Protecting ankles, feet & toes from life's rough roads
Protecting ankles, feet & toes from life's rough roads
Achilles Tendon Tear & Rupture, Heel Pain, Clubfoot, Calcaneus Fractures, Ingrown Toenail, Intoeing, and more.
Our orthopaedic surgeons have been uniquely trained to treat a wide variety of foot and ankle problems.
Achilles Tendon Tear & Rupture
The Best Achilles Treatment in the Tri-State Area
The Achilles tendon is the largest tendon in your body. It connects the muscles in the back of your lower leg to your heel bone (e.g., the calcaneus) and must withstand large forces during sporting exercises and pivoting. There are two main types of injuries that affect the Achilles tendon: overuse and inflammation, called Achilles tendonosis, and, a tear of the tendon.
Your Achilles tendon may tear if it is overstretched, usually while playing sports. The tear may be partial or complete, and it most commonly occurs just above your heel bone. A snap or crack sound may be heard at the time of injury.
To reduce your chance of developing Achilles tendon problems, follow these tips:● Stretch and strengthen calf muscles. Stretch your calves to the point at which you feel a noticeable pull, but not pain. Don’t bounce during a stretch. Calf-strengthening exercises can also help the muscle and tendon to absorb more force and prevent injury.● Vary your exercises. Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming. Avoid activities that place excessive stress on your Achilles tendons, such as hill running and jumping activities.● Choose running surfaces carefully. Avoid or limit running on hard or slippery surfaces. Dress properly for cold-weather training and wear well-fitting athletic shoes with proper cushioning in the heels.● Increase training intensity slowly. Achilles tendon injuries commonly occur after abruptly increasing training intensity. Increase the distance, duration, and frequency of your training by no more than 10 percent each week.
A person with a ruptured Achilles tendon may experience one or more of the following:● Sudden pain, which feels like they have been kicked or a stabbed, in the back of the ankle or calf—often subsiding into a dull ache● A popping or snapping sensation● Swelling or bruising on the back of the leg between the heel and the calf● Difficulty walking, especially upstairs or uphill, and difficulty rising up on the toes● Inability to bend your foot downward or to walk normally
In diagnosing an Achilles tendon rupture, a foot and ankle surgeon will ask questions about how and when the injury occurred, and whether the patient has previously injured the tendon or experienced similar symptoms. Your surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle, as well. If the Achilles tendon is ruptured, the patient will have less strength in pushing down, as on a gas pedal, and will have difficulty rising on the toes. The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, your surgeon may order a MRI or other advanced imaging tests.
Surgery is typically needed for a complete rupture. After surgery, your ankle will be kept stable in a cast or walking boot for up to 12 weeks. A torn ligament may also be managed non-surgically with a below-knee cast or boot, which would allow the ends of the torn tendon to heal on their own. This nonsurgical approach may take longer to heal, and there is a higher chance that the tendon could re-rupture. Surgery offers a better chance of full recovery and is often the treatment of choice for active people who wish to resume sports.
Say ‘Goodbye’ to Pain & Stiffness
The largest tendon in the human body, the Achilles tendon is connected to the calf muscles and allows feet to flex during walking, running, and jumping. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendonosis, a condition associated with overuse and degeneration.
Achilles tendonosis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendonosis, too. These factors include:● Sudden increase in the amount or intensity of exercise activity—for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance● Tight calf muscles—Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon● Bone spur—Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain
Many changes can be seen when the Achilles tendon becomes inflamed. Most of the time, there is no trauma or injury, but rather a slow progression of pain. Common symptoms of Achilles tendonosis include:● Pain and stiffness along the Achilles tendon● Pain along the tendon or back of the heel that worsens with activity● Severe pain the day after exercising● Swelling that is present all the time and gets worse throughout the day with activity
If you have experienced a sudden “pop” in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.
To diagnose Achilles tendonosis, a thorough medical history is taken and an examination is performed. Patients will usually have pain right on the tendon or at the back of the heel. They may also have swelling and thickening of the tendon. X-rays may be taken to see if there are any bone spurs. A MRI or ultrasound may also be performed to further evaluate how much of the tendon is affected and to look for any tears.
Our foot and ankle doctors treat Achilles tendon injuries using cutting-edge techniques, such as radiofrequency coblation, platelet rich plasma injections and minimal incision surgery. These types of procedures expedite the healing process and allow patients to resume regular activities faster than conventional surgery options. In severe cases, the surgeon may recommend surgery to reattach a torn Achilles tendon or to remove the bone spur. Our foot and ankle surgeons will evaluate each patient’s medical history and customize a treatment plan to suit their individual needs.
Adult-Acquired Flatfoot Deformity
Acknowledge Foot Pain & Seek Innovative Treatment
Adult-acquired flatfoot deformity (AAFD) is a painful, progressive condition that occurs when the soft tissues of the foot are overstretched and torn, causing the arch of the foot to collapse.
The posterior tibial tendon attaches to the bones on the inside of the foot, maintains the foot’s arch, and provides the strength needed for feet to effectively push off while walking. When this tendon loses its function, the bones will spread out of their aligned position and the foot will become “flat”—causing individuals to develop adult-acquired flatfoot deformity.
Without an AAFD repair, the condition may progress until the affected foot becomes entirely rigid and quite painful.
Who’s At Risk?
Common risk factors associated with adult-acquired flatfoot deformity include:● Age. The risk of developing the condition increases with age, with middle-aged women between 40 and 60 being three times more likely to be affected by the condition than men.● Weight. Obese individuals consistently carry more weight, meaning that their bodies steadily experience more stress placed on their feet and ankles. Gradually, bearing extra weight will begin to flatten the arch of the foot, until the foot becomes completely “flat” from the bones spreading out of position.● Previous injury. Individuals who have experienced previous ankle trauma or surgery are at a higher risk to develop AAFD due to a previous form of joint deformity.● Diabetes. Due to disease-related nerve damage, diabetics are more prone to stressing their posterior tibial tendon and acquiring AAFD.● Inflammatory Arthritis. Arthritis degrades the cartilage in the ankle and foot joints and the ligaments that support the foot, causing the foot to change shape over time, eventually flattening it to cause adult-acquired flatfoot deformity.
