Treatments

The Achilles tendon is the largest tendon in your body. It connects the upper calf muscles to the back of the heel bone. When the Achilles tendon degenerates and becomes inflamed, it is called Achilles tendinosis. If you have Achilles tendinosis, your tendon can swell and become painful. This condition is common in athletes, runners, and people who have calf tightness. Achilles tendinosis may occur in the middle of the tendon (known as midsubstance Achilles tendinosis) or at the point where the tendon connects to the heel bone (known as insertional Achilles tendinosis).

For midsubstance Achilles tendinosis, surgery focuses on removing the diseased portion of the tendon. If most of the tendon is damaged, your foot and ankle orthopaedic surgeon often will use the tendon that goes to the big toe to support the Achilles tendon after repair. Other procedures may include lengthening the Achilles tendon or calf muscles if they are too tight.

The goal of Achilles tendon repair is to reconnect the calf muscles with the heel bone to restore push-off strength. Regaining Achilles tendon function after an injury is critical for walking.

The goal of ankle arthrodesis (also known as ankle fusion) is to relieve pain and maintain or improve function for patients with ankle arthritis. Ankle arthritis is degeneration of the cartilage that covers the ends of the bones that form the ankle joint. These bones are the tibia, the fibula, and the talus. Pain typically is made worse with movement of the arthritic ankle. In ankle arthrodesis the ankle bones are fused into one bone. This eliminates the joint motion and reduces pain coming from the arthritic joint. 

Ankle arthroscopy is a minimally invasive surgical procedure that orthopaedic surgeons use to treat problems in the ankle joint. Ankle arthroscopy uses a thin fiber-optic camera (arthroscope) that can magnify and transmit images of the ankle to a video screen. Ankle arthroscopies can reduce ankle pain and improve overall function.

Arthroscopy can be used to diagnose and treat different disorders of the ankle joint. The list of problems that can sometimes be treated with this technology is constantly evolving and includes:

Ankle arthritis: Ankle fusion is a treatment option for many patients with end-stage ankle arthritis. Ankle arthroscopy offers a minimally invasive way to perform ankle fusion. Results can be equal to or better than open techniques.

Ankle fractures: Ankle arthroscopy may be used along with open techniques of fracture repair. This can help to ensure normal alignment of bone and cartilage. It also may be used during ankle fracture repair to look for cartilage injuries inside the ankle.

Ankle instability: Ligaments of the ankle can become stretched out, which can lead to a feeling that the ankle gives way. These ligaments can be tightened with surgery. Arthroscopic techniques may be an option for treating moderate instability.

An ankle cheilectomy is a surgery that removes a bone spur from the talus or tibia, which are the lower and upper bones of the ankle joint. 

The goal of an ankle cheilectomy is to relieve ankle pain caused by bone impingement or pinching at the front of the ankle. While this may be a sign of early ankle arthritis, an ankle cheilectomy is a joint preserving option that may help with pain and function and buy time before additional treatment is needed.

The ankle is made up of three bones:

• the tibia (shin bone), which forms the inside, front, and back of the ankle
• the fibula, which forms the outside of the ankle
• the talus, a small bone that sits between the tibia and fibula and the heel bone

The ends of these bones are called malleoli. The tibia has a medial (inside) malleoli and a posterior malleoli. The fibula forms the lateral (outside) malleoli. 

The goal of amputation is to remove unhealthy tissue and create a remaining leg that is less painful and more useful. Just like many reconstructive orthopaedic surgeries, the surgical goal is to improve a patient’s pain and function. Amputation can improve quality of life for many patients.

A below-knee amputation (BKA) is an amputation often performed for foot and ankle problems. The BKA often leads to the use of an artificial leg that can allow a patient to walk. A BKA is performed roughly in the area between the ankle and knee. This amputation provides good results for a wide range of patients with many different diseases and injuries.

Brisement is the injection of fluid into the space between a tendon and its lining, or sheath. This procedure breaks up scar tissue and stimulates healing of a tendon. While most commonly used for the Achilles tendon, brisement can be performed in any tendon of the foot and ankle.

