Become Pain Free | Pain Specialist in Texas

ANKLE/FOOT CONDITIONS

Broken bones and injury

• Infection
• Ankle fractures
• Bleeding
• Pain
• Blood in your leg
• Damage to blood vessels, tendons or nerves
• Difficulty with bone healing
• Arthritis
• Achilles tendon rupture
• Pain from plates and screws that are used to fix the fracture

Postsurgical treatment may include:

• rehab
• home exercises
• supports

Ankle Fractures in Children

Causes:

• Twisting force during sports or playing when the lower leg or foot twists unexpectedly

Types:

• Salter-Harris I and II fractures
• Salter-Harris III fractures
• Salter-Harris IV fractures
• Salter-Harris V fractures
• Distal Fibular fractures
• Special Distal
• Tibial fractures
• Tillaux Fractures

Calcaneus (heel bone)

 Causes:

• usually high energy forces (fall from height or motor vehicle collision)
• types:
• stable
• displaced
• open
• closed
• comminuted

Non-surgical treatment can include:

• casting
• immobilization (surgical treatment may be a consideration) 

Surgical procedures may include:

• open reduction internal fixation
• percutaneous screw fixation

Postsurgical care will include:

• early motion
• physical medicine modalities
• weight- bearing

Postsurgical complications can include:

• small or temporary areas of delayed wound healing
• nerve irritation around the incision
• tendon irritation caused by screws
• joint stiffness
• chronic pain
• blood clots
• failure of the wound to heal
• infection
• collapse of bone Arthritis – this can occur without or with surgery

Lawn Mower Injuries

Cuts Treatment may need cleaning and bandaging more serious cuts, may require irrigating more serious cuts may require surgery to ensure proper healing

Burns Treatment severe burns may require surgery and treatment from plastic surgery more than one surgical procedure may be necessary to avoid infection

Broken bones (fractures)

• Treatment Casting or splinting 
• Open fractures need to be cleaned before fixing the fracture
• Growth plate fractures can be treated with immobilization, but surgery may be indicated

Amputation

• Treatment Reattachment may be indicated if body part has not been detached for too long
• Severe Injuries Treatment may require reconstructive surgery to improve function and appearance.
• Complications Infection Loss of sensation or strength Adhesions Slow fracture healing Lack of fracture healing Healing with bones in poor position.
• Rehabilitation Physical medicine modalities Strategies to live with the injury Prosthesis Assistive devices

Lisfranc (midfoot) injuries - Results if the mid foot is broken or supporting ligaments are torn

• Is a severe injury, often mistaken for a simple sprain
• Low energy injury
• stumbling over the top of the foot flexed downwards

Non-surgical treatment can include: non-weight bearing cast for 6 weeks with slow progression to weight bearing in a removable cast boot or orthotic

Surgical treatment: is recommended in injuries with fracture or abnormal position of the joints

• Internal fixation
• Fusion
• Postsurgical treatment
• non-weight bearing for 6-8 weeks in cast or cast boot
• weight bearing is started when x-rays show good alignment after 6-8 week period

Recovery:

• some athletes may never return to pre-injury level, despite good surgical results
• arthritis may occur and lead to chronic pain

Pilon Fractures

Causes:

• high energy impact injury crushing the bones of the ankle joint
• fall from height
• motor vehicle/motorcycle collisions
• skiing

Non-surgical treatment:

• splints and casts
• monitoring during the healing stages
• recovery may take as long as 12 weeks

Surgical treatment:

• external fixation may be necessary if there is a fibular fracture
• this is to protect the fracture and skin
• once skin is healed, the surgery to fix the tibia is performed.

Post-surgical treatment:

• begins when you are allowed to start moving the ankle
• post surgical complications
• stiffness
• ankle arthritis
• infection
• bone healing problems
• painful plates and screws
• wound healing problems
• blood vessel or nerve damage

Stress Fractures of the foot and ankle

• small crack in a bone, usually developed from high impact sports like distance running or basketball
• most common in second and third metatarsals of the foot

Causes:

• Conditioning – doing too much too soon
• Equipment and environment
• Technique
• Bone Insufficiency
  • Osteoporosis
  • Medical problems
  • Certain medications
  • Female athletes
    • eating disorders, abnormal menstrual cycle and osteoporosis 

Treatment:

• First aid
• Rest
• Protective foot wear
• Casts
• Surgical Treatment

Talus Fractures

Causes:

