● Pain along the inside of the ankle, worsened by activity.● Swelling and redness.● Visible flattening of the foot.● Inability to rise onto toes on the affected side.

The physicians at Kayal Orthopaedic Center will perform a thorough physical examination, where they will observe the foot and ankle’s movement, and check for several distinguishing physical characteristics that indicate the condition’s presence. Our physicians will look for:
● Swelling from the lower leg to the inside of the foot and ankle
● Change in the shape of the foot, with either the heel tilted outward or the arch collapsed
● The presence of “too many toes” where, if looking at the heel from the back of the foot, more toes are visible than should be
● Ability to stand on one leg and rise up on the tiptoes
● Foot flexibility
● Limitations in the ankle’s range of motion
Imaging tests, such as an X-ray, an MRI, a CT Scan or an ultrasound, may be performed for further diagnosis confirmation.

When caught early, PTTD symptoms often improve without surgical intervention. Traditional treatment methods, like bracing and orthotics, short leg casts (for immobilization), physical therapy, and/or medication, may eliminate pain. When conservative measures fail, surgery is an effective option to relieve pain. Depending on the severity of PTTD, our expert surgeons may recommend:
● Hindfoot fusion in advanced stages when arthritis is present
● Minimally invasive arthroscopic surgery to repair inflamed or torn tendons
● Osteotomy to cut, reshape and realign the foot
● Viscosupplementation for arthritic pain relief, which involves injections to lubricate the bones for better range of motion
Our physicians' customized approach to foot and ankle treatment ensures that patients receive the best possible outcome.

● Tendon Transfer – Replaces damaged tendon with another from the foot, often the flexor digitorum longus.
● Tenosynovectomy – Removes inflamed or damaged tissue in early-stage cases to relieve pain and prevent progression.
● Osteotomy – Cuts and reshapes bones (often heel and midfoot) to restore the arch; may use bone grafts in severe cases.
● Fusion (Arthrodesis) – Joins joints in the back of the foot for better alignment in long-standing cases.
● Gastrocnemius Recession – Lengthens calf muscles and Achilles tendon to improve flexibility and prevent recurrence.

Recovery varies based on severity and surgical method. Significant pain relief may take up to a year, and return to sports depends on the foot’s condition before surgery.

Severe tears may require spring ligament repair or reconstruction, sometimes using a tendon transfer. This is often performed with flatfoot reconstruction.

Recovery includes six weeks of non-weightbearing, followed by a walking boot and physical therapy. Full healing may take 9–12 months.

Diagnosis involves a physical exam and imaging (X-ray or CT scan).
● Mild cases: Rest, ice, anti-inflammatory medication, bracing, and physical therapy.
● Severe cases: Surgery to realign bones and secure them with plates or screws, sometimes removed after healing.

Healing typically involves 6–8 weeks in a cast or boot, followed by physical therapy. While many patients return to normal activity, athletes may not always regain full pre-injury performance.

Though a visible bump on the side of the big toe is the most apparent symptom, there are several other indications that signal a bunion’s presence. These symptoms include:● Intermittent or chronic pain at the base of the big toe.● Redness and inflammation.● Hardened skin on the bottom of the foot.● Possible numbness.● A callus or corn on the bunion bump.● Big toe leaning toward or overlapping the second toe.● Pain, swelling, redness, and skin thickening.● Calluses between toes.● Reduced flexibility in the big toe.● Stiffness and restricted motion in the big toe, leading to walking difficulties
Bunions can be difficult enough on their own, and, unless surgically removed, they are permanent. They can also lead to complications, like bursitis, hammertoe, and metatarsalgia, which is a painful inflammation in the ball of the foot. Once symptoms start to appear, it is important to consult with your foot care specialist in order to reduce the pain and swelling, as well as slow the progression.

In order to diagnose you properly, your doctor will consider your symptoms, examine your feet, and take X-rays to get a clearer view of the alignment of your toes and the condition of the joints in your feet.

Non-Surgical TreatmentsSome of the non-surgical treatment methods for bunions are:● Rest – taking weight off, elevating, or gently massaging the area may be helpful. ● Icing – icing the area for 10-20 minutes a few times a day.● Medications – anti-inflammatory medication or pain relievers may provide temporary relief.● Shoe choice – choose shoes that are comfortable and provide enough space so that toes are not cramped. Avoid high heels. ● Padding – over-the-counter bunion pads can reduce pressure on the bunion.● Orthotics – custom-made foot supports can provide significant pain relief.
For most people, some combination of these suggestions will make enough difference that surgery will not be necessary. Others, though, may need to consider a surgical option.
Surgical Options (for severe or persistent cases)Bunions come in different sizes and shapes, and your orthopedic surgeon will choose the procedure based on your individual situation. The goal, in most cases, will be to realign the bones and make repairs to the surrounding soft tissue. Some of the more common procedures are:● Osteotomy – the joint is realigned with small cuts made in the bone and then held in place with screws, pins, and plates. This procedure is typically accompanied by soft tissue repair.
● Arthrodesis – this procedure is often used for especially severe bunions or if there is a lot of arthritic damage. The surface of the joint is removed and then held in proper alignment with plates, wires, and screws while healing takes place. Arthrodesis may be used when a previous bunion surgery was not successful.
● Lapidus – named for Dr. Paul W. Lapidus, one of the founders of the American Orthopaedic Foot and Ankle Society (AOFAS), the Lapidus is a joint fusion procedure. It may be recommended when the joint is hyperlax, or unstable. The procedure will include removing the cartilage between the bones, aligning them properly, and then using surgical hardware to hold them in place so that they grow together or fuse.

● Toe pain, especially in shoes.● Redness, swelling, or burning sensation.● Corns and calluses over the joint. ● Decreased flexibility or complete stiffness in severe cases.

Early, flexible hammertoes can often be managed without surgery through:● Taping or splinting to maintain alignment.● Custom orthotics to reduce pressure.● Proper footwear with wide toe boxes and good support
Surgical Options (for rigid or severe cases)● Tendon lengthening or transfer – to restore balance and straighten the toe.● Arthroplasty – removing part of the bone to improve movement.● Arthrodesis – fusing bones in a straight position using pins, wires, or plates.
Recovery from surgery varies but typically takes several months.