Osteochondral lesions of the talus (OLTs) are ankle joint injuries involving damage to the joint surface (cartilage) and/or underlying ankle bone (talus). A normal, healthy ankle joint is made up of smooth cartilage supported by strong bone underneath. Sometimes an ankle injury leads to damaged, rough areas of cartilage and bone underneath. Foot and ankle orthopaedic specialists call this type of injury an OLT. Since the ankle joint moves while walking, the rough spots may cause pain, swelling, stiffness, and decreased motion. It is kind of like having a pothole in the joint surface.

Bulk allograft transplantation takes bone and cartilage from a human cadaver and places it into the damaged talus. This surgery is reserved for severe cases of OLT that have either failed previous surgical treatment or involve a very large part of the talus. These types of OLTs may not respond to lesser surgeries.

A bunionette deformity is an abnormal bony prominence, or bump, on the outer side at the base of the fifth toe (the "pinky toe") at the metatarsophalangeal joint (MTPJ). The bony prominence can start out small and painless but become larger and more painful over time. When bunionettes become larger, it usually is because of growth of the bony prominence, a curved shape to the fifth MTPJ, or splaying of the fifth metatarsal away from the fourth metatarsal. The condition is also known as a tailor's bunion.

The calcaneus, or heel bone, plays an important role in walking. A calcaneal osteotomy is a controlled break of the heel bone, performed by a foot and ankle orthopaedic surgeon, to correct deformity of the foot and ankle. 

The heel bone can be realigned to achieve a different orientation, which can correct many different deformities and functional limitations. For example, abnormally high or low arches are deformities that can be addressed with a calcaneal osteotomy. The ultimate goal of all osteotomies is to relieve pain, improve alignment and walking, and reduce the likelihood of arthritis. 

The calcaneus is the heel bone. Fractures or breaks of the calcaneus commonly occur after a fall from a height or car accident. Treatment of these fractures may require surgery.

The goal of heel fracture surgery is to restore the shape of the heel bone as close to normal as possible. Restoration of normal alignment and contour is considered the best way to restore function and minimize pain.  

A cavus foot has a high arch. The cavus can range from being slightly high to severely deformed, causing a patient to walk on the outside of the foot. Surgery sometimes is needed to realign the foot.

While the cause of a high-arched foot it often unknown, a cavus could be caused by nerve disease, clubfoot, or injury. Treatment ranges from changes in shoes to surgeries, depending on the amount of deformity and related problems.

The main goals of cavus foot surgery are to reduce pain, improve function, and prevent further damage or injuries.

A bunion (also known as hallux valgus) is a misalignment of the knuckle of the big toe. This misalignment causes the big toe to turn toward the smaller toes. It often creates a bump at the base of the big toe. Bunions are not always painful, but this deformity generally will increase over time.

A Chevron osteotomy is a common bunion correction surgery. The foot and ankle orthopaedic surgeon cuts the end of the long bone leading to the big toe (metatarsal) and rotates the end of the bone to straighten the big toe. This procedure may be performed in conjunction with soft tissue adjustments around the joint. This osteotomy is mostly performed for mild to moderate bunion deformity. This bunion correction surgery relieves pain by restoring normal straightness to the first toe joint.

Most bunions can be treated without an operation, but sometimes surgical procedures are needed to relieve pain and deformity. Unfortunately, in some cases bunion repairs fail and the pain or deformity returns. There are multiple factors that can contribute to this challenging scenario. Bunions can recur because of medical conditions or non-healing of the bone after surgery. In some cases, there are technical aspects that can be improved to achieve the desired result with additional surgery.

The goal of correcting a failed bunion repair, using a procedure called revision surgery, is to relieve pain and deformity of the first toe that remains after the initial surgery. Sometimes arthritis develops after bunion surgery. This may require a different procedure than the first. It is important to figure out why the first surgery failed to prevent another failure.

The Charcot Restraint Orthotic Walker, or CROW, is a rigid boot designed to accommodate and support a foot with Charcot neuroarthropathy (CN).

CROW consists of a fully enclosed ankle/foot orthotic with a rocker-bottom sole. It is a common treatment used to minimize further deformity and prevent ulcer development after acute CN has calmed down.

