Achilles Tendon, Achilles Tendonitis & Achilles Tendonosis

Achilles tendonitis is an inflammation of the Achilles tendon.  Over time if left untreated can lead to a degeneration of the tendon (Achilles tendonosis), in which the tendon loses its organized structure and is likely to develop microscopic tears.  In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.

Achilles Tendon Pain Symptoms

• Pain – Aching, stiffness, soreness, or tenderness – within the tendon
• Pain appears in the morning or after periods of rest
• Tenderness – when the sides of the tendon are squeezed
• Chronic problems – the tendon may become enlarged and may develop nodules in the area where the tissue is damaged

Achilles Tendon Pain Causes

• Achilles tendonitis and tendonosis are usually caused by overuse.  A sudden increase of a repetitive activity involving the Achilles tendon, leading to micro-injury of the tendon fibers.
• Athletes and “weekend warriors”are at higher risk for developing disorders
• In addition, people with pronation (flattening of the arch) have a tendency to develop Achilles tendonitis and tendonosis.  If these individuals wear shoes without adequate stability, their over-pronation could further aggravate the Achilles tendon.

Achilles Tendon Condition Diagnosis

In diagnosing Achilles tendonitis or tendonosis, an examination of the foot and ankle including evaluating the range of motion and condition. The extent of the condition can be further assessed with x-rays, ultrasound or MRI.

Achilles Tendon Pain Treatment

• Immobilization
• Ice
• Oral medication [Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)]
• Physical therapy

If non-surgical approaches fail surgery may be necessary. Premier Podiatry Group will select the best procedure to repair your condition.

There are a wide variety of causes for broken ankles, most commonly a fall, an automobile accident, or sports-related trauma. Because a severe sprain can often mask the symptoms of a broken ankle, every ankle injury should be examined by a physician.

Ankle Fracture : Symptoms of a broken ankle include:

• Bruising.
• Swelling.
• Immediate and severe pain.
• Inability to put any weight on the injured foot.
• Tenderness to the touch.
• Deformity, particularly if there is a dislocation or a fracture.

Ankle Fracture Treatment

The treatment for a broken ankle usually involves a leg cast if the fracture is stable. If the ligaments are also torn, or if the fracture created a loose fragment of bone that could irritate the joint, surgery may be required to secure the bones in place so they will heal properly.

Where Can I Get My Ankle Fracture Treated?

Ankle Fractures and Foot Conditions need to be diagnosis by a Podiatrist and Foot Surgeon! Many times people are walking around on a problem that needs to be addressed.  Seeking medical advise is always the first step to recovery of any foot and ankle condition. Dr. Adam Katz is a highly train Foot and Ankle Specialist . At Premier Podiatry Group, we are always available and here to help you with a ankle fracture and all your foot care needs!

Sprained ankles often result from forces the cause the ankle joint to move out of its normal position. Ankle sprains commonly occur while participating in sports, wearing inappropriate shoes, or walking or running on an uneven surface.

Sometimes a ankle sprain occur because of weak a ankle, a condition that some people are born with.

Ankle sprains are not the same as strains, which affect muscles rather than ligaments.

Ankle Sprain | Sign & Symptoms

• Pain or soreness
• Swelling
• Bruising
• Difficulty Walking

Even if you don’t have pain or swelling with a sprained ankle, treatment is crucial. Any ankle sprain
whether it’s your first or your fifth requires prompt medical attention.

Ankle Sprain | R.I.C.E. Method

If you think you’ve sprained your ankle, contact Premier Podiatry Group for an
appointment as soon as possible. In the meantime, Use the “R.I.C.E.” method – Rest, Ice, Compression, and Elevation – to help reduce swelling, pain, and further injury.

Ankle Sprain | Why Prompt Medical Attention Is Needed?

There are four key reasons why an ankle sprain should be promptly evaluated and treated by Premier Podiatry Group:

• An untreated ankle sprain may lead to chronic ankle instability
• You may have suffered a more severe ankle injury along with the sprain, including a serious bone fracture
• An ankle sprain may be accompanied by a foot injury that causes discomfort but has gone unnoticed thus far
• Rehabilitation of a sprained ankle needs to begin right away

In evaluating your injury, a Premier Podiatry Group physician will take your history to learn more about the injury. We will examine the injured area, and may order x-rays, an MRI study, or a CT scan to help determine the severity of the injury.

Ankle Sprain | Non-Surgical Treatment & Rehabilitation

• Immobilization
• Early Physical Therapy
• Oral medication - Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
• Icing
• Compression Wraps

Ankle Sprain | When Is Surgery Needed?

In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments. Premier Podiatry Group will select the surgical procedure best suited for your case.

