Foot and Ankle Surgery
Injuries to the foot and ankle can cause severe pain, limit mobility and eventually lead to disability. Physical therapy and other treatments are not always sufficient. Surgery can provide more permanent solutions.A number of effective surgical procedures are available to patients suffering from a range of conditions. Your experienced San Diego orthopedic surgeon will walk you through every step of the process, from imaging and diagnosis through surgery and postoperative care.
Dr. Robert Afra is widely recognized as one of the nation’s leaders in the field of foot and ankle surgery. Dr. Afra was the Chief of Sports Medicine in the UCSD Department of Orthopedic Surgery,
and today runs one of the most respected shoulder surgery clinics in San Diego. With access to cutting edge technologies and an experienced technical team, Dr. Afra is proud to offer the finest orthopedic surgical care in Southern California. We have helped hundreds of patients from across the country achieve lasting relief from foot and ankle injuries and symptoms such as:
- Morton’s neuroma
- Metatarsal stress fracture
- Plantar fasciitis
- Flat feet
- Posterior tibial tendon dysfunction
- Dancer’s fracture
- Claw toe
- Ankle fracture
- Ankle tendonitis
- Ankle sprain
- Ankle osteoarthritis
If you would like to schedule your own Knee surgery consultation today, please contact us to learn more about the many good options available.
Anatomy of the Feet and Ankles
The feet contain bones, joints, muscles and tissues that allow you to stand, walk, run and jump. There are three main parts: the forefoot, featuring the toes and five metatarsal bones; the midfoot, which includes three bones that form the arch; and the hindfoot, consisting of the heel and ankle.
The ankle’s talus bone supports the tibia and fibula bones in the leg. The heel bone (calcaneus) is the biggest bone in the foot. The Achilles tendon, which attaches the heel to the calf muscle, enables running, jumping and standing on the toes. Muscles, tendons and ligaments permit movement and balance.
Types of Foot and Ankle Injuries
Conditions of the feet and ankle involve the bones, ligaments and tendons. The most common of these afflictions are:
A foot deformity known as hallux valgus, Latin for “turning the big toe outward,” can cause a bunion to develop. Bunions are bumps of bony material and soft tissue on a toe’s main bone. In most cases, this condition is caused by wearing shoes that do not fit properly for extended periods. Shoes with pointed toes are the biggest culprits. Bunions occur nine times more often in women than men. Arthritis and polio also can foster the formation of bunions, and some people are more genetically susceptible than others.
Most of the time, nonsurgical treatments are effective. However, some patients require surgery to relieve pain, stiffness and chronic inflammation; correct deformities; or regain full function of the feet and ankles.
Surgical procedures include:
- Tendon and ligament repair in the big toe;
- Arthrodesis, in which damaged joint surfaces are removed; and screws, wires or plates are implanted to hold the surfaces together until the joint heals;
- Exostectomy, removal of the bump on the toe joint;
- Resection arthroplasty, removal of the damaged part of the joint; and
- Osteotomy, which entails a surgeon cutting and realigning the joint.
- Morton’s Neuroma
Burning pain in the ball of the foot that radiates to the toes may be an indication ofMorton’s neuroma, a mass of tissue that forms around the digital nerve. The condition often occurs between the third and fourth toes, as a result of irritation or injury. Women are eight to 10 times more likely to have the problem. Runners, and people who wear high-heeled or narrow footwear, also are vulnerable.
Many find relief by simply changing the kind of shoes the wear. Wide shoes, with low heels and soft soles, are recommended. Individually crafted shoe inserts and pads also may be helpful. Doctors often prescribe anti-inflammatory drugs and corticosteroid injections.
In about 20 percent of cases, surgery is warranted. The procedure features cutting out part of the nerve, or removing some of the tissue that surrounds the nerve. Patients recovery quickly from these operations.
Metatarsal Stress Fracture
A small crack in one of the five metatarsal bones in the forefoot is called a metatarsal stress fracture. Athletes and dancers commonly sustain the injury due to the repetitive, high-impact pressure their feet sustain. Other patients are those with low bone density due to osteoporosis or irregular menstrual cycles.
Stress fractures frequently occur in the heel, the lower leg’s outer bone (the fibula) or in the navicular bone (on the top of the midfoot). Severe pain may occur on the top of the foot or the outside of the ankle. Swelling, tenderness and bruising are typical symptoms.
