Get back on your feet, with help from Michigan Orthopaedic Surgeons.
Sprain? Break? Arthritis? Plantar fasciitis? If you have a foot or ankle injury, the first step is seeing a specialist. And as the largest and most comprehensive orthopaedic team in Michigan, we have several highly skilled physicians who can help you put your best foot forward.
Achilles tendonitis is not the result of a specific injury, but the result of repeated stress on the Achilles tendon, which is a band of tissue that connects the calf muscle to the heel bone. Most commonly, this is the result of overuse – pushing your body too much and too often, increasing the intensity of a workout without giving your body a chance to adjust, or working out with tight calf muscles. Bone spurs can also rub against the tendon and cause pain.
There are two types of Achilles tendonitis:
- Noninsertional tendonitis: This condition occurs when the middle portion of the tendon begins to break down, causing swelling and thickening. It’s more common in younger and more active people.
- Insertional tendonitis: This condition occurs in the lower portion of the tendon, where it connects with the heel bone. In both noninsertional and insertional tendonitis, damaged tendons may harden or calcify. But only insertional injuries result in bone spurs (extra bone growth).
Common symptoms of Achilles tendonitis include:
- Pain and/or stiffness along the tendon in the morning
- Pain and/or stiffness along the tendon and heel that worsens with activity
- Severe pain the day after activity
- Thickening of the tendon
- Bone spurs
- Swelling that is always present, but worsens with activity
Additionally, if you feel and/or hear a pop in the back of your calf or heel, you may have ruptured your tendon. See a doctor immediately for a diagnosis.
Nonsurgical treatments will help reduce pain, but it may take a few months for symptoms to end completely. If you had symptoms for several weeks before seeking treatment, it may take as long as six months before treatment begins to work. Options include:
- Rest: Stop, or at least reduce, the workouts that are causing the pain. For example, if you normally do high-impact workouts, such as running, try switching to a low-impact workout, such as swimming. This will reduce the stress on your tendon while allowing you to stay active.
- Ice: Applying ice on the tendon reduces pain and can be done as needed. Do not apply ice for more than 20 minutes and always stop before your skin goes numb.
- Medication (non-steroidal): Drugs, such as ibuprofen and naproxen, can reduce pain and swelling. Be sure to consult your doctor before using medication for more than one month.
- Exercise: Stretches and exercises that focus on strengthening the calf muscle can reduce the stress on the Achilles tendon.
- Calf stretch: Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the pose for 10 seconds and relax. Repeat 20 times for each foot. A strong pull in the calf should be felt during the stretch.
- Eccentric strengthening protocol: Eccentric strengthening refers to contracting a muscle while the muscle is getting longer. A physical therapist can help you learn these exercises properly (they can be harmful if done incorrectly).
Surgery should be considered only if the pain doesn’t improve after six months of nonsurgical treatment. The type of surgery will depend on the location and level of damage to the tendon, but options include:
- Gastrocnemius recessions: This procedure lengthens the calf muscle. Since tight calf muscles apply pressure on the Achilles tendon, this procedure can be useful for people who have trouble flexing their feet.
- Debridement and repair: This procedure removes damaged tissue and calcium deposits from the tendon area and reinforces the tendon, if necessary.
- Debridement with tendon transfer: In cases where the tendon has greatly deteriorated, another tendon can be repositioned to reinforce the Achilles tendon.
A bunion is a bony bump that develops on the inside of the foot near the big toe. Bunions develop due to pressure on the foot that moves the big toe toward the second toe.
Who’s Likely to Get It
Though anyone can develop bunions, they are most common in women. Many women wear tight shoes that place pressure on the toes. And over time, this pressure changes the anatomy of the bone, which results in the bunion. If the condition worsens, it can make it difficult to walk or even wear shoes.
Common symptoms of bunions include:
- Pain and tenderness
- Redness and inflammation
- Hardened skin on the bottom of the foot
- A callus or corn on the bump
- Stiffness and restricted motion in the big toe
Nonsurgical treatments include:
- Wider footwear: In some cases, wearing wider shoes to give the toes more space can reduce pain and make the condition very manageable. Additionally, some shoes can be modified to stretch the area that puts pressure on your toes. Consult your doctor for more information.