CN occurs when bones and joints in the foot fracture, break up or pop out of place with minimal or no known direct injury. In the United States, this deformity most commonly occurs in people with diabetes. The foot first enters an acute stage of swelling, warmth and redness, that can be mistaken for an infection. Broken bones and dislocations can occur, causing severe deformities of the foot and ankle. Some patients develop pain or ulcers when the affected foot becomes deformed. CN can affect the other foot or happen again in the same foot. The foot does not regain its normal shape. 

Distraction arthroplasty is a distraction (stretching out) of the ankle joint. The ankle is held in this distracted position for a period of time. This technique is used to unload the ankle joint and allow healing of the damaged joint. It may be recommended for a patient who has ankle arthritis.

The major goal of this treatment is healing of damaged tissue that occurs from arthritis. Distracting and unloading the ankle joint, along with the use of range of motion activity, is believed to help restore some of the damaged tissue in the ankle. With this restoration, a patient may be able to avoid or delay a more invasive procedure such as an ankle fusion or total ankle replacement. This allows patients to maintain motion of the ankle joint, which would be lost with an ankle fusion, and potentially avoid activity restrictions that may be necessary after an ankle replacement.

Shock wave therapy is a non-invasive method that uses pressure waves to treat various musculoskeletal conditions. High-energy acoustic waves (shock waves) deliver a mechanical force to the body’s tissues.

The metatarsal bones are the long bones in the middle of the foot. Each metatarsal bone has a base, a shaft, a neck, and a head. The fifth metatarsal is the last bone at the outside of the foot, and most breaks of the fifth metatarsal occur at the base. 

The majority of fifth metatarsal fractures are treated without surgery. However, certain situations may require surgical treatment. Surgery can be performed to help the bone heal in a correct position and return the patient to full function. Surgery may reduce the time needed for immobilization and improve the chance of healing compared to non-surgical treatment.

A bunionette (also known as a tailor's bunion) is a painful bony prominence, or bump, on the outside of the fifth (little) toe. Over time, the bunionette may worsen as the fifth toe moves inward and the fifth metatarsal (the bone connected to it) moves outward. Rubbing between the bump and tight shoes may also cause a callus to grow over the fifth toe area. All bunionettes can cause pain and pressure on the outside of the foot, though often they do not cause symptoms.

An osteotomy is a surgically performed cut of the bone. A fifth metatarsal osteotomy refers to a cut in the head, neck, or shaft of the bone to make it straighter and the bony prominence smaller. This reduces rubbing on the outer side of the foot and decreases or eliminates the pain. 

The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP cheilectomy is a surgical procedure that removes bone spurs on the top surface of the big toe joint. Bones spurs develop due to arthritis of the big toe, also known as hallux rigidus. The spurs block the toe’s motion, which causes pain. A first STMP cheilectomy relieves pain and improves range of motion in the big toe.

The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP joint fusion is a surgical procedure to treat arthritis of the big toe. This condition can cause pain and swelling and lead to difficulty walking, running, and wearing shoes. Arthritis develops when the cartilage on each bone wears away and the two bones that make up the big toe joint rub against one another.

In a first MTP joint fusion, the bones are joined (fused) together permanently so they cannot rub against each other and cause pain. 

The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP joint interposition arthroplasty is a surgical procedure to treat arthritis of the big toe. The treatment can stop pain at the base of the big toe by preventing the surfaces of the bones from rubbing together. It also can preserve some motion in the big toe.

The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP joint replacement treats arthritis of the big toe. The bone on either side of the joint is partially removed and replaced with metal, plastic or a combination of both. First MTP joint replacement lessens pain, retains motion, and improves the position of the big toe.

The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP joint resection arthroplasty treats arthritis of the big toe. This procedure stops pain by preventing the surfaces of the big joint of the big toe from rubbing together. 

First MTP medial capsulorrhaphy is a procedure that tightens the soft tissue on the inner side of the big toe joint. This procedure is done along with other procedures to help correct a bunion deformity. It should not be performed alone due to the likelihood of the bunion returning. Bunions involve both an altered position of the bones of the foot as well as a stretching of the soft tissue around the joint, which allows the big toe to turn inward toward the second toe. Both of these should be addressed to allow long-term correction of a bunion.

The goal of tightening the soft tissue is to restore normal tension of the previously stretched out tissue, aiding in pain relief pain by straightening the big toe. Bunion procedures also may improve the cosmetic appearance of the foot but should not be done for this reason alone.

