Feet & Ankles

Conditions We Treat:

Achilles Tendonitis
Fractures
Heel Pain
Plantar Fasciitis
Rheumatoid Arthritis
Sprains/Strains

Achilles Tendonitis

The Achilles tendon allows you to push your foot down. You use your Achilles tendon when walking, running, and jumping. Achilles tendinitis occurs when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot.

Cause:

Achilles tendinitis may be more likely to occur if:

There is a sudden increase in the amount or intensity of an activity.
Your calf muscles are very tight (not stretched out).
You run on hard surfaces, such as concrete.
You run too often.
You jump a lot (such as when playing basketball).
You do not wear shoes that give your feet proper support.
Your foot suddenly turns in or out.

Tendinitis from arthritis is more common in middle-aged and older adults. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling. Flat feet will put more tension on the tendon.

Management:

The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away. Try putting ice on the Achilles tendon area for 15 to 20 minutes, 2 to 3 times per day. Remove the ice if the area gets numb.

Changes in activity may help manage the symptoms:

Decrease or stop any activity that causes pain.
Run or walk on smoother and softer surfaces.
Switch to biking, swimming, or other activities that put less stress on the Achilles tendon.

Your provider or physical therapist can show you stretching exercises or eccentric loading exercises for the Achilles tendon. You may also need to make changes in your footwear, such as:

Using a brace, boot or cast to keep the heel and tendon still and allow the swelling to go down
Placing heel lifts in the shoe under the heel
Wearing shoes that are softer in the areas over and under the heel cushion

Plantar Fasciitis

The plantar fascia is the thick tissue on the bottom of the foot. It connects the heel bone to the toes and creates the arch of the foot. When this tissue becomes swollen or inflamed, it is called plantar fasciitis.

Cause:

Swelling occurs when the thick band of tissue on the bottom of the foot (fascia) is overstretched or overused. This can be painful and make walking more difficult.

You are more likely to get plantar fasciitis if you:

Have foot arch problems (both flat feet and high arches)
Run long distances, downhill or on uneven surfaces
Are obese or gain weight suddenly
Have a tight Achilles tendon (the tendon connecting the calf muscles to the heel)
Wear shoes with poor arch support or soft soles
Change your activity level

Management:

Physical therapy with emphasis on heel and foot stretching exercises.
Night splints to wear while sleeping to stretch the foot.
Resting as much as possible for at least a week.
Wearing shoes with good support and cushions.
Apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes, more often in the first couple of days.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. It most often starts in the small joints of the hands and feet, and usually affects the same joints on both sides of the body.

More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease.

Cause:

The exact cause of RA is not known. There may be a genetic reason — meaning some people may be more likely to develop the disease because of family heredity. However, doctors suspect that it takes a chemical or environmental "trigger" to activate the disease in people who inherit RA.

Management:

Rest: Limiting or stopping activities that make the pain worse is the first step in minimizing the pain. Biking, elliptical training machines, and swimming are activities that allow patients to maintain their health without placing a large impact load on the foot.
Ice: Placing ice on the most painful area of the foot for 20 minutes is effective. This can be done 3 or 4 times a day. Ice application is best done right after you are done with a physical activity. Do not apply ice directly to your skin.
Orthotics (shoe inserts): The primary goal of wearing an orthotic is to minimize the pressure and decrease the pain and callous formation. For people with RA, hard or rigid orthotics generally cause too much pressure on the bone prominences, creating more pain. A custom orthotic is generally made of softer material and relieves pressure on the foot.
Supportive Footwear: Shoes that provide more support or have soles that are more rigid (not as flexible) will help protect the foot and ankle from bending forces while standing or walking. A supportive shoe can be combined with an orthotic to relieve pressure on the foot.
Braces: A lace-up ankle brace can be an effective treatment for mild to moderate pain in the back of the foot and the ankle. The brace supports the joints of the back of the foot and ankle. In patients with a severe flatfoot or a very stiff arthritic ankle, a custom-molded plastic or leather brace is needed.

Ankle Fractures

A fractured ankle can range from:

A simple break in one bone, which may not stop you from walking, to
Several fractures, which may require surgery. These types of fractures can be very disabling. In some cases, you may not be able to put weight on your ankle for a few months, affecting your ability to walk, drive, play sports, and work.

Although ankle fractures can occur in people of all ages, they typically happen more often in adults; in fact, they are the fourth most common type of fracture in adults.

Causes:

Fractures commonly happen because of car accidents, falls, or sports injuries. Overuse and repetitive motions can also cause fractures. Low bone density and osteoporosis are conditions which cause weakening of your bones. Having one of these conditions makes you much more likely to break a bone.