A Morton’s neuroma cannot be detected visually. It does not appear as a lump or growth. There is rarely any pain or discomfort while sitting or lying down; only when taking a step and applying pressure to the ball of the foot. The most common symptoms associated with Morton’s neuroma include:● Sharp, but sometimes intermittent, pain when putting pressure on the ball of foot.● A tingling or stinging sensation that extends to one or two toes that nerve supplies.● Numbness extending into the supplied toes.● A radiating sensation, like an electric shock that can extend out into the toes.● Feeling like something hard, like a rock or marble, is inside the shoe and pressing painfully on the ball of the foot.
Women develop Morton’s neuroma far more often than men do, up to ten times more often, in fact. This implies that high heels or other shoes with narrow toes are a major contributor to the development of neuromas. Some of the other factors believed responsible for creating this condition are activities, especially sports, that result in repeated pressure being put on the ball of the foot and physical conditions, like bunions, hammer toes, and fallen or high arches, that throw off the natural striking pattern of the foot.

Morton’s neuroma is far more common in women, likely due to high heels and narrow-toed shoes. Other causes include repetitive pressure from sports or foot problems like bunions, hammertoes, or high/low arches.

The severity of the Morton’s Neuroma condition determines the treatment method. For early stages or less severe cases, conservative treatment may be used. Most cases can be managed without surgery by:● Reducing activities that stress the ball of the foot.● Using ice and NSAIDs for pain and swelling.● Wearing shoes with a wide toe box and avoiding high heels.● Using orthotics or pads to relieve pressure.● Considering cortisone injections.

Once a neuroma has formed, it will not go away on its own, and we have yet to find a way to shrink it. The conservative treatment options listed above are sufficient for most people. For others that is not the case. It’s impossible to walk for any distance without placing weight on the ball of the foot, and if doing so causes significant and ongoing pain, your orthopedist may recommend surgery to remove the portion of the nerve that contains the neuroma. This procedure is called a neuroma excision.

The procedure is typically done under regional anesthesia, and the patient will be able to go home the same day.

A small longitudinal incision is made, usually on the top of the foot. The enlarged portion of the nerve is removed. The incision will then be closed, and the foot will be bandaged. Following surgery, a post-operative shoe will need to be worn until the wound fully healed, which is usually about two weeks. The foot should be kept elevated during this time. Around week 3, the patient should be able to gradually begin a return to normal activities.

Subtalar fusion is typically performed using an open approach:● An incision is made on the outer side of the foot to access the joint.● Damaged cartilage is removed, and any deformity is corrected.● The bones are aligned and secured with screws.● Imaging ensures proper positioning.● In some cases, a bone graft is added to help the bones fuse.

After surgery, rest and elevation are important to reduce swelling and allow healing. Weight should not be placed on the foot for several weeks. Once the initial dressings are removed, a cast or boot may be worn for up to 12 weeks to protect the joint while it fuses.

Common injuries affecting the sesamoid bones beneath the big toe include:
● Sesamoiditis – Chronic inflammation of the sesamoids and surrounding tendons, often caused by overuse. Symptoms include pain, swelling, bruising, and discomfort when bending or straightening the big toe. Common among runners, dancers, and athletes.
● Turf toe – A sprain caused by overextending the big toe joint. This leads to pain, swelling, and reduced mobility.
● Fractures – Sesamoids can fracture either suddenly (acute fracture from trauma) or gradually (stress fracture from repetitive strain). Both cause pain and swelling, though stress fracture symptoms may come and go.

An orthopedic evaluation will include pressing on the area beneath the big toe to check for tenderness, stiffness, and grinding sensations. X-rays help rule out arthritis and confirm the diagnosis. MRI or CT scans may be used to detect fractures, bone fragmentation, or bone bruising.

Most sesamoid injuries can be treated without surgery:● For sesamoiditis: Rest, ice, anti-inflammatory medication, cushioned footwear, activity modification, and sometimes steroid injections.● For turf toe: R.I.C.E. (rest, ice, compression, elevation), anti-inflammatories, protective boots or crutches, and rare surgical repair of soft tissue if severe.

If pain and inflammation persist despite conservative care, a sesamoidectomy may be recommended. The surgery is performed under regional anesthesia, with a small incision made on the side or bottom of the foot. The damaged sesamoid bone is removed, and any affected tendons are repaired. The incision is closed, and patients usually return home the same day in a splint or surgical boot.

● First few days: Keep the foot elevated and limit movement.● First 2 weeks: Use crutches to keep weight off the foot.● Full recovery: Gradual return to normal activities typically takes about 3 months.

Hallux rigidus is usually caused by wear-and-tear arthritis in the big toe joint. Over time, cartilage that cushions the joint wears down, leading to pain and stiffness. It can also result from previous injuries, repetitive stress (such as running or sports that strain the toe), or genetic predisposition to joint problems.

Cheilectomy treatment involves removing bone spurs and reshaping the joint to restore movement. The procedure is typically performed on an outpatient basis under anesthesia. After surgery, patients may need to wear a surgical shoe or boot for a few weeks and follow a rehabilitation plan that includes gentle range-of-motion exercises. Most patients experience significant pain relief and improved mobility.

Signs of a foot fracture may include:● Sudden or gradual pain that worsens with weight-bearing.● Swelling around the injured area.● Bruising or discoloration.● Tenderness to touch.● Difficulty walking or inability to bear weight.● Visible deformity in severe fractures.● Limited range of motion and stiffness are also frequent indicators.

Treatment depends on the location and severity of the fracture:● Immobilization – A cast, splint, or walking boot keeps the bone in place while it heals.● Rest and elevation – Limits swelling and promotes healing.● Ice therapy – Reduces pain and inflammation.● Medication – Over-the-counter or prescribed pain relievers as needed.● Surgery – Required for severe fractures, displaced bones, or fractures involving joints. Surgical treatment may involve screws, plates, or pins to stabilize the bones.

Most foot fractures heal within 6–8 weeks, though recovery time may be longer for more complex injuries. Physical therapy may be recommended to restore strength, flexibility, and balance.

Foot fracture fixation is a surgical procedure used to stabilize broken bones in the foot. It typically involves the use of screws, plates, or pins to hold the fractured pieces in place, allowing them to heal properly and restore normal foot function. This approach is usually recommended for severe fractures, displaced bones, or injuries that cannot be treated with casting alone. Proper fixation helps prevent long-term complications like deformity, chronic pain, or limited mobility.