Common symptoms of adult-acquired flatfoot deformity include:● Pain and/or swelling. As a result of inflammation of the nerve inside the tarsal tunnel, tenderness where the posterior tendon resides may occur and be accompanied by a burning, shooting, tingling or stabbing pain.● Difficulty walking. Individuals may experience a constant ache while walking long distances or an inability to walk altogether.● Change in foot shape. As an individual’s tendon stretches, the arch in their foot flattens, causing a change in the shape of the foot.● Inability to tiptoe. If an individual’s posterior tendon is damaged, he or she may find it difficult, painful or impossible to raise their heels or stand solely on their foot’s toes.
Diagnosis for adult-acquired flatfoot deformity is accomplished through a combination of physical evaluations and imaging tools, such as X-rays and MRIs.
If caught early, adult-acquired flatfoot can be effectively managed through non-surgical treatments, such as bracing, custom-molded orthotics, or cast immobilization. When conservative care fails, our physicians will select a surgical treatment that will restore mobility, reduce pain and stop the progression of this serious foot condition. Surgical treatment will be selected that best suits your needs. Procedure options include tendon transfer, tendon debridement, and joint fusion. Our foot and ankle surgeons may also perform an osteotomy, which involves surgically cutting and reshaping a bone to realign the foot.
Ankle Sprains & Strains
Stop the Pain & Get Back On Your Feet
Ankle injuries are often thought of as sports injuries—but you don’t have to be an athlete or even a “weekend warrior” to turn your ankle and hurt it. The truth is that a sprained ankle is a very common injury. A strained or sprained ankle can happen to athletes and non-athletes, children, and adults. It can happen when you take part in sports and physical fitness activities. It can also happen when you simply step on an uneven surface or step down at an angle.
Ankle sprains are caused by an injury that stresses a joint and overstretches or even ruptures the supporting ligaments, which connect bone to bone. Ankle strains, on the other hand, are typically caused when too much force is placed on muscles or tendons, which connect muscle to bone.
The best way to prevent ankle sprains and strains is to maintain good strength, muscle balance and flexibility. Plus, be sure to do the following:● Warm up before doing exercises and vigorous activities● Pay attention to walking, running or working surfaces● Wear good shoes● Recognize your body’s warning signs and slow down when you feel pain or fatigue
Sprains are usually noticeable when they occur. But sometimes, a minor sprain will happen without your noticing. The primary symptoms of sprains include limited mobility, inflammation, pain, swelling and bruising. Strains are often accompanied by pain, cramping, swelling, muscle spasms, and stiffness or soreness in the muscle. As with sprains, you may be aware of the exact movement or activity that created the strain, or you may notice symptoms only later.
To diagnose ankle sprains and strains, your doctor will look at the impacted area and ask questions about the injury or accident. He or she may also order X-rays to ensure that you don’t have a broken bone in the ankle or foot. A broken bone can have similar symptoms of pain and swelling. If there is no broken bone, the doctor may be able to tell you the grade of your ankle sprain based upon the amount of swelling, pain and bruising. The doctor may order a MRI, after the period of swelling and bruising resolves, if he or she suspects a severe injury to the ligaments, injury to the joint surface, a small bone chip or other problem. The MRI can make sure that the diagnosis is correct.
Minor ankle sprains and strains may heal on their own with rest, ice, compression and elevation (RICE). Over-the-counter or prescribed anti-inflammatory medications and bracing may also be used to alleviate discomfort and swelling. Moderate sprains may need to be immobilized with air splits or cast-boots for 1 or more weeks. If symptoms persist or your sprain is severe, surgery may be required to repair the fully torn ligament. Surgery involves reconnecting the ligament to the bone. Your doctor will discuss the surgical options that best meet the needs of your injury.
Here to Help You Every Step of the Way
A broken ankle is also known as an ankle fracture. This means that one or more of the bones that make up the ankle joint are broken.
A fractured ankle can range from a simple break in one bone, which may not stop you from walking to several fractures, which force your ankle out of place and may require that you not put weight on it for a few months.
Simply put, the more bones that are broken, the more unstable the ankle becomes. When the fracture occurs, various ligaments that hold the joint in place may also be simultaneously damaged.
● Twisting or rotating your ankle
● Rolling your ankle
● Tripping or falling
● Impact during an accident
Because a severe ankle sprain can feel the same as a broken ankle, a foot and ankle specialist should evaluate every ankle injury. Common symptoms for a broken ankle include:
● Immediate & severe pain
● Tender to touch
● Inability to put weight on the affected foot
● Deformity or feeling that the ankle is “out of place” particularly if the joint is dislocated
After discussing your symptoms and medical history, your doctor will do a careful examination of your foot and ankle. Then, he or she may order one or more tests, including:
● X-rays: Helps to determine if and where the bone is broken or displaced
● Stress test: Places pressure on the ankle to determine if the ankle fracture is unstable
● Computed tomography (CT) scan: Used to further evaluate an ankle injury, particularly when the fracture extends into the ankle joint
● Magnetic resonance imaging (MRI) scan: Captures high-res images of both bones and soft tissues, like ligaments
Whether the break involves a minor crack or multiple fractures, our surgeons deliver expert patient care to expedite rehabilitation. Treatment of broken ankles depends on which bone is broken and the severity of the injury, but typically includes:
● Reduction involves physically manipulating the bone to its original position. Once the bone is set, the ankle is immobilized with a cast or brace.
● Surgery may be required to stabilize the ankle. Pins, plates, and screws will help with proper alignment of the bone and may be removed after the ankle heals.
● Physical therapy helps to improve strength and flexibility after a period of immobilization.
