Foot & Ankle Specialists of Northeast Georgia

Products And Services

• ACHILLES TENDON

  The Achilles tendon is the strongest tendon in the body and attaches the calf muscles to the heel bone. Walking and other physical activities place stress on the tendon that can lead to inflammation (tendonitis) and small tears within the tendon. Occasionally, the Achilles tendon may rupture. Most ruptures happen in males between the ages of 30 to 40 who are usually playing tennis, basketball or soccer. Patients with Achilles tendon rupture usually describe as if they were hit in the back of the leg and may or may not have heard an audible “pop”. Rupture of the Achilles tendon usually requires surgery to restore normal function to the patient. RISK FACTORS Inadequate stretching prior to exercise Tight or weak calf muscles Engaging in sudden strenuous physical activity (often called the “weekend warrior”) Taking certain types of antibiotics, such as Cipro or Levaquin SYMPTOMS OF AN ACHILLES TENDON RUPTURE Achilles tendon ruptures are usually caused by sporting activities, frequently accompanied by a popping or snapping sound. Patients usually experience severe pain and swelling near the heel and are unable to walk normally or lack push-off strength with the affected leg. Because these symptoms are similar to those of other conditions, such as bursitis and tendonitis, it is important to seek prompt medical attention in order to determine the correct diagnosis. DIAGNOSIS OF ACHILLES TENDON RUPTURE Achilles tendon ruptures are usually diagnosed by physical exam. X-rays are usually obtained to rule out an avulsion type fracture, in which the Achilles tendon pulls off a piece of the heel bone when rupturing. MRI’s are also used in the diagnosis of chronic Achilles tendon ruptures, however rarely used in acute ruptures.

• FLAT FEET

  Pes Plano valgus or “flatfoot” is a common condition that affects many people of all ages. It is often used to describe a foot with a flattened or lowered arch. Patients may complain of walking on the inside of their ankles and have a heel that appears to be rolled-out from under the ankle. Often times, people will complain of pain to the arch of the foot after standing for long periods of time either at work or during physical activity. Infants feet are naturally flat and as they grow and begin to walk, their feet normally develop arches. Most children don’t fully form an arch until age 3-5. For some children, this does not happen, and they may begin to complain of sports-related knee, leg, heel, ankle or arch pain. It is also possible for patients with pes Plano valgus to develop bunions. While pes Plano valgus is usually inherited, there are many individuals who have normal arches as children and young adults but develop flat feet over time. These individuals are said to have an adult acquired flat foot deformity (AAFFD). RISK FACTORS FOR FLAT FEET Heredity is a major cause for people with flat feet. Other risk factors include wear and tear due to aging or obesity, rheumatoid arthritis, traumatic injuries, and dysfunctions of tendons or ligaments. SYMPTOMS Pes Plano valgus is not always symptomatic (painful). However, flatfeet are often associated with the feeling of tired and achy feet. Patients may experience pain on the instep of their foot and/or along the inside of their ankle. When the condition of an individual with flat feet deteriorates, the person may suffer from pain not only in the foot or ankle, but in the knee, or back. It is also common for such people to develop bunions and other deformities of the lower extremity. In such cases, surgical intervention may become necessary. DIAGNOSIS While flat feet are diagnosable through simple physical examination, diagnostic imaging is usually needed. This includes: X-rays MRI CT scan Ultrasound These tests are often necessary to determine the extent of deformity and which treatment option is best for you. TREATMENT We will almost always begin with conservative treatment in a patient with pes Plano valgus. This includes properly educating the patient on what types of shoe gear to wear and to avoid walking barefooted. Orthotics are a key component in the first-line treatment of pes Plano valgus. These are placed into both shoes to provide extra arch support. Keep in mind that foot orthoses should not be expected to create a permanent structural correction of the foot, but rather eliminate symptoms and improve the patient’s activity level. Other conservative measures can be implemented but can vary with each patients’ specific circumstances. When conservative measures have failed and the patient is unable to perform their daily activities secondary to pain, then surgical intervention is usually necessary. Surgery for flatfoot may involve cutting of bones and/or fusing one or more of the bones in the foot together. Our goal is to provide the patient with a more active pain-free lifestyle.