The most common causes for needing revision surgery include improper healing of bones after the first surgery (malunion or nonunion), failure or loosening of hardware such as screws or plates, infection, or recurrence of the original condition. In some cases, new injuries or additional wear and tear on the foot may create problems that require surgical correction.

Treatment involves carefully planning a second surgery to address the issues from the initial procedure. This may include removing or replacing hardware, realigning bones, or reconstructing soft tissues to restore proper function. Postoperative care often includes immobilization, physical therapy, and a gradual return to weight-bearing activities to ensure successful healing and improved long-term outcomes.

Every time we take a step or make any movement involving the foot, we rely on the Achilles tendon. Many different factors can contribute to an Achilles tendon rupture, but, most often, the cause is a forceful downward movement of the foot that meets with resistance, like the sudden push off at the beginning of a jump, burst of speed or change in direction. This is why it is such a common injury in sports like basketball, football, gymnastics and tennis.

Achilles tendon ruptures are typically the result of traumatic injuries rather than overuse or degeneration. Men tend to generate greater force in their movements, which leads to a higher incidence of injury to the tendon, and men over the age of 30 are the ones most likely to experience ruptures of the Achilles tendon.

Some of the other common factors that may contribute to an Achilles tendon rupture include:● Prolonged overuse of the tendon making it more vulnerable to injury.● Inadequate stretching habits prior to exercise or other physical activity.● Insufficient conditioning before returning to physical activity following a long break.● Steroid injections in the ankle joint to reduce pain and inflammation.● Taking fluoroquinolone antibiotics, such as levofloxacin (Levaquin) or ciprofloxacin (Cipro).● Running on uneven or difficult terrain.● Obesity.

The symptoms of a ruptured Achilles tendon can be mistaken for tendonitis, bursitis or even a sprained ankle. This makes it important to consult with a healthcare professional as soon as possible. Diagnosis will be made through a combination of medical history and physical exam, including range of motion tests. To determine the extent of the injury, imaging tests, such as X-rays, ultrasounds or MRI scans may be ordered.

There are surgical and nonsurgical options for the treatment of an Achilles tendon rupture; which is indicated depends primarily on the severity of the injury, as well as the age and level of activity of the individual. For those who are older and less active, the nonsurgical route for treatment typically consists of:● Relieving pressure on the tendon with the use of crutches● Using ice to reduce swelling● Taking over-the-counter pain medication● Immobilizing the ankle and keeping the foot flexed down with a cast or special boot
Younger, more-active individuals, especially athletes who are eager to get back to their sport, tend to opt for surgery to repair the tendon and have function and mobility restored as soon as possible. Repairing the Achilles tendon surgically is done through an incision in the back of the lower area of the leg. Once the surgeon has accessed the damaged tendon, it is stitched back together. If there is extensive damage, additional tendon tissue may also be required for reinforcement.

Whether treatment was surgical or nonsurgical, patients will need physical therapy to regain strength and restore full function to the Achilles tendon, as well as the leg muscles. For most people, full recovery to their previous level of activity will take between four and six months. It will then be important to continue the strength and stability exercises for an additional six months to prevent any problems from developing.

Once it has been determined that your chronic ankle instability is persistent and that more conservative methods of treatment have proven inadequate, your orthopedic surgeon will likely recommend ankle ligament reconstruction surgery. The procedure will typically be performed as an outpatient procedure and general anesthesia will be used for sedation.

Torn ligaments may be repaired with stitches or sutures. Ligaments that have been over-stretched or disconnected may be reattached. Tendons from another area of the body may be used to repair a ligament when there has been too much damage to stitching back together.

The surgeon will have different techniques to choose from for the repair and will determine which to use in repairing the ligament based on the condition of the ankle and the health of the patient. The most common technique used in repairing damaged ankle ligaments is the modified Bröstrom procedure. In this type of surgery, the surgeon makes a C- or J-shaped incision along the ankle on the outside of the joint. Once the affected ligament is identified, stitches may be used to tighten the tissue and restore stability, or one or more anchors may be used to attach the ligament to one of the bones in the ankle, usually the fibula.

When a tendon from another part of the body is used to replace severely damaged ligaments, the surgeon will weave it through the bones that make up the ankle joint. It will then be secured with stitches or anchored to the bone. These tendons are often taken from the patient’s own body, like using the hamstring, which is located in the knee but may also come from cadavers.

Following ankle ligament reconstruction surgery, patients can expect to be in a cast or splint and on crutches for around two weeks. Once the cast or splint is removed, it will likely be replaced with a removable walking boot. Your surgeon will give you instructions on when your ankle will be able to bear full body weight.

Physical therapy will be recommended for about six weeks following surgery, depending upon any remaining pain or swelling, and will be an important part of a successful rehabilitation program. Using muscle-strengthening and range of motion exercises, the goal will be to gradually return full mobility to the ankle without undoing the healing process by placing too much stress or weight on the ankle before it is ready.

For most people, full recovery from ankle ligament reconstruction will take from three to six months. Sport-specific movements, especially those that require sudden starts and stops or changes in direction, may require a longer healing period before returning. This should always be discussed with your orthopedic surgeon.

Individuals who participate in sports activities like running, basketball, baseball, soccer and gymnastics are especially susceptible to peroneal tendon injuries due to the constant and often high-stress ankle movements required. Some of the other common causes and risk factors for these types of injuries include:● Trauma, such as a direct hit to the outside of the ankle or foot● Overuse and/or repetitive movements of the ankle● Sudden or forceful movements● Improper training techniques or sudden increase in weight-bearing training or activities● Footwear that is not properly fitted or supportive● Excessive pressure on the peroneal tendons due to tight calf muscles● High arches, which force the peroneal tendons to work harder● Sprain or fracture in the ankle joint may cause tearing of the tendons

Whether due to trauma or chronic injury, some of the most common signs and symptoms associated with peroneal tendon injuries are:● Pain in the ankle area● Swelling● Tenderness, particularly on the outside of the ankle● Weakness or instability of the ankle or foot● Warmth and redness● Popping or snapping sensations at the outer edge of the ankle while walking

Peroneal tendon injuries are sometimes misdiagnosed, which can delay proper treatment and may cause the condition to worsen. Prompt consultation with a foot and ankle orthopedic surgeon is important. A physical examination to assess the level of pain, instability, swelling and weakness experienced by the patient will usually be followed by imaging tests, such as an X-ray or MRI scan, to fully evaluate the extent of the injury.