After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome.

Charcot foot is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn’t hurt. Diabetic foot ulcers and early phases of Charcot fractures can be treated with a total contact cast.

Charcot Foot Treatment

The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot’s movement and supports its contours if you don’t put any weight on it. To use a total contact cast, you need good blood flow in your foot. The cast is changed every week or two until your foot heals. A custom-walking boot is another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should keep from putting your weight on the Charcot foot. Surgery is considered if your deformity is too severe for a brace or shoe.

Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely.

Repeated ankle sprains often cause – and perpetuate – chronic ankle instability.

Symptoms

• A repeated turning of the ankle, espeically on uneven surfaces
• Continued discomfort & swelling
• Pain or tenderness

Diagnosis

If your ankle feels unstable and gives way repeatedly, or if you experience recurring ankle sprains, your condition should be evaluated and treated. Chronic ankle instability that is left untreated leads to continued instability, activity limitations, arthritis, and tendon problems.

In evaluating and diagnosing your condition, Premier Podiatry Group will examine your ankle to check for tender areas, signs of swelling, and instability of your ankle as shown in the illustration. X-rays, CT scans, or MRIs may be needed to  further evaluate the ankle complex.

Treatment

• Physical therapy
• Bracing – Can be found at our online store
• Oral medication [Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)]

In some cases Premier Podiatry Group will recommend surgery based on the degree of instability or lack of response to non-surgical approaches. The length of the recovery period will vary, depending on the procedure or procedures performed.

• Get periodic foot exams – Premier Podiatry Group surgeons offer routine foot exams to help prevent the foot complications associated with diabetes
• Inspect your feet daily
• Was your feet in lukewarm – NO HOT WATER!
• Be gentle when bathing your feet
• Moisturize your feet, but not between your toes
  DON’T moisturize between the toes—this could encourage a fungal infection.
• Cut nails carefully and straight across
• Never trim corns or calluses
  No “bathroom surgery”, let your doctor do the job
• Wear clean, dry socks daily
• Avoid the wrong type of socks
• Wear socks to bed
  NEVER use a heating pad or hot water bottle
• Shake out your shoes and inspect the inside before wearing
• Keep your feet warm and dry
• Never walk barefoot
• Take care of your diabetes
• Don’t smoke

People with diabetes are prone to many foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor blood circulation. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation. Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection.

When you have diabetes, you need to be aware of how foot problems can arise from disturbances in the skin, nails, nerves, bones, muscles, and blood vessels. Furthermore, in diabetes, small foot problems can turn into serious complications. You can do much to prevent amputation by taking two important steps: Follow the proactive measures discussed below—and follow up with Premier Podiatry Group regularly.

Three different groups of nerves can be affected by diabetic neuropathy:

• Sensory nerves, which enable people to feel pain, temperature, and other sensations
• Motor nerves, which control the muscles and give them their strength and tone
• Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating.

Diabetic Peripheral Neuropathy doesn’t emerge overnight—instead, it usually develops slowly and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy.

The loss of sensation and other problems associated with nerve damage make a patient prone to developing skin ulcers (open sores) that can become infected and may not heal. This serious complication of diabetes can lead to loss of a foot, a leg, or even a life.

Symptoms

Diabetic Peripheral Neuropathy | For sensory neuropathy:

• Numbness or tingling in the feet
• Pain or discomfort in the feet or legs – including prickly, sharp pain or burning feet

Diabetic Peripheral Neuropathy | For motor neuropathy:

• Muscle weakness and loss of muscle tone in the feet and lower legs
• Loss of balance
• Changes in foot shape that can lead to areas of increased pressure

Diabetic Peripheral Neuropathy | For autonomic neuropathy:

• Dry feet
• Cracked skin

Diagnosis

To diagnose diabetic peripheral neuropathy, Premier Podiatry Group will obtain the patient’s history of symptoms and will perform simple in-office tests on the feet and legs. This evaluation may include assessment of the patient’s reflexes, ability to feel light touch, and ability to feel vibration. In some cases, additional neurological tests may be ordered.

Treatment

• Diabetic peripheral neuropathy centers on control of the patient’s blood sugar level
• Medications are available to help relieve specific symptoms, such as tingling or burning
• Physical Therapy

Prevention

You play a vital role in reducing complications associated with diabetes

• Keep blood sugar levels under control
• Wear well-fitting shoes to avoid getting sores
• Inspect your feet every day
• Visit Premier Podiatry Group on a regular basis for an examination to help prevent the foot complications of diabetes
• Have periodic visits with your primary care physician or endocrinologist. Premier Podiatry Group will work with your primary care provider to prevent and treat the complications associated with diabetes

Flat feet are generally associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape).