Adult flatfoot is a condition that is characterized by the collapse of the arch of the foot. Surgery will improve alignment of the foot and restore more normal pressure during standing and walking. A combination of procedures often is needed to repair the ligaments and tendons that support the arch. Bone cuts are made to help restore the arch. Proper correction of flatfoot deformity can help reduce pain and improve walking ability.

The flexor digitorum longus (FDL) is one of the tendons responsible for bending the toes down to the floor. The goals of a FDL tendon transfer surgery are to relieve pain and to help restore the arch in patients with painful fallen arches. A fallen arch occurs when the foot loses its support and flattens out, generally due to weakening of tendons and ligaments in the foot.

A flexor hallicus longus (FHL) tendon transfer to the proximal phalanx of the big toe is used to treat clawing of the big toe.

Small muscles in the foot help to stabilize the big toe. When those muscles are weakened by disease, an imbalance occurs that leads to clawing. The clawing puts abnormal pressure on the ball of the foot that can cause an ulcer to form. In addition, clawing may lead to pressure on top of the toe from shoes. Clawing is associated with a variety of underlying disorders, including Charcot-Marie-Tooth disease, diabetic neuropathy, traumatic brain injury, polio, and stroke.

The primary goal of an FHL tendon transfer is to decrease the abnormal pressures on the big toe. This will prevent ulcer formation, or in the case of an existing ulcer, promote healing. An FHL tendon transfer often is done at the same time as other foot procedures.

The flexor hallicus longus (FHL) is the primary flexor muscle of the big toe. It originates at the back of the leg, transitions into a long tendon as it enters the foot and attaches on the bottom of the big toe.

The peroneus brevis (PB) muscle starts in the leg and continues along the outside of the ankle. It then takes a sharp turn and ends on the outside of the foot. The peroneus brevis works with the peroneus longus (PL) to turn the ankle and foot outward. 

The FHL to PB tendon transfer is a surgery to improve the function of the foot. The FHL is passed behind the ankle to the outside of the foot to either assist or replace the damaged PB tendon.

The goal of this surgery is to restore the power of the ankle and foot to turn outward, which is required for cutting and turning movement. 

This surgery is used to treat flexible hammertoe deformity. A hammertoe deformity is one in which the toe is bent and looks like a hammer. A flexible deformity is one in which the toe can be manipulated into a straight position. This deformity can cause shoe problems, corns, and pain with walking.

Foot drop occurs when the muscles and tendons that flex the foot up are no longer working. Commonly, it is the result of a nerve injury, stroke, or nerve disease (neuropathy). It also can occur after an injury to a muscle or tendon. If a person is unable to flex the foot up when walking, the foot or toes can drag on the ground. This can make walking difficult and lead to frequent falls. 

There are 26 bones in the foot, all of which can be fractured. There are different types of fractures. Sometimes a bone breaks but stays in place (non-displaced). Sometimes a bone breaks into two pieces that move apart from one another (displaced). Other types of fractures include a bone that is broken in multiple places (comminuted) and a bone that breaks through the skin after fracturing (open fracture).

If you injure your foot, your orthopaedic foot and ankle specialist will take X-rays to see if you have a fracture. X-rays will identify most fractures but some smaller and more subtle fractures may require CT or MRI scans to be seen. Not all fractures require surgery, and your foot and ankle orthopaedic surgeon will help determine how your fracture should be treated.

If you need surgery for your foot fracture, the goals are to restore the fractured bone to its correct position, stabilize the bone in this position, encourage healing, restore function and reduce the risk of future problems such as persistent pain, loss of motion, and arthritis.

A ganglion is a cyst that forms on top of a joint, ligament, or tendon. The cyst is filled with fluid. Because the ganglion is not cancerous and may disappear in time, if you do not have symptoms such as pain, your doctor may recommend observation only to make sure that no unusual changes occur.

The procedure to remove a ganglion is called ganglion resection. The initial treatment of a ganglion is not surgical, but if pain becomes a problem, your orthopaedic foot and ankle specialist may recommend aspiration, a procedure to remove the cyst’s fluid through a needle. If the cyst returns, surgery to remove the ganglion might be an option.