Arthritis of the Foot and Ankle
Don’t Let Joint Pain Rule Your Life
One common type of foot and ankle condition is arthritis. As people age, the cartilage that once served as a shock absorber for the body’s joints begins to wear away. This deterioration causes the ankle and foot bones to rub against each other, resulting in inflammation, pain, and stiffness within one or more joints and its surrounding soft tissue.There are over 100 forms of arthritis that exist, with the small joints of the feet and ankles enduring the condition often.
The three forms of arthritis that most commonly affect the foot and ankle are:● Osteoarthritis. An age-related degenerative disease where consistent wear-and-tear causes stiffness to slowly occur.● Rheumatoid Arthritis. A system-wide autoimmune disease that attacks multiple joints and destroys the body’s cartilage.● Post-traumatic Arthritis. Initiated by a foot and ankle injury, sprain or fracture, post-traumatic arthritis develops slowly in the affected joint.
The best way to prevent arthritis is by consistently taking care of your feet and ankles, which involves:● Wear shoes that are properly fitted and shaped to your foot● Wear shoes with rubber soles for elite foot and ankle cushioning● Regularly exercise and stretch your feet and ankles
Symptoms of arthritis may develop gradually over time or onset suddenly. Common symptoms include:● Flare-ups of pain in the affected joint when engaging in vigorous activity● Tenderness in the joint when pressure is applied● Swelling, warmth, or redness in the affected joint● Increased pain and swelling when first trying to walk either in the morning or after extended periods of sitting or resting● Experience difficulty in walking due to the aforementioned symptoms
Our physicians provide expert treatment for arthritis. Our specialists diagnose the condition through a thorough examination of a patient’s medical history and an evaluation of the patient’s symptoms. Gait analysis, which observes the way that the patient walks, will allow our physicians to better determine the severity and location of the condition, while diagnostic testing, including X-rays, CT scans, MRIs, and blood tests, will further confirm the presence of the condition.
Non-surgical techniques can slow the progression of the disease and lessen symptoms. Non-surgical treatment may include anti-inflammatory medication, wearing an ankle-foot orthosis (AFO), or undergoing viscosupplementation. During this procedure, lubrication fluid is injected into the joint, enabling it to move more smoothly. When debilitating arthritis pain still exists after conservative measures, our foot and ankle surgeons may recommend minimally invasive ankle arthroscopy, ankle arthrodesis or total ankle replacement. These surgical treatments can return patient’s to their normal daily activities and allow patients to remain active.
Calcaneus (Heel Bone) Fractures
Get Back on Your Feet
A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. This type of fracture commonly occurs during a high-energy event—such as a car crash or a fall from a ladder—when the heel is crushed under the weight of the body. When this occurs, the heel can widen, shorten and become deformed.
Since these fractures mostly result from falling or motor vehicle injuries, prevention is limited. Stress fractures—injuries that could be caused from twisting motion—can be prevented by strength training and stretching. Certain types of footwear, such as high heels or even running barefoot, can attribute to these fractures, too.
Patients with calcaneus fractures usually experience:● Pain● Bruising● Swelling● Heel deformity● Inability to put weight on heel or walk
With some minor calcaneus fractures, the pain may not be enough to prevent you from walking—but you may limp. This is because your Achilles tendon acts through the calcaneus to support your body weight. If, however, your calcaneus is deformed by the injury, your muscle and tendon cannot generate enough power to support your weight. Your foot and ankle will feel unstable, and you will walk differently.
After discussing your symptoms and medical history, your doctor will perform a careful examination. He or she will examine your foot and ankle to see if your skin was damaged or punctured from the injury, and then check your pulse at key points of the foot to be sure that there is a good blood supply to the foot and toes. Your doctor will also check to see if you can move your toes, and can feel things on the bottom of your foot. Our foot and ankle experts use advanced diagnostic testing during examinations to determine the extent of the injury.
Your doctor will consider several factors in planning your treatment, including the cause of your injury, your overall health, the severity of your injury and the extent of soft tissue damage. To restore function and the heel’s original dimensions, Dr. Rappaport may recommend:● Nonsurgical treatment. If the bones have not shifted out of place, temporary immobilization devices, such as a cast, may be used.● Surgical treatment. When the bones are displaced, patients may require:● Ankle Fusion. In traumatic fractures where the cartilage is severely damaged, the calcaneus bone will be fused to the joint to stabilize the foot for walking.● Reduction. Use small incisions to correct bone displacement, then insert screws and metal plates to keep the heel bone in place.
Improving Appearance, Restoring Function
Clubfoot is a congenital birth disorder that occurs in one out of every 1,000 newborns. When a baby is born with tendons and calf muscles that are shorter than normal, it causes the baby’s foot to twist out of position or shape producing clubfoot.
Ranging from mild to severe with the ability to affect one or both feet, clubfoot could potentially hinder a child’s ability to walk normally later in life, emphasizing the importance of providing treatment as quickly after birth as possible.
Causes and Risk Factors
Clubfoot is congenital, meaning it is a condition that’s present at birth. Though there are no known ways to prevent this condition from occurring, there are key risk factors that may indicate when a baby has an increased risk of being affected by the condition:● Family history. If parents or siblings were born with clubfoot, there is a higher chance that the unborn baby will have the condition too.● Congenital conditions. Abnormalities of a baby’s skeletal structure, along with other serious birth defects, such as spina bifida, can lead to the concurring combination of clubfoot.● Environmental factors. If a pregnant woman has a history of clubfoot and smokes cigarettes during her pregnancy, the risk of the unborn baby developing the condition significantly increases. The use of recreational drugs or the development of certain infections during pregnancy increases the risk of developing clubfoot, too.● Lack of amniotic fluid surrounding the baby. If a pregnant woman produces or retains too little amniotic fluid, which surrounds a baby in the womb, the risk of clubfoot escalates.
Clubfoot symptoms appear in newborns at birth:● The top of the foot is twisted downward and inward, increasing the arch and turning the heel inward● The foot is turned severely to the point where it looks as if the foot is upside down● Calf muscles in the affected leg are noticeably underdeveloped● The affected foot is anywhere from 1 centimeter to roughly ½ of an inch shorter than the unaffected foot.