When these signs appear, it is important to stop exercising to prevent a complete bone break. In addition to rest, ice and anti-inflammatories are recommended. Casts are sometimes used to provide the necessary healing time for fractures in the fifth metatarsal bone, on the outside part of the foot; and in the navicular and talus bones. Physical and recreational therapy are commonly prescribed.While stress fractures in the second and third metatarsals usually heal on their own, those in the fifth metatarsal may require a surgical procedure known as internal fixation. It entails holding the bones together by inserting pins, screws or plates. Bone grafting is another option that a surgeon might suggest.
Most patients who experience pain the bottom of the heel have plantar fasciitis, which results from irritation and inflammation of tissues that support the arch of the foot. The plantar fascia is a long, thin ligament right below the skin that connects the heel with the front of the foot. The primary cause of this condition is repetitive, high-impact activity like running and playing sports. High arches, tight calf muscles and obesity are additional risk factors. Most patients find relief through rest, physical therapy, cortisone injections, and supportive devices like heel pads and night splints.
When the symptoms do not subside after a year of such treatments, surgery is the next step. Gastrocnemius recession is the surgical lengthening of the calf muscles. This results in increased ankle mobility, and enables patients to flex their feet. In another operation, plantar fascia release, the surgeon partially cuts the plantar fascia ligament to reduce tissue tension.
Pes planus, or flat feet, is characterized by an insufficient arch that allows the instep of the foot to touch the ground when a person is standing. This is caused by loose tendons.
Infants and toddlers, who make up a majority of the patients, usually develop normal arches by the age of 2 or 3. In some cases, the problem persists into adulthood. The condition might occur in a single foot due to aging, injury or illness.
The symptoms are tired and achy feet after standing or playing sports for an extended period. Specially made shoes, inserts, heel cups and wedges can be helpful for children until their feet fully develop. Patients experiencing pain can benefit from placing arch-supporting orthotics in their shoes.
In serious cases, surgery is necessary to relieve the pain and restore foot function. Procedures involve cleaning or repairing the tendon, and fusing joints in the foot into proper alignment.
Another frequently diagnosed overuse injury, metatarsalgia, features pain and inflammation in the ball of the foot. The discomfort continues to worsen if you do not stop putting stress on the foot. Irritation of the bone covering, ligaments and tendons can occur.
People with short first metatarsal bones and hammertoe deformities are particularly at risk. Rest, ice and orthotics are recommended. When these noninvasive treatments fail, surgical realignment of the metatarsal bones might be necessary.
Posterior Tibial Tendon Dysfunction
A tear or inflammation can cause posterior tibial tendon dysfunction. That can leave the tendon unable to support the arch, resulting in a flat foot. Overuse and injuries are the primary reasons for the condition. Contributing factors include obesity, diabetes and hypertension. Athletes, women and the elderly make up a majority of the patients.
The main symptom is pain on the inside parts of the foot and ankle. Swelling also may occur, particularly following physical activity. In some cases, the shape of the foot changes, with the heel pointing outward. That limits flexibility and restricts the foot’s range of motion. The pain might progress to the point that a patient finds it difficult to stand or walk.
Immobilization of the foot, rest, ice, anti-inflammatories and steroid injections are the usual treatments. Many people get relief by being fitted with orthotics or braces.
Others need surgery to relieve the pain and regain function. Procedures include:
- Gastrocnemius recession, the lengthening of the Achilles tendon, to prevent flatfoot from recurring;
- Tenosynovectomy, the cleaning of the tendon, to remove inflamed tissues;
- Tendon transfer, the removal of a diseased posterior tibial tendon and the insertion of a tendon from another part of the foot;
- Osteotomy, the cutting and shifting of bones, to change the foot’s shape and restore the arch;
- Bone grafts, and the insertion of screws or plates, for severe cases of flatfoot; and
- Fusion (arthrodesis) of joints to realign the foot and make its shape more normal, which entails removing cartilage and inserting screws or plates.
When a twisting injury or rolled ankle causes a ligament to pull a bone fragment off the base of the fifth metatarsal, a patient is diagnosed with dancer’s fracture. Pain on the outside part of the foot, localized swelling and difficulty walking are common.
The bone often heals if immobilized in a walking boot. The patient is advised to avoid putting excessive weight on the foot. Recovery is slow, sometimes taking eight weeks or longer. Occasionally, a person suffers complete displacement of the fracture fragments, and has severely limited mobility. A surgeon can reposition the fragments and stabilize them with a screw.