Treatment options for peroneal tendon injuries range from the conservative, nonsurgical methods designed to reduce pain and improve function while the tendon heals, to the surgical repair of the damaged tendon. Your surgeon’s recommendation for treatment will depend on the severity of the injury.

Nonsurgical Treatment
Anytime there is the potential for healing without surgery, your orthopedic specialist will first recommend more conservative treatment options. The goal will be to reduce pain and discomfort while restoring function and strength to the ankle. These recommendations will likely include some combination of:● Rest● Ice● Nonsteroidal anti-inflammatory medications● Immobilization of the ankle with a walking boot● Physical therapy
Surgical Repair
When patients have experienced peroneal tendon tears or dislocations that are unresponsive to nonsurgical treatments, surgery may be necessary to repair or even reconstruct the tendon. Two surgical options for peroneal tendon tear or dislocation repair include retinaculum repair and groove reconstruction.
● Retinaculum repair is a procedure designed to restore the retinaculum ligament, the bands of tissue that surround and stabilize the peroneal tendons. During this procedure, an incision is made near the back and outer edge of the fibula (ankle bone). The retinaculum ligament is then repaired and advanced back to the point of original attachment.
● Groove reconstruction is a procedure performed to keep the peroneal tendons in place behind the bottom of the fibula. An incision is made near the back and lower edge of the fibula. A small flap is created toward the bottom of the fibula and then carefully folded back, resembling a hinge. A small amount of bone under the flap is removed to deepen the groove. The tendons are then returned to their normal place behind the fibula, and the incision is sutured closed. Groove reconstruction is occasionally performed when the fibula groove is shallow in combination with retinaculum repair.

Post-surgery recovery includes wearing a cast for two weeks, followed by a walking boot for another 4-6 weeks. Physical therapy will be necessary to help patients more quickly regain normal strength and range of movement.

Some of the more common causes and risk factors for Achilles tendon chronic tears include:● Sudden pivot or change in direction● Sports injury due to repetitive movement and injuries to tendon● Excessive activity or overuse● Running or exercising on a hard or uneven surface● Prior injury● Aging and just wear and tear● Improper or poorly fitted shoes● Underlying condition, such as diabetes or rheumatoid arthritis

Not everyone with Achilles tendon tears will have the same symptoms. The more common signs and symptoms include:● Pain, often severe, accompanied by swelling in the heel area● Soreness and stiffness in the heel area first thing in the morning when getting out of bed● Difficulty in bending or flexing the foot● Thickening of the tendon or bump at back of heel● Pain at back of heel in shoes

Achilles tendon repair can often be done by making an incision in the back of the lower area of the leg and repairing the tendon back together. In more extreme cases, where the injury was not adequately treated, where more than 50 percent of the tendon is degenerative, or when there are very large bone spurs, reconstruction surgery, which includes tendon transfer, may be needed.

The flexor hallucis longus (FHL) tendon, which is the tendon responsible for flexing the big toe, is commonly used in reconstruction surgery for the Achilles tendon. Originating in the fibula, the FHL runs down the leg and passes through the band of tendons in the back of the ankle on its way through the foot to the big toe. By transferring it to the back of the heel bone, the Achilles tendon attachment is strengthened.

The procedure is performed under regional anesthesia, with the patient positioned chest-down on the operating table. An incision is made in the back of the leg and the FHL tendon is repositioned to run through the damaged Achilles tendon and then attached to the heel bone.

Full recovery from Achilles reconstruction surgery may take as long as six months. Initially, the patient will be in a cast for about a month and instructed to avoid placing weight on the foot. Physical therapy will typically be recommended for rebuilding strength and restoring function as quickly as possible.

With ankle arthroscopy, orthopedic surgeons are able to use tiny instruments, guided by a miniature camera that displays images onto a large computer screen, to accurately diagnose and treat a wide range of problems. Issues and injuries affecting the ankle joint are common and the result of a variety of causes. Some of the more common causes of ankle pain and impaired function that arthroscopy is used to diagnose and treat include:● Trauma or injury, resulting from a blow or sudden movement or change in direction● Arthritis, especially osteoarthritis, which is an age-related form of arthritis● Scar tissue ● Osteochondral lesions of the talus, which are injuries of the cartilage that covers the talus bone and are common with ankle sprains● Bone spurs● Chips or loose bone fragments● Cartilage or ligament damage

Ankle arthroscopy is typically done on an outpatient basis and the purpose may be for diagnostic purposes, alone, or the repair may also be performed at the same time. The patient will be given general anesthesia for the procedure.

A tiny incision is made to provide access for a miniature, fiber-optic video camera called an arthroscope, and another, equally small incision is made through which the surgeon will insert specially-designed surgical instruments. The camera displays the area and guides the surgeon as repairs are made to damaged tissue or bone fragments are removed.

Treating osteochondral lesions of the talus or tibia is one of the more common conditions addressed with ankle arthroscopy. Microfracture, platelet-rich plasma (PRP) or bone marrow aspirate may be involved as part of the treatment.

Every surgery is different and the amount of time that it will require will depend upon the extent of the damage or problem. That said, ankle arthroscopy typically takes less than an hour, and the patient is able to go home that day.

One of the benefits of an arthroscopic procedure is that, due to its minimally invasive nature, there is far less trauma to surrounding muscles and tissue. Smaller incisions also mean less bleeding and scarring. All of this translates to a shorter and less painful recovery period following ankle arthroscopy than what has been the norm with traditional ankle joint surgery.

Ankle arthroscopy has a very high success rate. To ensure the best outcome, all post-surgery instructions should be followed. This will include avoiding strenuous exercise and activities for about six weeks.

Due to the complexity of its makeup, which is responsible for the foot’s wide range of motion, and because it is one of the weight-bearing joints, the ankle is very susceptible to injury. Fractures, even those that healed completely, very often lead to the development of post-traumatic arthritis later in life. Joints also simply wear out with age, resulting in the same degenerative damage to the ankle as is commonly seen in the knee and hip joints.

Whether from trauma or the natural wearing away that comes with aging, the damage to the ankle joint will get worse with time. This can have a significant effect on quality of life, as the pain, stiffness and swelling eventually result in the loss of function in the ankle. Conservative treatments, such as reduced activity, bracing, special inserts, shoe modifications, physical therapy, anti-inflammatory medications and cortisone injections will initially be suggested. If these prove ineffective, ankle replacement surgery will likely be recommended as the best treatment option.