If treated immediately and effectively, clubfoot typically doesn’t cause any tremendously noticeable or lasting problems with regards to difficulties later in life. That being said, mobility may be slightly limited on that side, shoe sizes may vary, and the calf on the affected side may appear smaller from its initial underdevelopment. Of course, it is extremely important that clubfoot is treated properly to prevent more serious problems from occurring later in life.
Physicians can quickly diagnose clubfoot by detecting shape or position abnormalities in newborns’ feet. After diagnosis, X-rays may be administered to determine the condition’s severity. Fetal ultrasounds allow doctors to diagnose clubfoot while a baby is still in the mother’s womb, allotting parents more time to research and absorb the knowledge that’s necessary to find qualified health experts with the most efficient treatment for their child’s condition.
Our podiatric specialists use a number of cutting-edge surgical and non-surgical techniques to treat patients dealing with clubfoot. A proactive approach will be taken to prevent long-term disabilities from clubfoot while improving the appearance and function of your foot and ankle. Non-surgical methods involve manipulating the foot into the correct position. This may include repeated stretching, casting, splinting, and bracing for several weeks or months. Once the foot is correctly aligned, the infant may continue to wear a brace. The foot muscles can return to their original position, so the foot will have to be monitored by a foot specialist. When clubfoot is severe or doesn’t respond to non-operative methods, surgery may help lengthen the tendons or adjust the ligaments in the foot and ankle.
Prevention, Diagnosis & Removal
Repeated irritation and persistent friction to an area of the foot will cause skin to thicken and harden, creating corns. Corns are localized areas with tender, soft centers, surrounded by yellowish, dead skin. The extra skin develops as a natural defense mechanism, and persistent friction may be due to shoes or socks that are too tight around the toes and/or pressure exerted by high-heeled shoes, foot deformities, or bone spurs.
There are several ways to prevent corns from developing, including:● Wear spacious shoes and socks. Ill-fitted shoes or socks that are too tight around the toes, and not wearing socks with shoes at all, increases irritation and friction. So, buy shoes and socks that give your toes plenty of room.● Use protective coverings. The pressures exerted on your feet by the consistent or extended wear of high-heeled shoes and other footwear with high friction potential can be alleviated through the use of felt pads, non-medicated corn pads, bandages and toe separators.● Treat other foot deformities. Make sure there isn’t a deeper cause. Hammertoe, flatfoot, bunions and bone spurs change the way that pressure is dispersed across the foot, making feet more susceptible to the irritation and friction that cause corns to develop.
● Thick and hardened skin● Bump on the skin of the foot that is hardened and raised● Tenderness or pain under the skin● Flaky, dry or waxy skin● Pain or bleeding occurring in a centralized area of the foot
A physical exam of your feet and an X-ray will help doctors to determine if corns are present and whether or not there are any other physical abnormalities that are causing this condition to arise.
Rather than using over-the-counter (OTC) corn remedies, it is best to seek advice from your doctor. Self-treatment can result in cuts and burns that lead to infection, and patients with diabetes or circulation problems may have trouble healing. Experienced podiatry specialists can relieve corn discomfort without harmful risk to your foot and ankle. Depending upon your unique situation, one of the following treatments may be recommended:● Preventing the spread of infection with antibiotics● Carefully shaving or trimming thickening skin during an office visitIf the presence of a foot deformity is instigating the production of corns, our doctors will concentrate on addressing the underlying problem through the performance of minimally invasive surgery or other techniques.
Alleviate the Pain & Prevent Further Problems
Diabetes is a disease that affects the whole body, prompting nerve damage and poor circulation. The lack of circulation and poor blood flow to the body’s extremities allows for a small matter or infection to progress into a more serious problem. If gone unnoticed or left unchecked, a small blister on the foot can quickly lead to a serious foot problem—in extreme cases, this includes the possibility of foot amputation.
Diabetes may make the feeling of small infections difficult to detect, but if properly taken care of, acknowledgment and treatment can prevent diabetic foot altogether.
Diabetic foot can be prevented through the practice of good habits, including:● Keep your diabetes in check. Stay on top of your diabetes, as a whole, with a close eye on your diet, nutrition, and blood sugar levels. Plus, remain in constant contact with a doctor to report any abnormalities or changes that may arise.● Regular self-examinations of your legs and feet. Nerve damage from diabetes makes it difficult for diabetics to feel the body’s normal indicators that signal when an infection is present. The use of visual examinations can counteract the lack of feeling caused by nerve damage—preventing small, treatable infections from growing into more serious conditions.● Wear proper footwear. Shoes and socks that fit appropriately will decrease the chance of blisters or other small infections from forming. Properly sized footwear will also help to maintain the integrity of the bone structure and improve the circulation that diabetes hinders.● Treat injuries quickly. Cuts and scrapes allow for bacteria to enter the body through the existence of open wounds. This increases the risk of larger infections developing. However, when injuries are treated quickly and efficiently, the risk of the wound intensifying decreases tremendously.● Professional feet examination. Doctors can test a patient’s level of sensation in the extremities of the body through a monofilament test. Diabetics should visit a doctor at least once a year, even if their diabetes is well controlled, to have this test performed to see if sensation has decreased in their feet, which would increase the likelihood of not feeling a small infection. Even small infections could potentially develop into more serious infections and lead to more serious complications.
Diabetic foot symptoms commonly come from the underlying issue that arises within the nerves and circulation of the peripheral extremities. Normal injuries to the foot or ankle, such as a twisting of the ankle or a puncture wound, can be exacerbated by an underlying diabetic issue. An infection of the foot, on the other hand, will cause redness, swelling, localized warmth, change in skin characteristics, fever, and chills.Several common conditions that arise from diabetic foot include:● Peripheral Neuropathy. More commonly known as nerve damage, this complication results in loss of pressure, temperature, and trauma to the feet, causing diabetics to be unaware that they have injuries or puncture wounds on their feet. Unattended cuts and wounds expose patients to open sores and potentially life-threatening infections. They may also state that they feel some numbness or tingling or a “pins and needles” feeling in the toes.● Charcot foot. Caused by numbness, this condition is a degenerative joint disease in which the bones disintegrate and fracture. Continuing to walk on the affected foot may result in more serious injuries that eventually warp the shape of the foot, leading to abnormalities or deformities.● Poor circulation. Diabetes can reduce the efficiency of the body’s circulation, which restricts the flow of nutrients and oxygen needed for natural repair and healing.