The gastrocnemius and the soleus are two muscles that make up the calf. The gastroc is the larger and more superficial of the two muscles. The soleus is a deeper muscle within the lower leg. The gastroc tendon combines with the soleus tendon to form the Achilles tendon.

Tightness in the calf can limit how for the ankle can flex up. This may make it difficult to walk with the heel on the floor. Over time this can cause problems such as pain and deformity. Calf tightness may contribute to many foot problems, including heel pain, Achilles tendon pain, flatfoot deformity, toe pain and bunions.

A Haglund's deformity is a bump in the back of the heel bone. The Achilles tendon runs over the bump. Patients with a Haglund's deformity may or may not have pain. Sometimes, the pain is caused by shoes rubbing against the bump. At other times it can be part of pain of degeneration in the Achilles tendon due to the pressure placed there. It is not always clear how much of this Achilles tendon problem is due to the Haglund's deformity.

If prominence is the main issue, then the goal of Haglund's deformity surgery simply is to make the heel bone less prominent. If the Achilles tendon has degenerated as well, then the procedure may involve the Achilles tendon directly.

A hammertoe is a deformity that causes a toe to become bent upward in the middle so it resembles a hammer. This can cause the toe to rub against the top of the shoe or irritate the end of the toe by jamming it into the ground. Hammertoes often occur in conjunction with other toe problems. It is possible to develop corns (calluses) on top of the middle joint of the hammertoe from rubbing against the top of the shoe.

Patients who have hammertoes try to manage them by treating the symptoms. This involves padding the toe and changing or stretching shoes for comfort. If you still experience discomfort from the hammertoe you may consider surgery.

The hammertoe can be flexible or stiff. Depending on the flexibility of the toe and the preference of your orthopaedic foot and ankle surgeon, several different surgeries are used to treat the hammertoe.

Many patients have questions about the hardware that is used in foot and ankle surgery. If you are having foot or ankle surgery, ask your physician if you will need implants like those discussed below.

Insertional Achilles tendinitis is a degeneration of the fibers of the Achilles tendon directly at its insertion into the heel bone. It may be associated with inflammation of a bursa or tendon sheath in the same area. 

A joint injection is a procedure your doctor uses to introduce medication into a joint. The injection is done under sterile conditions using a syringe and needle.

The goals of a joint injection are to relieve pain and improve joint function. Your foot and ankle orthopaedic specialist also may confirm your diagnosis when giving a joint injection.

The Lapidus procedure is a surgical procedure used to treat a bunion deformity, also known as hallux valgus. It involves fusing the joint between the first metatarsal and one of the small bones in your midfoot, the medial cuneiform. Surgery includes removing the cartilage surfaces from both bones, correcting the angular deformity, then placing hardware (screws and often a small plate) to allow the two bones to grow together, or fuse. This surgery often is done to correct a bunion deformity with a very large angle, or when there is increased mobility through the tarsometatarsal (TMT) joint. When the TMT joint has too much looseness or movement, the condition is known as hypermobility or instability. When this joint becomes hypermobile, the first metatarsal moves too far in one direction and the big toe compensates by moving too much in the other direction. When this happens, a bunion can develop. 

The goal of the Lapidus procedure is to surgically treat hallux valgus that is caused by first TMT joint hypermobility. When the first TMT joint is fused, the first metatarsal will not move abnormally. This will allow the first toe to stay straight and decrease the risk of the bunion coming back. 

Ankle sprains are one of the most common sports-related injuries. They affect 10,000 people per day. When the ligaments on the outside of the ankle are stretched or torn, patients can have pain and feelings of instability. If symptoms persist after non-surgical treatment, surgery may be required. The goal of this surgery is to restore normal stability to the ankle. This should also fix your feeling that the ankle “gives way” and any pain that is associated with an unstable ankle.

Each foot has five metatarsals. These are the long bones of the foot. They connect the toes to the rest of the foot. They also make the ball of the foot. The lesser metatarsals are the bones that connect to the second through fifth toes (not the first, or big toe). 

An osteotomy is a cut made in the bone. It is similar to breaking the bone but in a very controlled manner. A lesser metatarsal shortening osteotomy changes the pressure distribution under the ball of the foot, relieving pain. It also can be used to put a chronically dislocated toe back in position.