• motor vehicle collisions
• fall from heights
• snow boarding

Treatment:

• immediate treatment is to apply splint, elevation and ice
• can be treated without surgery, if bones are in good aligment Cast for 6-8 weeks
• most require surgery to minimize later complications Use of screws Cast for 6-8 weeks. Non weight bearing for up to 3 months J. Toe and Forefoot Fractures

Toe and Forefoot Fractures

Types:

• Stress fractures
• Jones fracture
• Avulsion fracture
• Dancer’s fracture 

Causes:

• dropping object on the foot (trauma)
• twisting injury

Treatment:

• see doctor as soon as possible
• keep weight off leg and apply ice to reduce swelling
• NSAIDs to relieve pain
• wear wider shoe with stiff sole
• avoid activity that caused the injury for 3-4 weeks
•  buddy taping
  • if you have a broken toe
• short-leg walking cast, brace or rigid flat-bottom shoe
• surgery is rarely needed

Turf Toe - sprain of the main joint of the big toe

• any sport or activity that causes injury of any soft tissue structure on the bottom of the big toe (plantar complex)

Types:

Grade 1:

•  plantar complex has been stretched causing pin-point tenderness and slight swelling

Grade 2:

•  partial tearing of the plantar complex causes more widespread tenderness, moderate swelling, and bruising. Movement of the toe is limited and painful

Grade 3:

•  plantar complex is completely torn causing severe tenderness, severe swelling, and bruising. Movement is difficult and painful

Treatment:

•  rest, ice, compression and elevation (RICE).
•  NSAIDs – can help with symptom relief - see doctor if symptoms persist

 Non-surgical treatment:

Grade 1:

• RICE, NSAIDs, buddy taping

Grade 2:

•  immobilization, walking boot may be indicated, for up to one week; after this follow Grade 1 protocol

Grade 3:

are more severe and are most often treated with immobilization for several weeks, walking boot or cast that keeps big toe in down position. As healing takes place Step down to Grade 2 and then to Grade 1

• Physical medicine modalities may be helpful as soon as tolerated
• exercises to stretch and strengthen the big toe
• early joint movement is essential for reducing or preventing stiffness

Surgical treatment:

• not often indicated
• if symptoms persist or level of athletic ability is affected, surgery may be an option
• indicated for severe tear, fracture of sesamoid, vertical instability, loose bony chip in the joint, damage to the cartilage of the joint or new or worsening bunion

Sprains, Strains and other injuries - Sprained ankle - very common injury

Types:

Grade 1:

slight stretching and some damage to the fibers of the ligament

Treatment:

• weight bearing as tolerated
• sometric exercises  
• full range of motion exercises as tolerated

Grade 2:

complete tears of some but not all fibers in the ligament

 Treatment:

•  immobilization with air splint
•  physical medicine with range of motion exercises
• stretching and strengthening

Grade 3:

complete tear/rupture of ligament

 Treatment:  

• immobilization  treatment similar to Grade 2
•  possible surgical correction

Non-surgical:

• as above
• three phases of recovery

Phase 1 – includes rest, protecting the ankle and reducing swelling - one week

Phase 2 – includes restoring range of motion, strength and flexibility - one to two weeks

Phase 3 – include gradually returning to activities that do not require

• turning or twisting the ankle and doing maintenance exercises. Followed later by activities that require sharp, sudden movements (cutting activities)
• medications
• surgical
• reserved for injuries that fail conservative treaments
• arthroscopy
• reconstruction
• post surgical physical medicine will be necessary to restore strength and range of motion
• this can take weeks to several months
• possible complications can include
• abnormal proprioception
• imbalance and muscle weakness
• re-injury
• if chronic situation, instability and chronic pain M. Diseases and Syndromes

Adult Flatfoot

Causes:

• Posterior Tibial Tendon Dysfunction (PTTD)
  • most common cause
• Arthritis
• Injury
  • Lisfranc (midfoot injury)
• Diabetic Collapse (Charcot Foot)

Arthritis of the Foot and Ankle

Types:

1. Osteoarthritis
   • degenerative wear and tear
   • aging, obesity and family history
2. Rheumatoid Arthritis
   • cause is unknown
   • ankle, hindfoot, midfoot, or forefoot locations
   • non-surgical treatments as below
   • fusion of the affected joints is most common surgical treatment
3. Post-Traumatic Arthritis
   • fractures and dislocations
   • Non-surgical treatment
     • Pain relievers
     • Shoe inserts – pads or arch supports
     • Custom made shoe
     • Ankle-foot orthosis (ASO)
     • Brace or cane
     • Physical medicine modalities and exercise
     • Weight control or nutritional supplements
     • Medications or injections
       • - Surgical Treatment – if failure of conservative treament
         1. Arthroscopic debridement
         2. Arthrodesis or Tusion
         3. Arthroplasty or Joint replacement
         4. Care of diabetic foot:
            • - never walk barefoot
            • - wash every day with soap and water
            • - use lotion to keep skin soft
            • - trim toenails straight across. If you have ingrown nails, see your doctor
            • - always keep feet warm and do not let feet get wet
            • - do not smoke
            • - do not use drugstore medications, heating pads, sharp instruments or antiseptic solutions on your feet.
            • - do not put feet in front of fireplace or on radiators
            • - choose shoes carefully, tight fitting shoe can cause ulcers and possibly to infection
            • - orthotics may be beneficial in lessening pressure on the foot
4. Clubfoot
   • unknown cause
   • non-surgical treatment
   • stretching and casting (Ponseti method)
   • surgical treatment
   • usually done at 9-12 months of age
   • casting to be done after surgery while healing takes place
5. Diabetic (Charcot) Foot
   • combination of bone disintegration and trauma warps and deforms the foot.
   • non-surgical treatment Casting Custom shoes
   • Surgical treatment Reserved for deformities that can cause ulcers If protective shoewear is ineffective Unstable fractures Dislocations
6. Flexible Flatfoot in Children
   • when arch disappears or shrinks upon standing
   • non-surgical treatment (if pain)
   • stretching exercises for the heel cord
   • surgical treatment
   • may be necessary for persistent pain
   • if rigid and doesn’t correct with growth
7. Plantar Fasciitis and Bone Spurs
   • most common pain on the bottom of the heel (plantar fasciitis)
   • non-surgical treatment – more than 90% improve within 10 months of starting treatment
   • rest
   • ice
   • NSAIDs
   • exercise – calf stretch, plantar fascia stretch
   • cortisone injection
   • supportive shoes and orthotics
   • night splints
   • physical medicine modalities
   • extracorporeal shockwave therapy
   • surgical treatment – only after 12 months of nonsurgical treatment
   • gastrocnemius recession
   • plantar fascia release
   • complications – most common is incomplete pain relief
8. Sesamoiditis
   • irritation of bones that are connected to tendons or embedded in muscle
   • non-surgical treatment
   • stop the activity causing pain
   • take NSAIDs for pain relief
   • rest and ice the area
   • use cushioning pads
   • gradual return to activity
   • taping
   • injection
   • removable short leg brace
   • fracture of the sesamoid
   • stiff-soled shoe or short, leg-fracture brace
   • taping
   • cushion pad to the area as the fracture heals
   • pain relievers
9. Verticle Talus
   • rare deformity diagnosed at birth
   • one cause of flatfoot in newborn
   • non-surgical treatment
   • series of stretching and casting
   • surgical treatment
   • if conservative treatment unsuccessful
   • recommended at 9-12 months old
   • cast applied after surgery
   • brace or special shoe may be required to prevent return of deformity
10. Achilles Tendinitis
    • inflammation of the tendon on the back of the leg, near the heel

Types:

1. noninsertional Achilles tendinitis
2. insertional Achilles tendinitis
   • non-surgical treatment
     • rest
     • ice
     • NSAIDs
     • Exercise – calf stretch
     • physical medicine modalitie
     • eccentric strengthening
     • single/bilateral heel drop
     • cortisone injections
     • supportive shoes and orthotics
     • extracorporeal shockwave therapy
   • surgical treatment
     • gastrocnemius recession
     • debridement and repair
     • debridement with tendon transfer
     • post surgical treatment can take up to 12 months
   • complications
     • moderate to severe pain after surgery
     • wound infection
3. Heel Pain
   • may have many causes
   • stone bruise
   • plantar fasciitis
   • heel spur
4. Toes
   • bunions
   • claw toe
   • corns
   • hammer toe
   • ingrown toenail
   • intoeing
   • Morton’s neuroma
   • stiff big toe (hallux rigidus)