- Padding: Protective bunion padding can be purchased at drugstores and pharmacies to cushion the painful area. Be sure to test the padding, as the size of the pad could increase the size of the bunion.
- Icing: Applying ice several times a day for no more than 20 minutes can help reduce swelling. Do not apply ice directly to your skin.
- Medication (non-steroidal): Drugs, such as ibuprofen and naproxen, can reduce pain and swelling.
Surgery may be suggested if nonsurgical treatments fail to relieve the pain. The goal of surgery is to realign the bone, tendons, ligaments and nerves to help bring the big toe back to the correct position.
Foot and Ankle Arthritis
Arthritis is the inflammation of one or more joints. There are more than 100 forms of it, with many affecting the foot and ankle – making it difficult to walk and perform other activities.
The two most common types of arthritis (and their causes) are:
- Osteoarthritis: As the most common form of arthritis, osteoarthritis usually affects middle-aged and older people, but can happen in younger individuals, too. As cartilage gradually wears away over time, it becomes rough, and the space between the bones decreases. This results in bone rubbing on bone, which produces painful bone spurs.
- Rheumatoid arthritis (RA): This chronic disease affects multiple joints throughout the entire body (including the foot and ankle). However, RA is symmetrical, which means the disease normally affects the same joints on both sides of the body. It is an autoimmune disease in which the immune system triggers abnormal inflammation in the synovium, or the membrane which covers the joint. Then, the inflamed synovium can damage the bone, cartilage, tendons and ligaments. The cause of rheumatoid arthritis is unknown, but it is known that the condition is hereditary.
Symptoms of arthritis include:
- Pain with motion
- Stiffness in the affected joint(s)
- Flaring pain with vigorous activity
- Tenderness when pressure is applied
- Inflammation, warmth and redness in affected joint(s)
- Increased pain in the morning, or after sitting or resting
While there is no cure for arthritis, there are treatments that can help relieve pain. Nonsurgical treatments include:
- Lifestyle changes, like:
- Reducing participation in activities that aggravate the disease
- Switching from high-impact to low-impact exercises (for example, instead of running, try cycling or swimming)
- Losing weight to reduce stress on foot and ankle joints (this will reduce pain and discomfort)
- Physical therapy: Practicing certain exercises can increase range of motion and strengthen the joints. Consult your doctor or physical therapist to find the correct exercises for your condition. NOTE: Physical therapy can reduce stress, but it also can increase friction. If your condition is caused or aggravated by friction, your symptoms will worsen. If this happens, your doctor or therapist will encourage other treatments.
Surgery may be recommended if your condition does not improve with nonsurgical treatment. The type of surgery will depend on the location and severity of your condition. Surgical procedures include:
- Arthroscopic debridement: Performed in the early stages of arthritis, debridement is the removal of loose cartilage, inflamed synovial tissue and bone spurs from around the joint.
- Arthrodesis: This procedure fuses the bones of the joint together. The goal is to reduce pain by eliminating motion in the joint.
- Total ankle replacement (arthroplasty): In this procedure, the surgeon will remove the damaged cartilage and bone, then replace them with metal and plastic joint surfaces to restore the function of the joint.
The plantar fascia is a strong band of tissue that supports the arch of your foot. Spanning from the heel to the front of your foot, it helps absorb pressure and stress. Too much stress can damage the plantar fascia, causing it to become irritated and inflamed, which leads to pain and stiffness in the bottom of your heel. This common condition is known as plantar fasciitis.
Symptoms of plantar fasciitis include:
- Pain in the bottom of the foot, near the heel
- Pain near the heel in the morning or after a long rest
- Increased pain after exercise or activity
More than 90% of patients with this condition will see improvement within 10 months with simple, nonsurgical treatments, including:
- Rest: Reduce or stop physical activity, especially the activity that caused the pain. It may be necessary to stop activities where your feet pound on the ground (such as running).
- Ice: Roll your foot over a cold ice bottle or ice for 20 minutes, three to four times a day.