Diagnosing diabetic foot relies on a doctor thoroughly examining a patient’s medical history, including his/her diabetic history, and performing a physical exam, X-ray, ultrasound, angiogram and lab tests.
The best way to treat diabetic foot is by preventing small wounds from escalating into larger problems. Our physicians will provide a professional inspection of your feet, checking for the presence of any wounds or abnormalities, and provide the necessary care for any abnormalities that are found. They will also use tools to test the sensation that is able to be felt in the foot and lower extremities to determine how at-risk you are with diabetic neuropathy. All abnormalities and injuries—even the most minor—should be reported to our physicians. Diabetic foot treatment options are centered on increasing sensation and improving blood flow to the feet. Options include:● Proper-fitting footwear to maintain the integrity of the bone structure and improve circulation● A total contact cast or a custom-walking boot to promote blood flow● Surgical procedures to correct foot and ankle deformitiesOur foot and ankle doctors utilize diagnostic and treatment innovations to manage foot complications from diabetes. Diabetic foot care can help to alleviate pain and prevent further health problems.
Expedite Your Return to Activity
Affecting any but the big toe, hammertoe is characterized by a bending of one or both toe joints. The deformity generally worsens over time, and patients may develop corns or calluses as a result of bent toes rubbing against shoes. Untreated hammertoes become rigid, leading to sores, infection, and pain.
Noninvasive measures can be taken to alleviate symptoms in the beginning stages of the condition and may prevent a hammertoe from advancing if caught early. However, if the condition continues to progress, or is left unacknowledged or untreated for an extended period of time, toes will develop sores, infections, and the intensity of the pain will increase drastically.
The most efficient way to prevent the development of hammertoe is by wearing properly fitted shoes. Avoid shoes that feel too snug on your feet or increase the pressure being applied to your toes. If you frequently wear high-heels, the heel height should be two inches or less, to ensure that a manageable amount of tow pressure is retained, especially when heels leave your toes bent for an extended period of time.
Other common causes of hammertoe include:● Heredity factors● Injury to the toes or foot● Muscle and tendon imbalance
Symptoms of hammertoe range in severity, but include:● Toes that are fixed in a downward bending position● Corns or calluses forming on the top of the toe joint● Difficulty walking● Inability to flex, wiggle, or move the affected toe joints● Pain or irritation on the top of a bent toe when putting on a shoe● Red coloring and swelling of the toe joint● Pain on the ball of the foot, under the bent toe
The physical characteristics of hammertoe make diagnosis readily apparent, but our physicians will perform a physical examination to further certify that the toe deformity is, in fact, hammertoe. During the exam, our physicians will manipulate the patient’s foot in ways to reproduce the symptoms that are being experienced and study the contractures of the affected toes. X-rays can help to determine whether other deformities are present and to further clarify the severity of the condition.
In the early stages, flexible hammertoes may be treated with non-surgical methods. Our foot and ankle experts may prescribe:● Orthotic devices to correct muscle imbalances● Padding to prevent corns and calluses● Proper fitting shoes● SplintingIf conservative measures fail or the toe has become tight and painful, our surgeons may suggest minimally invasive surgery to reposition the tendons and straighten the toe. The procedure reduces trauma to surrounding tissues, minimizes scarring and offers a faster recovery time. In some cases, traditional surgical correction may be required.
Professional Care & Treatment For Foot Pain
There are numerous causes for heel pain, including arthritis, stress fractures and nerve irritation. The two most common contributors of chronic pain are heel spurs and inflammation of the plantar fascia—a ligament attached to the heel bone that helps maintain the foot’s arch. In plantar fasciitis, there are microscopic tears on the ligament. These occur when individuals spend hours on their feet without support. Patients suffering from the problem tend to experience pain when they wake up in the morning. Pain may subside as walking stretches the fascia, but returns and intensifies during the day with activity.
Faulty structure of the foot is the most common cause of chronic heel pain. Individuals who put abnormal strain on their feet, struggle with obesity, or wear non-supportive footwear, especially on hard, flat surfaces, are more susceptible to developing heel pain. Wearing supportive shoes, and reducing body weight will help alleviate added stress on the heels.
The main symptom of chronic heel pain is a discomfort that resides on the bottom of the heel and in the arch of the foot, which escalates upon arising and worsens over an extended period of time. Extended periods of inactivity, including waking in the morning or sitting for an extended period of time, increases heel pain. When the heel has been inactive, stiffness in the heel occurs along with heel pain.
Though plantar fasciitis is the most common diagnosis for heel pain, there are still several potential conditions that may cause this condition. It is important to have one of our physicians properly evaluate and examine your heel to determine the true underlying source behind your chronic heel pain. In doing so, our team can offer the best treatment approach for you.
Our expert foot and ankle doctors provide innovative nonsurgical options to alleviate chronic heel pain and restore full range of motion. The following may be recommended:● Icing● Stretching● Orthotic devices● Anti-inflammatory medication● Physical therapy● Extracorporeal shockwave therapy (a procedure that uses high-frequency impulses to break up scar tissue in the hindfoot)In rare cases when nonsurgical treatments are ineffective, our foot and ankle experts may suggest performing surgery to relieve heel pain. In cases of plantar fasciitis, specifically, the goal is to release tension in the plantar fascia ligament.
Prevention and Treatment to Outgrow the Pain
An ingrown toenail is a painful condition, triggered by a corner or side of a toenail curving inward and growing into the soft flesh of the toe. Even though the big toe is most commonly affected, any toe is susceptible to developing the condition.