Once the decision has been made for replacing the ankle joint, a customized plan will first be developed using computer imaging and a CT (computerized tomography) scan, which is a series of x-rays that provides cross-sectional images of all of the parts of the ankle. This is commonly done using the Wright Infinity and Inbone Total Ankle Systems, which utilize the Prophecy Preoperative Navigation Guides.

Prior to the surgery, Wright’s technology creates a unique model of the patient’s ankle and a simulation of the procedure. It also recommends size, placement and alignment of the implant based on this modeling.

The patient will be under general anesthesia for the surgery. An incision is made along the front of the ankle so that the damaged bone and other tissue can be removed. Based on the pre-surgery modeling, the artificial joint, made of metal or plastic, will be inserted and aligned. It will then be secured to the surrounding bones of the leg and foot, and the incision will be closed.

Following total ankle replacement surgery, the patient will remain in the hospital for a short stay. Pain medication will help to reduce discomfort. The patient will be sent home with their ankle splinted or in a cast and will be non weight bearing.

Once any discomfort from the procedure itself has passed, most patients are immediately aware of significant relief from the pain they were experiencing prior to the joint replacement surgery. Even before the ankle has totally healed, there will also usually be a dramatic improvement in range of motion and movement.

It will be important to follow all post-operative instructions, especially those pertaining to physical therapy, which is an essential part of recovery following any type of joint replacement surgery. As soon as there has been sufficient healing for the patient to be able to put weight on the ankle, it will be time to begin a structured physical therapy routine designed to strengthen muscles and restore mobility.

As previously noted, the ankle is a complex, weight-bearing joint. Restoring full function with joint replacement surgery may not always be possible. That said, many patients report a significant reduction in pain as well as a marked improvement in function. Depending on the overall health and activity level of the recipient, many total ankle replacements last 10-15 years or longer.

An open approach is often used for this procedure. Any remaining cartilage is removed from the joint, and the ankle and leg bones are surgically joined together with the use of plates and screws. Bone graft material may also be used to promote the fusion of the bones. After ankle fusion surgery, the screws and plates usually remain in the ankle after healing.

After the ankle fusion procedure, the ankle will be wrapped in a cast for approximately 2 weeks. Patients are advised to keep the foot elevated for 1 to 2 weeks after surgery and not to put weight on the foot until about six weeks, at which time a walking cast is placed. Fusion can take between 10 and 12 weeks.

Anyone can experience a broken ankle, no matter how old or young. That said, there has been an increase in the number of ankle fractures during recent years, as well as an increase in severity. Doctors attribute this, at least in part, to people remaining active later in life than those in previous generations.

Some of the most common causes of ankles fractures include:● Simple missteps, like putting the foot down incorrectly when stepping off a curb● Tripping● Rolling the ankle inward or outward● Twisting or rotating the ankle side to side, especially with any force● Over-flexing or over-extending the joint● High impact force, such as a falling or jumping● Impact from an automobile accident or similar kind of trauma● Sports injury

Most people know when they have suffered a broken ankle due to immediate pain and swelling, which may or may not be confined solely to the ankle area. This will often be accompanied by difficulty walking or putting weight on the ankle. Some may even hear the actual fracture, which can sound like a snapping or grinding.

Everyone’s experience is different, and the symptoms differ based on the severity of the fracture and the number of bones broken. Some of the other common signs and symptoms of an ankle fracture are:● Pain, often throbbing, along with swelling, tenderness and bruising around the ankle joint● Difficulty moving the ankle through normal range of motion● Obvious deformity with pieces of fractured bones visible through broken skin, known as an open fracture● Possible dizziness from extreme pain or sight of bones protruding through skin
Without obvious broken bones, an ankle fracture can be mistaken as a sprained ankle. It is important to have ankle injuries examined by a healthcare professional.

Your orthopedic surgeon will determine the best course of treatment for an ankle fracture based on the type and severity of the fracture. If it is a stable fracture and there is only one break, with the segments of bone close together, it can usually be treated by immobilization in a cast. This type of fracture can usually will heal in 6 weeks.

Displaced fractures, which are those in which the ends of the broken bone are no longer in alignment, may require reduction. In this procedure, which is not surgery, your ankle doctor will manipulate the bones back into place. Muscle relaxants, local anesthesia or sedation may be used during reduction.

With more severe fractures that are displaced or fragmented, immobilization or reduction will be inadequate and surgery will be required. Your orthopedic surgeon will repair the fracture or fractures with special screws and plates that will hold the bones in their correct position during healing.

No matter what method was used in treating the ankle fracture, there will be a rehabilitation period that follows. Physical therapy will be recommended once the patient can bear weight on the joint. This is necessary to help return patients to their normal level of activities with as much range of motion and mobility restored as possible. Without proper rehabilitation, there may be complications, including chronic pain, inflammation, weakness and difficulty walking.

Ankle revision surgery generally takes longer to complete than an initial foot surgery and is often more challenging since there is a greater risk of complications. Some complications associated with revision procedures include failure of bones to heal properly, postoperative infection, and damage to nerves or blood vessels. Recovery from ankle revision surgery usually takes the same length of time as that of the first procedure and often requires protecting the ankle with a boot or brace as well as weight-bearing restrictions.

After the allograft procedure, the joint is splinted. Most patients will use crutches for 6 to 9 weeks after surgery before they can successfully bear weight on the joint again. A physical therapy program helps to restore mobility and improve strength and flexibility of the affected joint. While recovery times vary, exercise and and regular activity can normally resume 6 to 12 months after the allograft procedure.

Ideal candidates for juvenile allograft transplantation are patients who have an osteochondral lesion of the talus . These patients often experience pain and swelling weeks or months after the initial trauma or injury, and the pain has become progressively worse with time. When conservative treatment measures fail, surgical intervention may be necessary to alleviate the discomfort. Juvenile allograft transplantation is especially beneficial for patients with large or refractory cartilage lesions.

Prior to surgery, MRI or CT scans will be performed to determine the location and size of the cartilage lesions. A diagnostic arthroscopy may also be performed to thoroughly visualize the ankle lesion. Small portions of cartilage are harvested from the donor in preparation for the procedure, and these are formed into grafts. Next, the donor tissue is examined, sterilized, prepared and tested to ensure it is all healthy and that there will be no disease transmission prior to the transplantation.