- Medication (non-steroidal): Drugs, such as ibuprofen and naproxen, can reduce pain and swelling. Consult your doctor before using medication for over a month.
If the condition does not improve after 12 months of nonsurgical treatment, these procedures may be considered:
- Gastrocnemius recession: This procedure lengthens the calf muscle. Since tight calf muscles apply additional stress on the plantar fascia, this procedure can be helpful for people who still have trouble flexing their feet after nonsurgical treatment.
- Plantar fascia release: In this procedure, the plantar fascia ligament is partially cut to relieve stress. This procedure is recommended when you have normal range of motion in your ankle, but continue to have heel pain.
Lisfranc (Midfoot) Fracture
A Lisfranc fracture occurs when bones in the midfoot are broken, or ligaments supporting the midfoot are torn or strained. It happens most commonly when someone trips over the top of a downward flexed foot. However, more severe injuries occur from direct trauma to the midfoot, such as a fall from a great height.
Who’s Likely to Get It
Football and soccer players often experience this injury, which can happen with a simple twist and fall.
The most common Lisfranc injury symptoms are:
- Swelling or pain in the top of the foot
- Bruising on the top or the bottom of the foot
- Pain that increases with standing, walking or pushing off with the affected foot
Treatment varies depending on the severity of the injury. If there are no fractures, dislocations or torn ligaments, nonsurgical treatment may be all that’s required. One option is to wear a non-weight-bearing boot for six weeks. It will be critical to refrain from putting weight on the injured foot during this time. In the next stage of treatment, you progress to wearing a weight-bearing boot.
Surgical treatment is recommended when there is a fracture in the joint or an abnormal positioning of the joint. Possible procedures include:
- Internal fixation: This procedure includes properly positioning the bones and then fixing them in place with plates or screws. Plates or screws can potentially be removed later (usually between three to five months).
- Fusion: This procedure, the fusing of two bones together to form one, is recommended when there is severe damage that cannot be repaired. Because the joints in the midfoot have very little motion as they transfer stress to the front of the foot, many patients who need fusion surgery can still have a normal gait.
Toe fractures are very common. They can be the result of direct trauma, such as kicking something or dropping a heavy object on your toe, or the result of overuse from high-impact sports (like basketball or running).
Pain and swelling are the most common symptoms of a fracture. Other symptoms include:
- Bruising or dislocation that extends to nearby parts of the foot
- Pain while walking or bearing weight on the foot
While painful, most toe fractures do not require surgery. Fractures will heal with rest and reduced activity. Initially, there will be pain when you place weight on the injured foot. However, as the pain reduces, you can begin placing weight on the toe as you are comfortable. Buddy-taping (bandaging your injured toe together with an uninjured toe next to it) can also help relieve pain.
If the bone is out of place or looks deformed, it may be necessary for a doctor to “manipulate” the fracture. You will be given a local anesthetic to numb your foot and your doctor will manipulate the fracture back into the correct position.
Heel Bone Fracture
Calcaneus fractures, or heel fractures, are uncommon. These fractures may cause the heel bone to widen or shorten, and they can be the result of:
- A fall from a great height
- A twisting-related injury to the ankle
- An automobile collision
Symptoms of heel bone fractures include:
- Heel deformity
- Inability to put weight on the heel or walk
With minor fractures you may still be able to walk, or walk with a limp.
Your doctor will consider several factors when planning your treatment:
- Cause of the injury
- Your overall health
- Severity of the injury
- Extent of soft tissue
However, the goal will always be to restore the normal anatomy of the heel.
When pieces of the broken bone have not been displaced by the injury, nonsurgical treatment is recommended, and the main method is immobilization. A brace, splint and/or cast will help hold your bones in place while they heal. You will have to wear a cast for six to eight weeks, possibly more. During this process, it is critical not to put any weight on your foot until your bone heals.
If the bones have moved out of place as a result of the injury, your doctor will likely recommend one of these surgical procedures:
- Percutaneous screw fixation: If the bone pieces are large, it’s possible for the surgeon to move them back into place with only a small incision. Special screws are inserted through the incision to hold the fracture together.