If an ingrown toenail digs deep enough to break the skin, bacteria may enter the area and cause an infection, intensifying the severity of the condition.
While some individuals are susceptible to ingrown toenails because of genetic factors, most individuals can reduce their risk of developing ingrown toenails by practicing preventative measures. These include:● Protecting the feet from sources of trauma. Be observant of your surroundings. Avoid accidental toe injuries, such as your toe getting stubbed or stepped on.● Investing in appropriate footwear. Continually wearing tight shoes is the most common cause of ingrown toenails. Wear shoes that leave adequate room for the toes to move to prevent unnecessary applied pressure to the toenails and the base of the foot. Plus, always wear socks with closed-toe shoes, especially sneakers, to reduce the friction produced by the shoe to bare skin contact.● Taking proper care of your feet and toes. Put an emphasis on keeping your feet clean and dry at all times. Make it a habit to cut your toenails straight across with a sanitary, sharp nail trimmer, and do it often. Steer clear of tapering or rounding the corners of the nail and avoid cutting the nail shorter than the edge of the toe.
Unfortunately, it is impossible to prevent genetic factors. If a toenail is congenitally larger than its associated toe, there is a highly increased risk that an ingrown toenail will develop.
As the condition progresses, so do the symptoms. Early symptoms include:● Tender, swollen, or hard skin surrounding the toenail● Pain when applying pressure to the affected toe● Fluid build-up around the disturbed toe
A progressed condition typically indicates an infection, with symptoms including:● Red, swollen skin● Pain● Bleeding● Oozing Pus● Overgrowth of skin around the toe
Our physicians expertly diagnose and treat podiatric problems. Our specialists will physically examine the affected toe, and possibly perform X-rays to determine the depth of the nail under the skin and the severity of the condition.
If the toenail has pierced the skin, any sign of infection develops, or if you have diabetes or another medical condition that causes poor circulation and puts your feet at an increased risk for future injury or infection, consult our team right away. Our surgeons will examine the affected area and select the treatment best suited for your particular condition. Whether we perform minimally invasive surgery to fix the toenail or execute other tactics for pain relief, our team skillfully treats ingrown toenails, taking our every precaution to avoid harming the nail bed.
Straightforward Treatment for a Straightforward Walk
Commonly referred to as a “pigeon-toe,” intoeing is a congenital condition in which the toes and feet are turned inward, rather than straight forward. Though this condition frequently dissipates on its own in time, there are cases where children continuously struggle with intoeing’s lasting effects well into their later childhood years.
There are three main causes of intoeing:● Metatarsus adductus. A curved foot caused by being pressed into a rounded position while growing inside the uterus. As the child matures, the curve should straighten out naturally.● Internal tibial torsion. A twisted tibia, or shinbone, is normal for babies and typically straightens out within the first year after birth—but intoeing becomes a concern when this twisted shinbone doesn’t straighten out by the time the child begins to walk, prohibiting the feet from properly pointing forward while walking.● Excess femoral anteversion. All babies are born with some form of an inward twisting femur. Only does it become a concern when the thighbone remains twisted as the child grows and becomes more active.
Because of intoeing’s substantial abnormal physical appearance, the condition’s symptoms reflect its exterior form:● Crescent moon-shaped feet● Inward turned shins or thighbones● Presence of pain or swelling in the feet and ankles● Development of limping as the condition progresses● Tripping, unusual clumsiness, and other walking complications
If pain, swelling, or a steady limp continues throughout the later years of childhood, contact the podiatric experts at Kayal Orthopaedic Center. Our physicians will provide a physical examination, diagnostic testing to evaluate the alignment of your child’s leg bones, and a standard X-ray or X-ray video to observe the child’s leg bones while in motion to come to an effective treatment solution.
In time, most intoeing conditions will heal and correct themselves. However, more severe cases may require further treatment. Oftentimes, if a baby between 6 and 9 months has a drastic case of intoeing with rigid or severely deformed feet, a cast or a pair of corrective shoes will be used to realign the feet, reduce the pain, and may be the only treatment the child will need. But, if intoeing does not dissipate with age or worsens as the child matures, our physicians are able to evaluate the patient and provide the proper treatment, based on the condition type and its severity.
Lisfranc (Midfoot) Injury
Everything You Need to Know
Located in the middle of the foot, the Lisfranc joint is the point at which the metatarsal bones, which are the long bones that lead to the toes, attach to the tarsal bones (e.g., arch bones). Lisfranc injuries result if bones in the midfoot are broken or if ligaments that support the midfoot are torn. The severity of the injury can vary from simple to complex, involving many joints and bones in the midfoot.
A Lisfranc injury is often mistaken for a simple sprain, especially if the injury is a result of a straightforward twist and fall. However, injury to the Lisfranc joint is not something that should be simply “walked off.” It is a severe injury that may take many months to heal and may require surgery to treat.
Lisfranc injuries can happen with a simple twist and fall. This is a low-energy injury. In fact, it is often seen when someone stumbles over the top of a foot that’s flexed downward.
More severe injuries occur from direct trauma, such as a high-impact fall. These high-energy injuries can result in multiple fractures and dislocations of the joints.
The most common symptoms of a Lisfranc injury include:● The top of foot may be swollen and painful● There may be bruising on both the top and bottom of the foot; bruising on the bottom of the foot is highly suggestive of a Lisfranc injury● Pain that worsens with standing or walking
The diagnosis of a Lisfranc injury is made using several things: your symptoms, a foot exam, X-rays, and other imaging tests. Your orthopaedic foot and ankle specialist will examine the middle part of your foot to identify the location of pain, and then perform tests to check the stability of this area. X-rays may show broken and/or shifted bones in the middle of the foot. An MRI scan may be helpful, too, to determine if the ligaments in the foot are damaged. A CT scan can help determine the extent of the bone injury and is particularly useful when planning surgery.