• ANKLE INSTABILITY

  ANKLE INSTABILITY Ankle instability is a condition in which the ankle has a chronic sensation of weakness and constantly “gives way” during walking and other activities. Patients most often complain of re-occurring ankle sprains. This condition can occur during physical activity (walking, running, jumping) but can also occur when a patient is simply standing still. Chronic ankle instability commonly affects athletes and is often caused by a previous ankle sprain that did not heal properly. A sprained ankle tears or stretches the ligaments holding the ankle together, affecting balance, and if not treated properly, chronic ankle instability and ankle arthritis may develop. SYMPTOMS The most common symptom of ankle instability is an unstable feeling within the ankle. Patients complain of constantly rolling their ankles. Additional symptoms that may affect the ankle may include: Pain Tenderness Swelling and discomfort Some individuals with ankle instability may develop tendonitis or even partial tearing of the tendons adjacent to the ankle. This can occur with continued activity without the proper bracing needed to prevent re-occurring ankle sprains. DIAGNOSIS Ankle instability is most commonly diagnosed through physical examination. The use of x-ray and MRI’s are sometimes needed to evaluate the extent of instability. TREATMENT Most cases of ankle instability are treated through conservative measures that may include: Physical therapy Anti-inflammatory medication Ankle bracing Patients with ankle instability who do not respond to conservative treatment (non-operative) methods usually require surgical intervention. Surgery for ankle instability involves reconstructing the damaged ligaments that cause the ankle to be unstable. Recovery from surgery varies depending on the specific procedure that is performed, but usually, patients can return to a tennis shoe in 3 weeks.

• TOTAL ANKLE REPLACEMENT/ANKLE FUSION

  Osteoarthritis is a condition that causes pain, stiffness and swelling in joints. It occurs more frequently in older individuals. Primary ankle arthritis, “wear and tear” arthritis, is rarely found in the ankle. More common is post-traumatic arthritis, which can be caused by a previous ankle fracture, a series of recurrent ankle injuries or even an alignment deformity which causes uneven loading of the ankle joint. These injuries all result in cartilage loss to the bones that comprise the ankle joint leading to pain and stiffness. Rheumatoid arthritis which is an autoimmune condition caused by an inflammation in the lining of the joints can also cause ankle arthritis. In addition to osteoarthritis and rheumatoid arthritis, there are other types of arthritis, and depending on the cause, may affect people of different ages. A gout is a form of arthritis caused by a build-up of uric acid within the body, that causes painful, swollen, red and inflamed joints. Patients with severe or end-stage ankle arthritis usually present with decreased range of motion to the joint accompanied by pain and swelling. Patients will usually complain of pain as they begin the activity and it may take a few minutes to “warm-up” the ankle. Bone spurs usually develop around the ankle as arthritis progresses. DIAGNOSIS OF ANKLE ARTHRITIS Ankle arthritis is diagnosed through physical examination and imaging exams. Weightbearing x-rays are obtained and will usually show a loss of joint space to the ankle. Bone spurs and bone whitening near the joint is usually visible on x-ray examinations. CT scans and MRI’s are also utilized in the evaluation of arthritis. TREATMENT Conservative (Non-Operative) Treatment Ankle arthritis is one of the most common conditions we treat in the office. Treatment for ankle arthritis varies based on type and symptoms. Conservative treatment may include oral medications, joint injections, and lifestyle modifications. Shoes with a stiff sole and a rocker bottom contour can be used to decrease the load through the ankle during ambulation, resulting in decreased pain. When conservative treatment fails, surgical intervention is often necessary. SURGICAL TREATMENT Ankle arthroscopy is a minimally invasive procedure used to treat mild forms of arthritis. A tiny camera that transmits images onto a computer screen is utilized to guide small instruments to remove bone spurs and inflamed tissue within the ankle joint. The most common treatment for severe ankle arthritis is an ankle fusion, in which the bones are fused together with screws. This method is very successful in relieving ankle pain. Due to the motion of your hindfoot joints, patients will still be able to move their foot up and down in an arc of approximately 20-30 degrees. However, total ankle replacement is becoming more popular for the treatment of ankle arthritis. It is a surgical procedure used to relieve pain and restore movement to the damaged ankle joint. It involves removing the damaged joint and replacing it with an artificial joint. While it is difficult to restore full function to the ankle, many patients are able to experience a drastic improvement in ankle function after this procedure.