- Open reduction and internal fixation: In this procedure, an open incision is made to reposition your bone in the correct alignment. The new alignment will be held together with wires, plates and screws.
A neuroma is a benign growth of tissue that surrounds the digital nerve leading to the toes. Neuromas usually develop between the third and fourth toes in response to irritation, trauma or excessive pressure.
Who’s Likely to Get It
The condition is eight to 10 times more likely to occur in women than men.
Common symptoms of neuromas include:
- Burning pain in the bottom of the foot that radiates into the toes
- Increased pain with activity and wearing shoes
- Numbness or an unpleasant feeling in the toes
Initial treatments will be nonsurgical, including:
- Changing shoes: Avoid high heels and tighter shoes to allow the bone to spread and reduce pressure on the nerve, which will promote healing.
- Wearing custom shoe inserts or adding padding: This can help lift and spread the bone, which will reduce irritation.
- Medication: One or two injections of corticosteroid can reduce swelling and irritation.
Diabetic Foot Disease
Foot conditions resulting from diabetes are a common health problem. One of the more critical foot issues is diabetic foot disorder, or charcot, which can lead to disability. Nerve damage is a common complication of diabetes, which leads to a loss of feeling in the foot. It also damages the blood vessels, which in turn decreases the blood flow to the foot. As a result of the poor circulation, the bone and the joints weaken. And due to the nerve damage, people with diabetes can fracture bones and not know it. Walking on the fractured foot can lead to more severe fractures and joint dislocations, and this combination of bone disintegration and trauma leads to deformities of the foot.
Unlike other conditions, pain is not a common symptom of charcot. Common symptoms include foot swelling (without injury) and redness.
The swelling and redness often cause charcot to be confused for a bone infection, but bone infections are very uncommon if the skin has not broken.
Nonsurgical treatments include:
- Casting: Early stages of charcot can be treated effectively with a cast to protect the foot and ankle. A cast reduces the swelling and protects the bone.
- Custom shoes: Once swelling has reduced and the bone has begun to fuse back together, a walking boot or diabetic shoe can be recommended. These special shoes are designed to reduce the risk of ulcers.
Surgery may be recommended if the foot deformity leads to increased risk of ulcers or if the specialized shoe is ineffective. Procedures recommended may include:
- Achilles tendon lengthening: In some cases, the deformity is mild and can result in tightness in the back of the heel. Thus, ulcers in the front of the foot can be treated by surgically lengthening the Achilles tendon to reduce the stress on the midfoot and front foot. This allows the ulcers to heal and reduces the chance of them returning.
- Surgical repair of deformity: A severe deformity that appears as a large bony bump on the bottom of the foot (known as a bony prominence) may require a more extensive surgical procedure. The type of surgery is dependent on the stability of the bone and joints in the foot.
Most children are born with a small arch in their feet. As they grow, the soft tissue on the bottom of the foot begins to tighten, which gradually shapes the arch over time (usually by the age of 5 or 6). However, when a child has flat foot syndrome, the arch of the foot disappears when they stand.
This condition affects both feet and is very common. It’s normally painless, does not affect walking or sport participation and most children outgrow it. But, if the condition continues into adolescence, it may cause arching pain along the bottom of the foot.
Nonsurgical treatment includes:
- Exercises: If the child has activity-related pain in the ankle, foot or leg, your doctor may recommend therapeutic stretches.
- Shoe inserts: If discomfort continues, your doctor can recommend shoe inserts. Arch support may relieve the pain and fatigue.
- Physical therapy: Your doctor may recommend physical therapy if your child has tight heel cords in addition to flat foot syndrome.
Occasionally, surgical treatment may be necessary, if the pain continues.
Shin splints are a common problem, usually resulting from vigorous sports activity. They occur when muscle and bone tissue in the leg become overworked, often due to changes in the frequency, duration or intensity of physical activity. Other factors that can contribute to shin splints are having flat feet or exercising in improper footwear.
The most common symptom of shin splints is pain on the border tibia, but mild swelling may also occur. Pain can be sharp and razor-like or dull and throbbing, and it may occur both during and after a workout. The pain is also likely to be aggravated when the sore spot is touched.