Many types of injuries can cause an ankle fracture. They include:

Twisting, rotating, or rolling your ankle while walking or running
Tripping or falling from a height, such as a fall from a ladder
Impact during a car accident

Management:

Treatment of ankle fractures depends on the type and severity of the injury.

Surgery is required when:

The ends of the bone are out of line with each other (displaced).
The fracture extends into the ankle joint (intra-articular fracture).
Tendons or ligaments (tissues that hold muscles and bones together) are torn.
Your health care provider thinks your bones may not heal properly without surgery.
Your provider thinks that surgery can allow faster and more reliable healing.
In children, the fracture involves the part of the ankle bone where bone is growing.

If surgery is not required, your ankle will be placed in a cast or splint for 4 to 8 weeks. The length of time you must wear a cast or splint depends on the type of fracture you have. Wearing a cast or a splint will keep your bone from moving while it heals. How long you need to wear it will depend on the type of fracture and which bone is affected.

At some point, you will use a special walking boot as the healing progresses.

Additional information: Recovering from fractures (Bone Health and Osteoporosis Foundation)

Heel Pain

Heel pain is most often the result of overuse. However, it may be caused by an injury.

Causes:

Your heel may become tender or swollen from:

Shoes with poor support or shock absorption
Running on hard surfaces, such as concrete
Running too often
Tightness in your calf muscle or the Achilles tendon
Sudden inward or outward turning of your heel
Landing hard or awkwardly on your heel

Conditions that may cause heel pain include:

Swelling and pain in the Achilles tendon
Swelling of the fluid-filled sac (bursa) at the back of the heel bone under the Achilles tendon (bursitis)
Bone spurs in the heel
Swelling of the thick band of tissue on the bottom of your foot (plantar fasciitis)
Fracture of the heel bone that is related to landing very hard on your heel from a fall (calcaneus fracture)

Management:

The following steps may help relieve your heel pain:

Use crutches to take weight off your feet.
Rest as much as possible for at least a week.
Apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes. Ice more often in the first few days.
Take acetaminophen or ibuprofen for the pain.
Wear well-fitted, comfortable, and supportive shoes.
Use a heel cup, felt pads in the heel area, or shoe insert.
Wear night splints.

Strains/ Sprains

A sprain is a stretched or torn ligament. A strain is a stretched or torn muscle or tendon.

Causes:

Falling, twisting, pulling, or getting hit can all cause a sprain or a strain. Sprains most commonly occur at ankles and wrists. Strains can happen suddenly or develop over time. Back and hamstring muscle strains are common.

Management:

You can decrease swelling by:

Resting and not putting weight on your foot
Elevating your foot on a pillow at or above the level of your heart

Apply ice every hour while you are awake, 20 minutes at a time and covered by a towel or bag, for the first 24 hours after the injury. After the first 24 hours, apply ice for 20 minutes 3 to 4 times per day. Do not apply ice directly to your skin. You should wait at least 30 minutes in between ice applications.

Vertical Talus

Vertical talus is a rare deformity of the foot that is diagnosed at birth. Because babies are born with the condition, it is also known as congenital vertical talus (CVT). It is one of the causes of a flatfoot in newborns. One foot, or both feet, may be affected.

Although it is not painful for the newborn or even the toddler, if it is left untreated, vertical talus can lead to serious disability and discomfort later in life.

Cause:

The exact cause of vertical talus in not known. Many cases, however, are associated with a neuromuscular disease or other disorder, such as arthrogryposis or spina bifida. Your child's doctor may decide to perform additional tests to discover whether your infant has any of these other conditions.

Management:

Treatment for vertical talus usually involves a combination of nonsurgical and surgical intervention.
Initial treatment is usually nonsurgical and includes a series of stretching and casting designed to stretch tight tendons in the foot and bring the front part of the foot into a better alignment with the hindfoot (talus and calcaneus).
This typically involves casts that are applied in the clinic by your doctor, with your baby awake. Casts are usually changed every week and go from just below the hip to the tips of the toes. This type of casting has been called "reverse Ponseti" casting because it involves an opposite sequence of casts compared to the Ponseti casting that is used to treat clubfoot deformities.
Following stretching of the foot and improved alignment with casting, most babies will need a small surgical procedure. This involves release of the tight Achilles tendon in the back of the ankle, a procedure called tenotomy.
After the foot position is corrected, bracing is needed to prevent the foot from going back into a vertical talus position. Physical therapy and stretching at home may also be needed.
Your child's doctor will likely recommend repeat clinic visits over the years to observe the growth and development of your child's foot.