Juvenile allograft transplantation is performed under general anesthesia through an arthroscopic technique. After an incision is created, the affected ankle cartilage lesion will be removed and a viable space for the healthy donor cartilage is created. Fibrin glue is applied to the lesion base, and the healthy cartilage pieces are inserted into the space through a cannula. An additional layer of fibrin glue is then used to fully embed the cartilage tissue. Once the graft is securely placed, the incisions can be sutured closed. The healthy cartilage cells from the transplanted cartilage will begin to integrate with surrounding tissues, multiply and produce new cartilage tissue.

Following juvenile allograft transplantation, patients will usually be advised to avoid putting pressure on the ankle joint for at least 6 weeks. The patient will wear a splint to maintain a normal position for the joint until the sutures are removed. Two weeks after surgery, the patient may be switched out of the splint and into a removable boot brace instead. At this time, strengthening exercises are typically started to help restore complete function to the ankle.

The length of time for a complete recovery following juvenile allograft transplantation varies by the individual patient, but frequently takes up to 6-12 months.

There are several benefits to using PRP therapy. These include the fact that the platelet-rich plasma being injected is autologous (comes from the patient), so there is no risk of cross-reactivity, immune reaction or disease transmission. PRP injections, unlike surgery, are only very minimally invasive, yet, unlike corticosteroid injections, PRP injections actually facilitate healing.

During the PRP injection procedure, which usually takes place in the doctor’s office with the assistance of ultrasound imaging, a small amount of blood is withdrawn from the patient. This blood sample is processed in a centrifuge to separate its various elements and concentrate the platelets. The resulting plasma is up to five times more concentrated with platelets than natural blood. Once concentrated, the platelets are loaded into a sterile syringe and injected into the patient, along with some of the patient’s whole blood, used to activate the process.

This procedure is performed under local anesthetic. Most patients experience little or no discomfort from the injection, but the site is expected to be inflamed and sore for about 48 hours. Benefits of the procedure can take up to 6 weeks to occur.

Bone marrow stimulation is a surgical technique used for repairing damaged cartilage in the ankle area. The operation is minimally invasive as it is typically performed via arthroscopic means. Arthroscopy uses tiny incisions to insert a probe-like camera and surgical instruments. These small incisions allow for more precise movement and reduce the risk of infection and other complications of surgery. Arthroscopy can be especially effective in treating joint conditions.

Bone marrow stimulation is performed while the patient is under anesthesia. The procedure requires two small incisions on the ankle. Through one incision, the arthroscope is inserted, which is connected to a small camera that will display an image on a monitor. This is this image that provides the surgeon with a clear view of the inner ankle during the procedure.

A small surgical tool called an awl will be inserted through another incision into the damaged area of the ankle. It is used to create small holes, known as microfractures, in the underlying subchondral bone. Microfractures help release the cells that produce healthy articular cartilage, creating a healing effect that restores the damaged ankle. The number of holes created will vary depending on the size and location of the lesion and extent of the damage. Most patients require between two and five small holes. At times, this technique is combined with platelet rich plasma or bone marrow aspiration. Once the microfracture has been performed, the arthroscope will be removed and the incisions are sutured. The surgery usually lasts for 30 to 45 minutes.

Following a bone marrow stimulation procedure, patients are usually allowed to return home the same day. Patients may be prescribed medications to alleviate pain after the surgery. During the recovery process, the ankle joint requires the protection with splint for two weeks. Placing weight or added pressure on the ankle should be avoided initially.

In most cases, patients will need to undergo physical therapy to help restore function and strength to the ankle. The recovery process following bone marrow stimulation is usually lengthy, and it may be up to six months before a person is able to return to sports or other intense activities.

While bone marrow stimulation usually yields positive results for patients, some cases may require a second bone marrow stimulation procedure or more extensive surgery if the newly created cartilage breaks down or becomes damaged once again. This may occur within one to two years after the initial procedure. For most patients, however, bone marrow stimulation can provide effective, long-term pain relief.

When we are born, all of our bones contain bone marrow, which is the soft, spongy tissue inside bones. This is where the red blood cells, white blood cells and platelets are produced. On average, there are more than 220 billion new blood cells created in the bone marrow each day. By the time we become adults, new bone marrow cells are only being produced inside the bones of the skull, breast, shoulders, ribs, hips, and spine.

The bone marrow in the spine and hip contains the richest concentration of bone marrow cells. It is the iliac crest, which is one of the bones in the pelvis, where bone marrow cells are taken for bone marrow aspirate concentrate. This area is a common source for obtaining mesenchymal (adult) stem cells, progenitor cells, which are descendants of stem cells that have become more specialized, and other cells associated with growth factors.

All of these cells are believed to aid the healing process, especially once they have become more concentrated. Mesenchymal stem cells (MSCs) are the body’s active healing agents and they are at the heart of the blood marrow aspirate concentrate process. This is due to their ability to self-replicate and their potential for reducing inflammation, combating cell death, being able to differentiate into specialized cells, particularly bone and cartilage, and recruit other cells with healing properties to the site of an injury.

Bone marrow aspirate concentrate is obtained by your physician drawing a sample of bone marrow, usually from the region of your pelvis known as the iliac crest. The aspiration process consists of a trochar, which is a three-sided cutting instrument that also has a tube for collecting the sample, being inserted into the site, and withdrawing the bone marrow fluid.

Once the sample is removed, it is filtered and placed into a centrifuge where the stem cells, platelets, and growth factors will become concentrated. What is now the bone marrow aspirate concentrate will be transferred into a sterile syringe and injected back into the same individual at the area of the body that is being targeted for treatment.

The BMAC procedure is typically done on an outpatient basis, with the patient being sedated.

For most individuals, it is normal to expect some soreness in the area of the extraction. This should only last for a few days. With regard to the issue being treated, many patients experience improvement within the first couple of months following the BMAC procedure. Outcomes will depend on each individual’s condition, but reports include decreased pain and discomfort, as well as an increase in strength and stability.