Diseases like diabetes and alcoholism damage nerves and weaken foot muscles. That can cause claw toe (or hammer toe), a condition in which the toes curve downward. Painful calluses and permanent deformity can result.
Tight shoes and high heels are sometimes responsible for claw toe. In the early stages, when the toes can still be bent into their normal position, tape or a splint might be used to hold the digits in place. Eventually, the claw shape can become inflexible. Inserts or special shoes, as well as cortisone injections and other noninvasive treatments, sometimes help.
The primary surgical methods of correcting claw toe are:
- Joint resection (arthroplasty), the removal of part of a joint in the toe beneath the digit’s abnormal bend;
- Bone-mending procedures, to realign the digit by removing small toe joints;
- Fusion, the insertion of an implant or temporary wire into the toe to hold it in position; and
- Toe relocation, the repositioning of a joint, performed in conjunction with joint resection or bone mending.
Commonly known as a broken ankle, an ankle fracture can feature a simple break in a single bone or multiple fractures. Ligament damage often occurs with fractures. The ankle joint consists of three bones: the tibia, or shinbone; the fibula, the smaller bone of the lower leg; and the talus, between the heel bone and the other two ankle bones. The location of a fracture determines its clinical name.
Among the causes are twisting, rotating or rolling the ankle; tripping or falling; and traffic accidents. Ankle fractures and sprains cause similar pain, so diagnostic testing is necessary. Other symptoms of a fracture include swelling, bruising and tenderness. The ankle might be deformed if the joint has been dislocated.
For a small fracture, special shoes or a cast can be used to hold the ankle in place while the bone heals. If the fracture is out of place, or the ankle is unstable, surgery is likely warranted. The bone fragments are repositioned and realigned, then held together with screws, metal plates, wires or a rod.
Two peroneal tendons, or fibula, on the outside of the ankle can become irritated and inflamed. This is known as ankle tendonitis, for which overuse and repetitive activity are generally responsible.
Rest and physical therapy usually relieve the symptoms. Some patients are fitted with walking boots or ankle braces until the swelling subsides. Surgery to clean and repair a tendon can become necessary if the pain does not go away. A surgeon might deepen a groove in the back of the fibula, to give the tendons more room. In the most severe cases, a tendon must be removed.
One of the most common injuries of the lower body is a sprained ankle. It happens when a person twists or rolls a foot to such a degree that a ligament is stretched too far. The symptoms are pain, swelling, bruising, tenderness and an inability to put weight on the foot. In more serious instances, the ligaments are partially or completely torn.
Crutches, walking boots, braces and splints may be used to take pressure off the joint until it can heal. Rest, ice and compression dressings are frequently prescribed. Ultrasound, electrical stimulation and anti-inflammatory drugs reduce the pain and swelling. Physical therapy aids in regaining range of motion.
Surgery becomes necessary if an ankle is still unstable after months of rehabilitation and treatment. Procedures include arthroscopy, the removal of loose bone fragments and cartilage; and reconstruction, the repair of torn ligaments with stitches or suture.
The nation’s No. 1 cause of disability, arthritis can afflict many joints in the body. There is no cure, but treatments and surgery can reduce the severity of symptoms.
Osteoarthritis of the foot and ankle results from the gradual deterioration of cartilage that protect bones in the joints. Patient experience pain, inflammation, swelling, stiffness, reduced motion and a loss of balance. Risk factors for the disease are age, obesity and family history.
The foot contains 28 bones and more than 30 joints. Lower-extremity osteoarthritis occurs most often in the ankle, or tibiotalar joint; the three joints of the hindfoot; the midfoot; and the big toe.
Nonsurgical treatments are pain relievers and anti-inflammatories, shoe inserts like pads and arch supports, specially made shoes, braces and canes, and exercises and physical therapy. If a patient does not respond to those methods, surgical means of correcting the problem are available.
The types of surgery are:
- Arthroscopic debridement, or arthrodesis, in which a fiberoptic instrument with a diagnostic camera is inserted into the joint and manipulated to clean out inflamed tissues and bone spurs;
- Arthrodesis, or fusion, of bones in the joint with pins, plates, screws or rods;
- Bone grafts, when a piece of bone from the lower leg or pelvis is transplanted in the ankle joint; and
- Arthroplasty, replacing damaged joints with artificial implants.