The Lisfranc ligament runs between two bones in the middle of the foot called the medial cuneiform and the second metatarsal. The place where these two bones meet is called the Lisfranc joint. The name comes from French surgeon Jacques Lisfranc de St. Martin (1790-1847), who was the first physician to describe injuries to this ligament.  

Tearing of the Lisfranc ligament and other ligaments around the Lisfranc joint can lead to instability and disruption of the joints in the middle of the foot. The goal of surgery is to restore normal alignment to the foot. Whether the injury results in a subtle misalignment of the bones or a more obvious dislocation of joints, the surgery is intended to put the bones back into their original position.

The midfoot is the middle of the foot. It refers to the bones and joints that make up the arch and connect the forefoot (front of the foot including the bones of the toes) to the hindfoot (back of the foot including the ankle bone and the heel bone).

Midfoot fusion is a procedure in which the different bones that make up the arch of the foot are fused together. Fusion eliminates the normal motion that occurs between two bones. Since there is very little movement in the small joints of the midfoot, the function of the foot can be preserved.

Osteochondral lesions of the talus (OLT) are ankle joint injuries involving damage to the joint surface (cartilage) and/or underlying ankle bone (talus). A normal, healthy ankle joint is made up of smooth cartilage supported by strong bone underneath. Sometimes an ankle injury leads to damaged, rough areas of cartilage and bone underneath. Foot and ankle orthopaedic specialists call this type of injury an OLT. Since the ankle joint moves while walking, the rough spots may cause pain, swelling, stiffness, and decreased motion. It is kind of like having a pothole in the joint surface.

One way to treat the damaged ankle cartilage is through surgery. One type of surgery is called mosaicplasty (MP), which is the transplant of small amounts of bone and cartilage. The primary goal of this procedure is to smooth out the surface of the ankle joint by replacing the unhealthy spots with healthy, smooth cartilage. By reconstructing the surface, pain and other symptoms should decrease or stop all together.

The naviculocuneiform (NC) joint is located in the middle of the foot. It consists of four bones: the tarsal navicular and the medial, middle, and lateral cuneiforms. 

The main reason to perform NC joint fusion is to relieve pain related to arthritis. Arthritic joints in the midfoot typically occur after trauma to that region or as part of a collapsing foot arch. When a joint is arthritic, the cartilage has worn away and the bony surfaces rub together, which causes pain. The goal of the fusion is to get the bones to heal together so the pain goes away. Sometimes patients whose arches have collapsed will have a deformity that requires NC fusion to correct it.

Orthotics, also called orthoses, are devices that are worn to relieve pain associated with foot and ankle deformities and help prevent or delay surgery. Most people think of shoe inserts or arch supports when they hear the word orthotics, but they can include devices such as foot pads, shoe inserts, ankle braces, and similar items. Treatment often can begin with less expensive off-the-shelf orthotics and progress to custom orthotics if the symptoms and diagnosis require it.

Percutaneous Achilles tendon lengthening in a procedure used to stretch a tight Achilles tendon and increase motion at the ankle joint.

A peroneus longus (PL) to Achilles tendon transfer is done to restore strength across the ankle joint. Strength may have been lost due to an injury to the Achilles tendon or a neurological disorder. Also, patients with Achilles tendon pain that has not improved from non-surgical treatment may benefit from this transfer. Other tendons (such as the tendon to the big toe or lesser toes) may be chosen for the transfer instead of the PL, based on the underlying anatomy and function.

The tibia (shin bone) and the fibula are the bones of the lower leg. Pilon fractures are injuries that occur at the lower end of the tibia and involve the weightbearing surface of the ankle joint. The fibula also may be broken. These injuries were first described more than 100 years ago and remain one of the most challenging problems for orthopaedic surgeons to treat. Common causes of pilon fractures are falls from a height and car accidents. 

The goals of pilon fracture surgery are to restore alignment and stability and allow healing of the tibia and fibula at the ankle joint. Once the fractures are healed, your foot and ankle orthopaedic surgeon's goals are to restore movement and strength at the patient’s ankle. 