Some of the more common causes and risk factors for Achilles tendon chronic tears include:● Sudden pivot or change in direction● Sports injury due to repetitive movement and injuries to tendon● Excessive activity or overuse● Running or exercising on a hard or uneven surface● Prior injury● Aging and just wear and tear● Improper or poorly fitted shoes● Underlying condition, such as diabetes or rheumatoid arthritis

Not everyone with Achilles tendon tears will have the same symptoms. The more common signs and symptoms include:● Pain, often severe, accompanied by swelling in the heel area● Soreness and stiffness in the heel area first thing in the morning when getting out of bed● Difficulty in bending or flexing the foot● Thickening of the tendon or bump at back of heel● Pain at back of heel in shoes

Achilles tendon repair can often be done by making an incision in the back of the lower area of the leg and repairing the tendon back together. In more extreme cases, where the injury was not adequately treated, where more than 50 percent of the tendon is degenerative, or when there are very large bone spurs, reconstruction surgery, which includes tendon transfer, may be needed.

The flexor hallucis longus (FHL) tendon, which is the tendon responsible for flexing the big toe, is commonly used in reconstruction surgery for the Achilles tendon. Originating in the fibula, the FHL runs down the leg and passes through the band of tendons in the back of the ankle on its way through the foot to the big toe. By transferring it to the back of the heel bone, the Achilles tendon attachment is strengthened.

The procedure is performed under regional anesthesia, with the patient positioned chest-down on the operating table. An incision is made in the back of the leg and the FHL tendon is repositioned to run through the damaged Achilles tendon and then attached to the heel bone.

Full recovery from Achilles reconstruction surgery may take as long as six months. Initially, the patient will be in a cast for about a month and instructed to avoid placing weight on the foot. Physical therapy will typically be recommended for rebuilding strength and restoring function as quickly as possible.

The symptoms of an Achilles tendon rupture run from no signs or symptoms at all, which is rare, to the telltale “pop” accompanied by sudden, intense pain. An Achilles tendon rupture is often experienced by professional athletes. Other common symptoms include:● Pain in the calf area of the leg, especially near the heel.● Swelling, often painful, that worsens with activity.● The sensation of having been hit or kicked in the back of the leg.● Swelling as well as pain, which may be severe, near the heel.● Difficulty bending or flexing the injured foot.● Pain and stiffness in the tendon when first walking in the morning.● Noticeable thickening of the tendon.

Every time we take a step or make any movement involving the foot, we rely on the Achilles tendon. Many different factors can contribute to an Achilles tendon rupture, but, most often, the cause is a forceful downward movement of the foot that meets with resistance, like the sudden push off at the beginning of a jump, burst of speed or change in direction. This is why it is such a common injury in sports like basketball, football, gymnastics and tennis.

Achilles tendon ruptures are typically the result of traumatic injuries rather than overuse or degeneration. Men tend to generate greater force in their movements, which leads to a higher incidence of injury to the tendon, and men over the age of 30 are the ones most likely to experience ruptures of the Achilles tendon.

Some of the other common factors that may contribute to an Achilles tendon rupture include:● Prolonged overuse of the tendon making it more vulnerable to injury.● Inadequate stretching habits prior to exercise or other physical activity.● Insufficient conditioning before returning to physical activity following a long break.● Steroid injections in the ankle joint to reduce pain and inflammation.● Taking fluoroquinolone antibiotics, such as levofloxacin (Levaquin) or ciprofloxacin (Cipro).● Running on uneven or difficult terrain.● Obesity.

The symptoms of a ruptured Achilles tendon can be mistaken for tendonitis, bursitis or even a sprained ankle. This makes it important to consult with a healthcare professional as soon as possible. Diagnosis will be made through a combination of medical history and physical exam, including range of motion tests. To determine the extent of the injury, imaging tests, such as X-rays, ultrasounds or MRI scans may be ordered.

There are surgical and nonsurgical options for the treatment of an Achilles tendon rupture; which is indicated depends primarily on the severity of the injury, as well as the age and level of activity of the individual. For those who are older and less active, the nonsurgical route for treatment typically consists of:● Relieving pressure on the tendon with the use of crutches● Using ice to reduce swelling● Taking over-the-counter pain medication● Immobilizing the ankle and keeping the foot flexed down with a cast or special boot
Younger, more-active individuals, especially athletes who are eager to get back to their sport, tend to opt for surgery to repair the tendon and have function and mobility restored as soon as possible. Repairing the Achilles tendon surgically is done through an incision in the back of the lower area of the leg. Once the surgeon has accessed the damaged tendon, it is stitched back together. If there is extensive damage, additional tendon tissue may also be required for reinforcement.

Whether treatment was surgical or nonsurgical, patients will need physical therapy to regain strength and restore full function to the Achilles tendon, as well as the leg muscles. For most people, full recovery to their previous level of activity will take between four and six months. It will then be important to continue the strength and stability exercises for an additional six months to prevent any problems from developing.

Individuals who participate in sports activities like running, basketball, baseball, soccer and gymnastics are especially susceptible to peroneal tendon injuries due to the constant and often high-stress ankle movements required. Some of the other common causes and risk factors for these types of injuries include:● Trauma, such as a direct hit to the outside of the ankle or foot● Overuse and/or repetitive movements of the ankle● Sudden or forceful movements● Improper training techniques or sudden increase in weight-bearing training or activities● Footwear that is not properly fitted or supportive● Excessive pressure on the peroneal tendons due to tight calf muscles● High arches, which force the peroneal tendons to work harder● Sprain or fracture in the ankle joint may cause tearing of the tendons

Whether due to trauma or chronic injury, some of the most common signs and symptoms associated with peroneal tendon injuries are:● Pain in the ankle area● Swelling● Tenderness, particularly on the outside of the ankle● Weakness or instability of the ankle or foot● Warmth and redness● Popping or snapping sensations at the outer edge of the ankle while walking

Peroneal tendon injuries are sometimes misdiagnosed, which can delay proper treatment and may cause the condition to worsen. Prompt consultation with a foot and ankle orthopedic surgeon is important. A physical examination to assess the level of pain, instability, swelling and weakness experienced by the patient will usually be followed by imaging tests, such as an X-ray or MRI scan, to fully evaluate the extent of the injury.

Treatment options for peroneal tendon injuries range from the conservative, nonsurgical methods designed to reduce pain and improve function while the tendon heals, to the surgical repair of the damaged tendon. Your surgeon’s recommendation for treatment will depend on the severity of the injury.