Nonsurgical treatments include:
- Rest: Because shin splints are the result of overworked muscles, rest is a great treatment option. Usually, it’s recommended you stop the activity that caused the pain for several weeks. But, you can add low-impact exercises, like swimming, in place of high-impact exercises during this time.
- Medication: Drugs like ibuprofen, aspirin and naproxen can reduce pain and swelling.
- Ice: Apply ice for no more than 20 minutes, several times a day. Do not apply ice directly to your skin.
- Compression: Wearing a compression bandage can prevent additional swelling.
Very few people require surgery for shin splints. Though it may be considered if nonsurgical treatment fails to relieve the pain, it’s unclear how effective surgery is for this condition.
Ankle sprains occur when the foot twists unexpectedly, causing the ligaments that support the ankle to stretch past their limits and tear. This can happen during many activities, but some of the more common are:
- Walking on uneven surfaces
- Participating in sports that require cutting or rolling of the ankle, such as basketball, soccer or football
- Someone stepping on your foot during one of the previously mentioned sports, causing your ankle to twist or roll
Symptoms of an ankle sprain include:
- Tenderness to touch
- Instability on the damaged ankle (This is a symptom that the ligament has torn, or the ankle is dislocated.)
Nearly all ankle sprains can be healed with nonsurgical treatment, even sprains with torn ligaments. A three-phase treatment program for sprains of all severities includes:
- Phase 1: Resting, protecting the ankle from further damage and reducing swelling
- Phase 2: Restoring range of motion, strength and flexibility
- Phase 3: Exercises and gradual return to activities that do not require turning or twisting the ankle. This is followed by the return to all activities, including those that involve cutting and rolling the ankle.
This program takes about two weeks to complete for minor sprains and between six to 12 weeks for severe sprains.
Additionally, a common at-home remedy program for sprains is:
- Rest: Rest your ankle from any further activity.
- Ice: Apply ice immediately to reduce the swelling. Apply for 20-30 minutes per day, up to four times a day. Do not apply ice directly to your skin.
- Compression: Bandages or ace wraps will immobilize and support the injured ankle.
- Elevation: Raise your ankle above the level of your heart as often as possible in the first 48 hours.
Other nonsurgical treatment options are:
- Crutches: Swelling will last two to three days, making walking difficult. Use crutches as needed during this time.
- Immobilization: In the early stages after injury, it’s important to protect your ankle from sudden movements.
- Physical therapy: Rehabilitation exercises can prevent stiffness, increase ankle strength and prevent chronic ankle problems.
Surgery is rarely needed for a sprained ankle – only when the injury does not respond to nonsurgical treatment for several months. In that case, common surgical procedures include:
- Arthroscopy: In this procedure, the doctor uses a small camera, called an arthroscope, to look inside the ankle joint. Miniature instruments are used to remove any loose fragments of bone or cartilage.
- Reconstruction: A doctor can repair torn ligaments with stitches or sutures.
A broken ankle, or ankle fracture, is defined as one or more breaks in the bones that make up the ankle joint. A break in one bone may not prevent you from walking, but multiple fractures could require several months of recovery.
Common causes of a broken ankle:
- Twisting or rotating your ankle
- Rolling your ankle
- Tripping or falling
- Impact during a car accident
Broken ankle and sprained ankle symptoms are very similar. Thus, all ankle injuries should be evaluated by a doctor. Common symptoms include:
- Immediate and severe pain
- Tenderness when touched
- Inability to put weight on injured ankle
- Deformity (a symptom of ankle dislocations)
Treatment options vary based on the type of break or fracture and the amount of damage. Nonsurgical treatment may be sufficient if the fracture is not out of place and the ankle is stable. But, if the fracture is out of place and the ankle is unstable, surgery may be required to fix bone fragments (using screws and plates). The specific procedure will vary based on the type of injury.
A stress fracture is a small crack in the bone or severe bruising in the bone. The most common cause of stress fractures is an increase in the duration or frequency of physical activity. A change in surface, such as shifting from treadmill running to outdoor running, can also increase the risk of having a stress fracture.