The plantar fascia (PF) is a thick band of tissue that connects your heel bone to your toes. It helps support the overall shape of your foot, especially when standing, and helps with shock absorption. Irritation and scarring of the plantar fascia, known as plantar fasciitis, is one of the most common causes of heel pain.

Ten percent of people have pain in the bottom of the heel at some point in their life. The most common cause is plantar fasciitis, which can result from overactivity, improper shoes, flat feet or excessive weight on the feet.

The plantar fascia is a thick band of tissue that connects your heel bone to your toes. It helps support the overall shape of your foot, especially when standing. Irritation and scarring of the plantar fascia, known as plantar fasciitis, is one of the most common causes of heel pain.

Often there is no one event that triggers heel pain. It generally develops over time and can become extremely painful, especially with the first few steps in the morning. It is more common in women, those who walk a lot and people who are overweight. Risk factors include your natural foot shape (flat or high arch), your activities (walking, running) and improper shoes.

Posterior ankle endoscopy/arthroscopy is a technique used to look at and treat problems in the back of the ankle. 

First, it’s important to understand ankle anatomy. The ankle joint is the joint between the lower leg bones (tibia and fibula) and the ankle bone (talus). The joint below the ankle joint is called the subtalar joint; it lies between the ankle bone and the heel bone (calcaneus). The talus has a bony prominence in the back next to the flexor hallucis longus (FHL) tendon. This is the tendon that moves the big toe downward toward the floor.

The bony posterior prominence might be the cause of ankle pain in some people if it is large (called a trigonal process) or it is not completely fused with the talar bone (called an os trigonum).

The flexor digitorum longus (FDL) is one of the tendons responsible for bending the toes down to the floor. The goals of a FDL tendon transfer surgery are to relieve pain and to help restore the arch in patients with painful fallen arches. A fallen arch occurs when the foot loses its support and flattens out, generally due to weakening of tendons and ligaments in the foot.

Bone grafts may be needed for various orthopaedic surgeries of the foot and ankle. Bone grafts provide bony support and/or fill in areas where bone is missing. Bone grafts are either taken from the patient (autograft), or taken from a bone donor (allograft). The best bone graft provides enough bone and healing with minimal problems for the patient.

Proximal tibial bone graft (PTBG) is a type of autograft. The proximal tibia is the upper portion of the leg or shin bone that is just below the knee joint. Getting bone graft from this body part usually is less painful than from other areas like the pelvis.

Regional anesthesia makes a specific body part numb so that surgery can be performed. The goals are to make the foot and ankle numb during surgery and relieve pain after surgery. This helps patients need less medicine during and after surgery. 

Regional anesthesia may be considered for almost any surgery of the foot and ankle. It is not allowed in patients with certain medical conditions like blood clotting problems or active infections. Some surgeons prefer their patients not have this type of anesthesia. 

Many foot and ankle procedures require insertion of metal plates, screws, rods or similar implants for stabilization of the bones while they heal. There are a number of reasons why a foot and ankle orthopaedic surgeon will chose to remove this hardware. Hardware can be removed if it is painful, associated with an infection, or if your bone didn’t heal as hoped, which may require new hardware to be placed.

The goal of the procedure is to safely remove the hardware without causing damage to the surrounding soft tissues. These tissues often are scarred from previous surgery. Nerves and blood vessels and other soft tissue structures in this area may be at greater risk than at the time of the original surgery. A larger incision than the original surgical incision may be required to safely remove the hardware.

The metatarsals are the long bones in the foot that connect the toes to the midfoot. The metatarsals are numbered one through five, starting with the big toe. So the second metatarsal is the long bone of the second toe.

A second metatarsal shortening osteotomy is a procedure that cuts and shortens the second metatarsal. The goal of shortening the metatarsal is to decrease pain at the base of the second toe (in the ball of the foot) and/or help straighten out the second toe. 

The subtalar joint is located just below the ankle joint between the talus and the calcaneus (heel bone). The main job of the subtalar joint is to allow for side-to-side movement of the foot and ankle. This movement aids in walking, especially on uneven surfaces.

When there is a problem in the subtalar joint, the location of pain is described as being deep. The exact location may be hard to describe. Pain may be felt in the soft spot on the outside of the ankle or in a horseshoe distribution behind and below the ankle.