If there are no fractures or dislocations in the joint, and the ligaments are not completely torn, nonsurgical treatment may be all that is necessary for healing. In these instances, a Lisfranc injury may be treated with casting, followed by custom-molded orthotics. However, a majority of Lisfranc fractures are unstable and displaced, so they require surgery. Your doctor will carefully assess your injury to determine the precise type and severity of the fracture. If you require surgery, your foot and ankle surgeon will reposition the joints and realign fractured bone fragments. Once bones are in their proper place, screws and metal plates are used to stabilize the joint and allow injured tissues to heal. In cases of severely ruptured ligaments and irreparable bone damage, your surgeon may even recommend fusion to “weld” together with the joints as a single piece.
Fix the Ball of the Foot, Pass on the Pain, Return to the Game
Morton’s Neuroma is a painful and uncomfortable condition that affects the ball of the foot, most commonly in between the third and fourth toes. This condition often causes an individual to feel as if he or she is standing on a pebble that’s stuck in their shoe or a fold in their sock.
Symptoms may persist for weeks and intensify as the neuroma grows. Eventually, if left untreated, the thickening of the nerve leads to nerve damage—but discovering Morton’s Neuroma early can prevent the condition from progressing and reduce the potential need for surgery.
The most effective way to prevent Morton’s Neuroma is to avoid excessive irritation, pressure or injury to the foot. Other foot stress factors include:● Ill-fitting shoes. Wearing high-heels, and shoes that are too tight or place extra pressure on the toes and the balls of the feet should be limited and not worn for an extended period of time.● Types of exercise. High-impact sports and activities, such as jogging or running, subject feet to increased exposure to repetitive stress and trauma. Counteract these stress effects by substituting strenuous exercises for lower impact ones, or alternate between the two.● Certain sports. Be mindful of the type of footwear required for certain sports and activities. Snow skiing and rock climbing require tight shoes and put an extraneous amount of pressure on the toes, making it beneficial to limit these activities.● Foot deformities. Treating foot deformities, such as bunions, hammertoes, high arches or flatfeet, eliminates the high risk that the presence of these deformities adds to developing Morton’s Neuroma. Avoiding treatment of these deformities increases the risk for developing the condition.
Morton’s Neuroma symptoms are typically felt, rather than seen, and intensify as the neuroma grows. These symptoms include:● Tingling or numbness in the toes● A sensation that resembles walking on marbles or pebbles● Burning pain in the ball of your foot that may radiate into the toes
Often times, to diagnose Morton’s Neuroma, doctors will physically evaluate a patient’s foot by pressing on the foot in the affected area to feel for a mass or tender spot. Physicians will also keep an eye out for the presence of a “clicking” feeling between the bones of the foot. Our physicians will use X-rays, ultrasound or an MRI for further diagnosis and to determine the severity of the condition.
After diagnosis, the treatment approach is evaluated. The severity of the Morton’s Neuroma condition determines the treatment method. For early stages or less severe cases, conservative treatment may be used, which involves the use of custom foot orthotics and footpads to lessen the pressure that’s being put on the affected nerve and the balls of the feet. For more severe cases or instances where conservative treatment methods fail, our physicians will use alternative treatment measures to treat Morton’s Neuroma. These methods include:● Injections. Steroid injections temporarily alleviate pain in the affected area.● Decompression surgery. This procedure aims to relieve the pressure that’s being applied to the nerve by cutting nearby structures, such as ligaments that bind together some of the bones in the front of the foot.● Removal of the nerve. Surgically removing the growth that formed on the nerve may be necessary if other treatments fail to provide pain relief.
Posterior Tibial Tendon Dysfunction
Catch It Early & Halt the Worry
Attaching the calf muscle to the foot bones, the posterior tibial tendon serves an important role in supporting the foot structure and enabling proper foot function. Posterior tibial tendon dysfunction (PTTD) is caused by overuse and repetitive stress, which results in overstretching and inflammation of the tendon. When the tendon is overstretched, it no longer supports the arch, and the foot begins to flatten under body weight. When the arch collapses, the foot and toes roll outward, and the ankle rolls inward. If unaddressed, posterior tibial tendon can lead to adult-acquired flatfoot and painful arthritic symptoms.
Posterior tibial tendon dysfunction often occurs when the tibial tendon incurs an acute injury or is overused, which causes tears or inflammation. Over time, the tendon will slowly collapse, further worsening the condition and potentially causing other conditions to arise.
Pain is the most reported symptom of posterior tibial dysfunction. Typically, pain will occur along the inside of the foot and ankle or on the outside of the ankle, due to the foot collapsing and the heel bone shifting into a new outward position.
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 motionImaging 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 motionOur physicians' customized approach to foot and ankle treatment ensures that patients receive the best possible outcome.
Diagnose, Treat & Relieve Pain
Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s defense system turns against itself and causes attacks on healthy joints, cartilage and tissues throughout the body, along with damage to blood vessels, nerves and tendons. Typically, individuals affected by the condition are between the ages of 40 and 60, and are three times more likely to be women than men.
The exact causes of RA are unknown, yet there are indications that genetics play an impactful role in the condition’s development.
Rheumatoid arthritis symptoms often begin in small joints such as the knuckles of the hands and the toes of the feet. The most common symptoms are pain, swelling and stiffness in the joints. Typically, these symptoms transpire in multiple joints throughout the body. Since this condition is a systemic disease, an affected individual may feel more diffuse symptoms including fever, loss of appetite, body tiring easily, and lumps developing near the joints.
Diagnosis of rheumatoid arthritis involves a thorough physical examination of the affected area and an evaluation of the patient’s medical history. The Kayal Orthopaedic Center physicians in Bergen County will look for specific physical characteristics that indicate the presence of RA. These include:● Skin. The presence of callouses indicates areas where abnormal pressure is being applied.● Joint shape. RA weakens ligaments, which causes joint deformities, such as bunions, claw toes, finger angulation, and flat feet to arise.● Flexibility. A joint’s flexibility directly relates to the stage of the condition. If the joint still has a decent level of flexibility, then the condition is in its early stages. If flexibility is limited or barely present, it’s a good indication that there has been a significant loss of cartilage and the condition has progressed.● Tenderness. To determine which joints RA has affected and the severity of treatment required, our physicians will apply pressure to specific areas to see which joints react to the pressure and which remain unbothered.There are other tests our physicians may request to further confirm the affected patient’s diagnosis, including an X-ray, a CT scan, and an MRI scan, which can be conveniently scheduled at Kayal Medical Imaging in Bergen County. A blood test is frequently utilized to test the patient’s blood for certain autoimmune markers.