Symptoms of stress fractures include:
- Pain in the foot and ankle, which develops gradually and increases during weight-bearing activities
- Pain that reduces during rest
- Pain that increases with normal daily activities
- Swelling on the top of the foot or the outside of the ankle
- Tenderness to the touch on the fracture
- Bruising (in some cases)
The goal of all treatment is to reduce pain and allow the fracture to heal, so it will vary based on location and severity of the fracture. Most stress fractures are treated nonsurgically using these recommendations:
- The RICE protocol: Rest, Ice, Compression, Elevation
- Anti-inflammatory medication
- Crutches: The use of crutches is recommended to prevent any weight bearing on the ankle.
- Modification of activities: It takes six to eight weeks to heal a fracture. During this time, switch to low-impact activities, like cycling or swimming.
- Protective footwear: Your doctor may recommend wearing protective footwear to reduce stress on your foot and leg.
In some cases, a surgical procedure called internal fixation can help the fracture heal. Internal fixation is the process of using pins, screws and plates to hold the small bones together.
Gout is a form of inflammatory arthritis that causes sudden attacks of intense pain, swelling and redness in your joints. It occurs when the body produces too much uric acid, or when it does not eliminate enough of it. Having a high level of uric acid is called hyperuricemia.
Who’s Likely to Get It
Risk factors for developing gout include:
- Gender and age: Men get gout more often than women. Men also get it earlier, usually between the ages of 30-45, compared to 50+ for women.
- Family history: If someone in your family has gout, you have a greater risk of getting it, too.
- Medical problems: Other conditions can cause an increase uric acid, including high blood pressure, diabetes and kidney disease.
- Lifestyle: Individuals who are overweight or drink too much alcohol are also at an increased risk.
The first attack of gout often occurs in the joint of the big toe, but any affected joints are normally red and swollen, and they may feel warm.
If you are diabetic and begin to run a fever, this may be a sign of infection. Seek medical attention right away.
Gout is a chronic disease that worsens over time, but with treatment, you can control the disease and reduce the risk of joint damage. Nonsurgical treatments include:
- Ice: Apply ice to the affected area. Do not apply directly to the skin and only apply for 20 minutes at a time.
- Elevate: Keep the affected area above the heart level frequently.
- Rest: Move the affected joint as little as possible during an attack.
- Medications: For a mild attack, ibuprofen or naproxen can reduce swelling and pain. However, there are side effects to using any non-steroidal anti-inflammatory drug. Consult your doctor before taking them.
- Lifestyle changes: You can help prevent attacks by making changes to your daily habits, including:
- Exercising and monitoring your eating habits to maintain a healthy weight
- Drinking plenty of water to flush the uric acid in your system
- Lowering your calorie intake, especially fat calories
- Avoiding sugary and alcoholic drinks
- Eating complex carbohydrates
- Getting protein from low-fat dairy products
Individuals who develop destructive arthritis as a result of chronic gout may need surgery. Surgical procedures for gout include:
- Removal of tophi: The removal of the painfully inflamed large nodules of uric acid around the finger and toe joints and tendons.
- Joint fusion: When the gout has caused permanent joint destruction, smaller joints may need to be fused together to limit movement and reduce chronic pain.
- Joint replacement: The painful joint is removed and replaced with an artificial joint. The goal of this procedure is to provide pain relief and maintain joint movement.
Experts at Michigan Orthopaedic Surgeons offer the following treatment options:
- Achilles Suture
- Achilles Tendon Surgery
- Ankle Fracture Surgery
- Ankle Fusion
- Ankle Joint Replacement
- Ankle Replacement
- Bridge to Repair Chronic Achilles Calcific Tendonitis
- Calcaneal Fracture Fixation
- Debridement of Achilles Tendon
- Jones Fracture Fixation
- Lateral Ankle Ligament Reconstruction
- Lateral Column Lengthening to Correct Low Arch or Flatfoot
- Lengthening Calf Muscles
- Lisfranc Fracture Fixation
- Minimally-Invasive Arthroscopic Ankle Surgery
- Plantar Fascia Release
- Plantar Fasciitis Surgery
- Repair Ruptured Achilles Tendon