Nonsurgical Treatment
Anytime there is the potential for healing without surgery, your orthopedic specialist will first recommend more conservative treatment options. The goal will be to reduce pain and discomfort while restoring function and strength to the ankle. These recommendations will likely include some combination of:● Rest● Ice● Nonsteroidal anti-inflammatory medications● Immobilization of the ankle with a walking boot● Physical therapy
Surgical Repair
When patients have experienced peroneal tendon tears or dislocations that are unresponsive to nonsurgical treatments, surgery may be necessary to repair or even reconstruct the tendon. Two surgical options for peroneal tendon tear or dislocation repair include retinaculum repair and groove reconstruction.
● Retinaculum repair is a procedure designed to restore the retinaculum ligament, the bands of tissue that surround and stabilize the peroneal tendons. During this procedure, an incision is made near the back and outer edge of the fibula (ankle bone). The retinaculum ligament is then repaired and advanced back to the point of original attachment.
● Groove reconstruction is a procedure performed to keep the peroneal tendons in place behind the bottom of the fibula. An incision is made near the back and lower edge of the fibula. A small flap is created toward the bottom of the fibula and then carefully folded back, resembling a hinge. A small amount of bone under the flap is removed to deepen the groove. The tendons are then returned to their normal place behind the fibula, and the incision is sutured closed. Groove reconstruction is occasionally performed when the fibula groove is shallow in combination with retinaculum repair.

Post-surgery recovery includes wearing a cast for two weeks, followed by a walking boot for another 4-6 weeks. Physical therapy will be necessary to help patients more quickly regain normal strength and range of movement.

With ankle arthroscopy, orthopedic surgeons are able to use tiny instruments, guided by a miniature camera that displays images onto a large computer screen, to accurately diagnose and treat a wide range of problems. Issues and injuries affecting the ankle joint are common and the result of a variety of causes. Some of the more common causes of ankle pain and impaired function that arthroscopy is used to diagnose and treat include:● Trauma or injury, resulting from a blow or sudden movement or change in direction● Arthritis, especially osteoarthritis, which is an age-related form of arthritis● Scar tissue ● Osteochondral lesions of the talus, which are injuries of the cartilage that covers the talus bone and are common with ankle sprains● Bone spurs● Chips or loose bone fragments● Cartilage or ligament damage

Ankle arthroscopy is typically done on an outpatient basis and the purpose may be for diagnostic purposes, alone, or the repair may also be performed at the same time. The patient will be given general anesthesia for the procedure.

A tiny incision is made to provide access for a miniature, fiber-optic video camera called an arthroscope, and another, equally small incision is made through which the surgeon will insert specially-designed surgical instruments. The camera displays the area and guides the surgeon as repairs are made to damaged tissue or bone fragments are removed.

Treating osteochondral lesions of the talus or tibia is one of the more common conditions addressed with ankle arthroscopy. Microfracture, platelet-rich plasma (PRP) or bone marrow aspirate may be involved as part of the treatment.

Every surgery is different and the amount of time that it will require will depend upon the extent of the damage or problem. That said, ankle arthroscopy typically takes less than an hour, and the patient is able to go home that day.

One of the benefits of an arthroscopic procedure is that, due to its minimally invasive nature, there is far less trauma to surrounding muscles and tissue. Smaller incisions also mean less bleeding and scarring. All of this translates to a shorter and less painful recovery period following ankle arthroscopy than what has been the norm with traditional ankle joint surgery.

Ankle arthroscopy has a very high success rate. To ensure the best outcome, all post-surgery instructions should be followed. This will include avoiding strenuous exercise and activities for about six weeks.

Lisfranc injuries vary in location and severity, ranging from torn or sprained ligaments to dislocations or fractures in bones. They result from a variety of causes and often involve a blow or twisting of the foot. This type of injury is found in many different sporting activities, like football and soccer, where another player may step or fall on a flexed foot or the individual may land wrong or over-twist a foot. Other common causes include falling from a height or being in an automobile accident.

Because of the consequences that can result from an inaccurate diagnosis of what is actually a Lisfranc injury, it is important to recognize the symptoms. Some of the more common of those symptoms include:
● Pain – the pain from a Lisfranc injury can be extreme. Present while merely standing, the increase in pain while engaged in any type of “pushing off” motion will be considerable. In fact, this injury can make it too painful to place weight on the injured foot or try to walk without using crutches. ● Swelling – the swelling that accompanies a Lisfranc injury will typically be noticeable on the top of the foot.● Bruising – the pattern of bruising with a Lisfranc injury is considered a signature sign because it is often visible on the bottom arch part of the foot.
When these symptoms are present it is important to consult your healthcare professional in order to promptly begin treatment and optimize the potential for successful healing.

Lisfranc injuries are diagnosed based on symptoms and a physical examination. X-rays or CT scans will then be used to determine the exact nature of the injury, its location and degree of severity.

If the tests reveal that the ligaments have not been completely severed and there are no displaced or dislocated bone fractures, conservative measures, such as rest, icing and anti-inflammatory medications will usually be the prescribed course of treatment. This may be followed with bracing and physical therapy.

In the more extreme cases, like those that involve a serious bone fracture, fragments breaking off of a bone or when there is malalignment within the joint, surgery will usually be recommended.

The main goal of Lisfranc injury fixation is the realignment of the joint and restoration of broken bones or fragments of bones to their proper positions. This surgery may require the use of plates or screws to secure the alignment and add stability to the foot until it is back to normal. Some or all of the hardware supports may need to be removed several months post-surgery.

The recovery period following Lisfranc injury fixation is typically six to eight weeks in a cast or boot until the patient can put weight on the injured foot. Physical therapy will be recommended to help the patient increase strength in the foot and restore normal functioning as soon as safely possible. It may be necessary to wear an arch support for the first year following surgery.

Results will vary following this surgery. Most people will be able to return to their previous level of activity or close to it. This is not always true for athletes. Some return to pre-injury performance levels, after sitting out most or all of a season. Others may not have the same degree of success.

Hallux rigidus is usually caused by wear-and-tear arthritis in the big toe joint. Over time, cartilage that cushions the joint wears down, leading to pain and stiffness. It can also result from previous injuries, repetitive stress (such as running or sports that strain the toe), or genetic predisposition to joint problems.

Cheilectomy treatment involves removing bone spurs and reshaping the joint to restore movement. The procedure is typically performed on an outpatient basis under anesthesia. After surgery, patients may need to wear a surgical shoe or boot for a few weeks and follow a rehabilitation plan that includes gentle range-of-motion exercises. Most patients experience significant pain relief and improved mobility.