• BUNIONS

  Hallux valgus or “bunion” is a common pathology in which an abnormal bony bump develops at the base of the big toe, causing the joint to stick outward and become painful. As a result of this deformity, the big toe joint may become stiff and begin to deviate towards the other smaller toes. The more deformed the joint becomes, the more it can lead to difficulty walking and to the development of other pathologies such as corns and calluses. Although bunions are not a health risk, they can be painful and unsightly. Left untreated, they will usually grow larger and more painful over time. Bunions can occur as a result of an inherited foot type, biomechanical abnormalities or shoes that do not fit properly. In some cases, bunions may develop because of injury or neuromuscular disease. Although less common, bunions can also occur on the small toe where they are referred to as a tailor’s bunion. Bunions are diagnosed through physical examination and X-rays which are obtained at your doctor’s office. CONSERVATIVE TREATMENT (NON-OPERATIVE) Depending on the severity of the condition, the following methods may be employed: Custom made orthotics (devices that go inside both of your shoes) Anti-inflammatories (NSAIDs) Wearing roomier, low-heeled shoes Cold therapy to decrease the pain and swelling Taping or splinting the foot into a normal position Corticosteroid injections to further reduce inflammation in the joint When conservative methods fail to provide relief and the pain from the bunion/s interfere with the patient’s everyday activities, surgical intervention is necessary. SURGICAL TREATMENT OPTIONS There are numerous surgeries that may be performed to treat bunions. The most common surgical procedure for correcting a bunion is where the bony protrusion itself is removed and the first metatarsal (long bone in your foot) is cut and moved. Other surgical procedures which may or may not be performed in conjunction with the bunionectomy include: The fusion of the big toe joint Removal of bone spurs surrounding the joint The fusion of the joint at the mid-foot region (Lapidus procedure) Insertion of the implant to maintain motion across the joint Bunion surgeries are typically performed under light sedation, but general anesthesia may be required depending on the type of procedure. Most patients can return to normal tennis shoes by 6 weeks. Returning to activities such as running and other high intensity sports is usually around the 4-6 month mark, depending on procedure and age.

• FOOT AND ANKLE TRAUMA

  An ankle fracture, commonly known as a broken ankle involves a break or crack in the tibia and/or fibula. The more bones that are broken, the more complicated and severe the fracture is. Symptoms that a patient may experience with a broken ankle are a pain, swelling, bruising, tenderness to the ankle or leg and an inability to walk. Treatment for a broken ankle depends on the type and severity of the fracture, but often includes bracing or casting of the ankle, icing and anti-inflammatory medications. Stable fractures can be treated conservatively (non-operatively) and usually heal on their own, while more complicated ones require surgery to reposition the broken bone. CALCANEAL (HEEL BONE) FRACTURES A calcaneal fracture or heel bone fracture is usually a result of a fall of significant height or an automobile accident. Patients will likely be unable to bear weight on their foot or leg. Significant swelling may be present to the foot with associated bruising. Heel bone fractures are treated both conservatively (casting/bracing) or surgically. Your surgeon will decide which treatment option is best for you. METATARSAL FRACTURES A metatarsal fracture is a break in one or more of the five long bones you have in the foot. Common symptoms of a metatarsal fracture include increased pain when walking, bruising and swelling of the foot. Often times they can be treated conservatively with proper immobilization in a walking boot. Surgery is only necessary for severe fractures in which the bones are displaced or out of alignment. TOE FRACTURES A toe fracture, though very painful, is not usually a serious injury. They are typically caused by stubbing your toe or dropping something on the toe. When a toe is fractured, it may appear bruised and swollen. In most cases, the patient is placed into a special post-operative shoe with the injured toe taped to the adjacent normal toe for stabilization. Rarely do toe fractures require surgical intervention.