily relieve bunion pain, they will not get rid of your bunion
What is a bunion?
A bunion is a bump on the inside of your big toe. It is a result of the bones not being in alignment. This results in your big toes moving towards your smaller toes.
Why does my big toe hurt?
Big toe pain can result from from multiple conditions. Some of the most common are Gout, Bunions, and Arthritis.
Gout is unique as it comes on suddenly and is associated with a very painful, red, swollen toe. It is best treated with medications. If left untreated it can lead to irreversible damage.
Arthritis also is associated with a red swollen toe. It is gradual onset and worse with activities. It can cause swelling and redness. It is managed with inserts and medications. There are surgical options as well if non surgical management does not work.
Bunions are when the bones of the big toe move out of alignment. This results in a bump over the inside of the great toe. This can be painful. Often it is treated with wider shoes or surgery.
What can I do for my bunion? Can I get rid of it?
Initial Bunion treatment is focused on taking the pressure of the bump. This includes wider shoes, open shoes, toe spacers, therapy and splinting. Unfortunately despite the marketing and online promises, they cannot get rid of your bunion. The only way to remove or get rid of a bunion is surgery.
Will my bunion get worse?
Bunions do get worse over time. However, It is impossible to predict the rate of progression. Some take decades to get worse, while others take less than a year. We do know family history and show wear can contribute to worsening bunions.
What causes my bunion?
Bunions are believed to arise from multiple factors. These include:
Genetics – Foot shape, joint flexibility. Not everyone has as family history of bunions but many do
Shoe wear choices – heels, narrower shoes
Injuries- Can be a one time injury, or chronic repetitive micro-traumas.
We normally believe today it is a combination of these factors thus we call it “multifactorial”
What is the best surgery for a Bunion?
The best bunion surgery is debated today. There are over 200 different surgical techniques to fix a bunion. Surgeries that have less pain, smaller wounds, low complication rates and quicker healing are ideal. One surgery that meets all these criteria is minimally invasive bunionectomies. These were pioneered in Europe and over the past 10 years, as studies have proven their long term effectiveness, are being adopted in the U.S. Selecting a surgeon who performs these minimally invasive techniques is recommended.
Why Minimally Invasive Bunionectomy (MIS)?
• MIS bunionectomy is proven to be successful.
Less Painful – 50% less narcotic use post operative compared to open bunion surgery
Less Scarring
Very low infection rate
Low bunion recurrence rate – 7%
Early Weight bearing - can walk the same day
Quick return to full activities by 4 -6 months
Minimal Stiffness - Preserves all joint movement (no fusions)
Why are my toes curling and turning? Can I stop them from turning?
The smaller muscles in the foot control toe movement and position. Weakening and Imbalances in the muscles leads to these deformities. We call these hammertoes or curly toes.
This bending of the toes over time leads to stiffness in the small joints of the toes, and thus rubbing and irritation of the toes.
Treatment is focused on limiting the rubbing and irritation. Toe pads, toe sleeves, bigger wider shoes, wearing spacers between the toes.
These non surgical treatments can help the symptoms but will not permanently straighten your toes. To achieve permanent correction surgery is often required.
Why is my second toe crossing over my big toe?
This crossover toe is due to a ligament under the second toe becoming weak. This ligament (the plantar plate) is mean to hold the toe down. When it weakens and tears the toe will start to claw and cross over. This can lead to pain not only where the second toe rubs, but under the second toe joint. People will say it feels like a marble is under the there foot, or that they are walking on a rock. This is because, once the ligament begins to tear, the pressure under the ball of the foot increases.
Risk factors such as a bunion, high heel shoes, repetitive trauma, are known to increase the risk of a crossover toe. Left untreated the ligament can rupture, leading to a dislocation of the second toe, and chronic pain.