Once a diagnosis has been made, Dr. Kayal and his team will assist patients, who can choose from several convenient offices in Bergen County, with deciding on treatment options. Although there is no existing cure for rheumatoid arthritis, there are progressive approaches that may alleviate symptoms and slow down the progression of the condition. Conservative, non-surgical treatment measures may involve steroid injections, orthotic devices, and viscosupplementation, in which lubrication fluid is injected into the joint. Medications can also help to slow down the progression of the disease. For more severe cases, surgical options may be recommended based on our physician’s discretion. Possible surgical treatment options include:● Minimally invasive arthroscopy to remove diseased cartilage● Fusion for severely damaged joints or ligaments● Total ankle replacement to restore the ankle’s range of motion
Diagnose, Treat & Walk Pain-Free Again
Sesamoids are the only bones in the body that are not connected to another bone, but rather solely connected by tendons or embedded in a mass of muscle. There are three sesamoids: the kneecap, which is the largest, and two small, pea-sized sesamoids located on either side of the big toe. Because of sesamoids’ unique no-bone-to-bone contact characteristic, they act like pulleys, increasing the tendons’ abilities to transmit muscle force, assist with the foot’s ability to bear weight, and elevate the bones of the big toe.
Sesamoiditis is a form of tendonitis where the tendons surrounding the sesamoids become irritated or inflamed, caused by fracturing of the sesamoid bones, rupturing its accompanying tendons, or incessantly bearing increased stress.
Marked by dull, intensifying pain beneath the big toe, this condition makes it difficult and painful for the big toe to push off while an individual is running or walking, and reduces the strength of the foot—lessening its weight-bearing potential and causing an affected individual discomfort.
Depending on the cause of development, sesamoiditis symptoms will vary—with immediate pain indicating the presence of a fracture to the sesamoids and gradual development of pain indicating tendonitis caused by an increase of applied stress to the affected area. In addition to the most reported symptom of pain, affected individuals may experience difficulty bending and straightening the big toe, along with the potential presence of swelling and bruising. If left untreated, sesamoiditis symptoms will intensify and turn into constant, debilitating foot pain.
Our physicians will examine the patient’s foot to look for tenderness at the sesamoids bones, while strategically manipulating the big toe to see which movements intensify the pain. In addition, our foot and ankle specialists may take X-rays of the forefoot to confirm diagnosis.
Once a diagnosis has been made, Dr. Kayal and his team will determine the best treatment plan for the patient. Possible non-surgical treatment options include:● Discontinuation of any activities that stimulate pain● Use of padding to cushion the inflamed area● Wear soft-soled, low-heeled shoes● Take oral medications to reduce pain and inflammation● Wear custom orthotic devices designed to assist with chronic sesamoiditis
Despite the rarity of the need for surgery, our expert podiatrists may recommend it as a treatment approach for extremely severe cases and when no other methods manage to provide the patient with relief.
Symptoms, Diagnosis & Treatment
The talus is located in the middle of the ankle joint and connects the shinbone to the heel bone and foot. Acting as a hinge, the talus enables the foot to flex up and down, and side to side. Therefore, injuries to the talus have a profound effect on movement and function of the foot & ankle. When a fracture to the talus occurs, patients will feel acute pain, difficulty with bearing weight, and swelling or tenderness around the ankle joint.
Even more, a talus fracture can cause complications later in life, including arthritis or osteonecrosis (avascular necrosis). A fractured talus can interrupt blood flow to the bone. If the proper nutrients can’t reach the talus, the bone is unable to heal.
Most talus fractures are the result of high-energy trauma, such as a car collision or a high-impact fall. Injuries from sports, particularly from snowboarding, are another, less common, cause of talus injuries.
Patients with talus fractures usually experience:● Acute pain● Inability to walk or bear weight on the foot● Considerable swelling, bruising and tenderness
After discussing your symptoms and medical history, your doctor will do a careful examination. To minimize future complications, our New Jersey foot and ankle specialists will promptly pinpoint the site of the fracture, check to see if there is an adequate blood supply to the foot, and look for damaged nerves. Then, your doctor will order imaging tests to determine whether surgery is required.
Our podiatric specialists treat talus fractures with the latest technology, including innovative surgical procedures, to restore motion, function and strength. Treatment options vary based on the magnitude of the talus fracture. If bones are in their proper positions, your doctor may suggest wearing a cast. After the cast is removed, prescribed exercises can restore strength and range of motion. Unfortunately, though, most fractures require surgery to reset the talus. During surgery, your surgeon will remove small bone fragments and insert screws or pins to hold the bone in place while it heals. Patients should avoid placing weight on the injured foot and ankle during the recovery period.
Discover the advantages
● Our orthopaedic surgeons have been uniquely trained to treat a wide variety of foot and ankle problems. ● Innovations in the diagnosis and treatment of the foot are emerging very quickly, and our foot and ankle surgeons pride themselves in keeping up to date with the latest technologies and treatments of foot and ankle disorders.● Ultimately, our team’s goal is to decrease patients’ pain and hasten their recovery time.
What to expect
Before your appointment, you will receive paperwork to fill out. Please bring any relevant health records to your appointment.
During your visit
During your first visit, your doctor will perform a physical exam and ask questions to fully understand what you are experiencing. Please try to be specific about any problems you are having. It may help to write down notes in the days leading up to your appointment so that you remember details about when your pain is worst, at-home pain-relief methods that help or have no effect, etc
Questions and Notes
Don’t be afraid to ask your own questions. We are committed to a collaborative approach to your care. Also, feel free to take notes to help you remember important points after you leave.