The subtalar joint is located just below the ankle joint between the talus and the calcaneus (heel bone). The main job of the subtalar joint is to allow for side-to-side movement of the foot and ankle. This movement aids in walking, especially on uneven surfaces.

When there is a problem in the subtalar joint, the location of pain is described as being deep. The exact location may be hard to describe. Pain may be felt in the soft spot on the outside of the ankle or in a horseshoe distribution behind and below the ankle.

The two bones in the lower leg are the tibia and the fibula. The point just above the ankle where these two bones meet is called the syndesmosis. While technically a joint, it does not function like most joints as there is very little motion between the two bones. Its main functions are to provide stability to the ankle joint and allow for motion of the joint.

The most common way the syndesmosis is hurt is from a twisting or rotational injury to the ankle. The ligaments that support the syndesmosis are needed to stabilize it, and it is these ligaments that are stretched or torn when this type of injury occurs. Ankle sprains can injure the syndesmosis. The ligaments also can be injured when the ankle is broken. High ankle sprains that are commonly seen in football players are injuries to the syndesmosis.

Surgery of the syndesmosis most often is needed after a traumatic disruption. The goal of surgery is to properly align and stabilize the joint so the ligaments can heal in the correct position.

A Syme amputation is an amputation done through the ankle joint. The foot is removed but the heel pad is saved so the patient can put weight on the leg without a prosthesis (artificial limb). The goals of a Syme amputation are to remove diseased tissue or a non-usable foot and create a functional, painless limb.

The talus bone makes up part of the ankle joint and the subtalar joint. The ankle joint allows for up-and-down motion and the subtalar joint supports side-to-side motion. A talar fracture is a break in the talus bone that often involves both of these important joints. 

The ankle and foot must be well-aligned for proper function. The goal of surgery is to realign the bone pieces and restore the normal bone shape. The surgery also will restore the function of the ankle and subtalar joints. This surgery should reduce the chances of developing arthritis or losing blood supply to the bone.

A tendon transfer is moving a tendon from its normal, anatomic location to another area of the foot or ankle. Tendons typically are transferred in order to restore more normal movement to a foot and ankle that has lost function. A common problem is loss of the ability to raise the foot up, which is called foot drop. This can result from nerve or muscle damage due to stroke, injury, or other diseases. This muscular weakness or paralysis decreases movement and can lead to the foot becoming bent or twisted, making it difficult or painful to stand, walk or wear shoes.

Some tendon transfers allow the ankle and foot to move up and down and regain strength and motion. Others bring the foot into a position where it is easier to walk, stand and wear shoes, but will not increase range of motion. Realigning the foot and ankle can also decrease pain by more evenly distributing pressure across the foot. In some cases, a tendon transfer may eliminate the need for a brace altogether. 

Tendoscopy is a procedure that allows an orthopaedic surgeon to see the inside of a tendon sheath to treat tendon disorders of the foot and ankle. Tendoscopy is very similar to arthroscopy. A small camera and special instruments are placed through small incisions along the course of a tendon. Sterile fluid is used to expand the sheath and provide direct exposure to the tendon.

The goal of tendoscopy is to treat tendon disorders without using large incisions. Patients have less pain and smaller scars than with traditional open surgery. Patients also can return to work and exercise sooner with this procedure versus open surgery.

Total ankle replacement, also known as total ankle arthroplasty, is a surgical procedure that foot and ankle orthopaedic surgeons use to treat ankle arthritis. Arthritic changes may be a result of normal wear and tear due to aging or from an injury such as a broken ankle or dislocation. Arthritis eventually leads to loss of cartilage, pain, and/or deformity.

The goal of ankle replacement is to provide pain relief while preserving ankle motion so the patient has less pain and better function during activity. 

Fusion is locking the bones together. A triple arthrodesis is a fusion in the hindfoot (back of the foot) used to treat many types of painful foot deformities. This procedure fuses the joints under the ankle that allow the foot to move from side to side. These joints are the talonavicular, subtalar, and calcaneocuboid.

Surgeons try to avoid fusions, but sometimes pain and deformity are so severe that this procedure offers the best chance of producing a less painful foot with better alignment. Fusions often improve stability and allow for easier standing and walking. The hindfoot fusion is a time-tested, durable procedure.