Many people with flat feet do not experience pain or other problems. When pain in the foot, ankle, or lower leg does occur, especially in children, the feet should be evaluated.

Flat Feet Conditions

Painful progressive flatfoot, otherwise known as tibialis posterior tendonitis or adult-acquired flatfoot, refers to inflammation of the tendon of the tibialis posterior. This condition arises when the tendon becomes inflamed, stretched, or torn. Left untreated, it may lead to severe disability and chronic pain. People are predisposed to tibialis posterior tendonitis if they have flat feet or an abnormal attachment of the tendon to the bones in the midfoot.

Flat Feet Treatment

Nonsteroidal anti-inflammatory medications, icing, physical therapy, supportive taping, bracing, and orthotics are common treatments for painful progressive flat feet. Note: Please consult your physician before taking any medications. In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function. In the most severe cases, foot surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.

The main symptom of gout is waking up in the middle of the night with an acute throbbing pain around the big toe and top of the foot. The pain lasts for several days or even weeks before subsiding. It is common to have several attacks throughout the year.

Treatment

The acute inflammatory symptoms and pain from Gout can be decreased quickly with prescription medications and steroid injections. Long term uric acid control can be obtained from prescription medications and diet control. By controlling the blood uric acid levels this will prevent future flare ups of gout.

Hammer Toe Symptoms

• Pain or irritation of the affected toe when wearing shoes
• Corns – A buildup of skin on the top, side, or end of the toe, or between the toes
• Calluses – Another type of skin buildup on the bottom of the toe or on the ball of the foot

Because of the progressive nature of hammer toes conditions, they should receive early attention. Hammer toes never get better without some kind of medical intervention.

Hammer Toe Causes

• Muscle/Tendon imbalance is the most common cause of a hammer toe
• Hammer toes are often aggravated by shoes that don’t fit properly
• Hammer toe may be caused by some kind of trauma, such as a previously broken toe
• Can be inherited

Hammer Toe Diagnosis

In diagnosing Achilles tendonitis or tendonosis, an examination of the foot and ankle including evaluating the range of motion and condition of the tendon. The extent of the condition can be further assessed with x-rays, ultrasound or MRI.

Hammer Toe Treatment

Non-Surgical Hammer Toe Approaches:

• Trimming corns & calluses – This should be done by a healthcare professional
• Padding corns & calluses – Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful
• Changes in shoewear
• Orthotic devices
• Injection therapy
• Oral medication [Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)]
• Splinting/Strapping

When Is Surgery Needed For Hammer Toe ?

In some cases, usually when the hammer toe has become more rigid or conservative therapy has failed, hammer toe surgery is needed to relieve the pain and discomfort caused by the deformity.

The most common surgical procedure performed to correct a hammer toe is called arthroplasty. In this procedure, the surgeon removes a small section of the bone from the affected joint.

Another hammer toe surgical option is arthrodesis, ( fusing of a joint)  which is usually reserved for more rigid toes or severe case. A pin or other small fixation device is typically used to hold the toe in position while the bones are healing.

Some other procedures that might be needed depending on the severity of the toe include skin wedging, tendon/muscle rebalancing or lengthening, small tendon transfers, or relocation of surrounding joints.

Ingrown Toenail Symptoms

• Pain at the border of the nail
• Redness
• Swelling
• Warmth in the toe
• Foul odor
• Pus from the nail

However, even if your toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.

Causes of Ingrown Toenails

• The most common cause of ingrown toenails is improper cutting of your toe nails
• Inherited nail shape
• Trauma to the nail
• Certain nail conditions are often increase the risk of ingrown toenails. Such as toenail fungal infection or if you have lost a nail through trauma

Treatment of Ingrown Toenails

Home treatment is strongly discouraged if you suspect you have an infection, or if you have a medical condition that puts your feet at high risk—for example, diabetes, nerve damage in the foot, or poor circulation.

Treating Your Toenail At Home

If you don’t have an infection or any of the above conditions, you can soak your foot in room-temperature water (add Epsom’s salt if you wish), and gently massage the side of the nail fold to help reduce the inflammation.

Avoid attempting “bathroom surgery.” If your symptoms fail to improve, it’s time to see Premier Podiatry Group.

Ingrown Toenail Medical Care

A Premier Podiatry Group physician will examine your toenail and select the treatment best suited for you.

• Oral Antibiotics
• Surgery – A simple procedure, often performed in the office, Surgery involves numbing the toe and removing a corner of the nail, a larger portion of the nail, or the entire nail
• Permanent removal – Various techniques may be used to destroy or remove the nail root. Most people experience very little pain after surgery and may resume normal activity the next day.
• Preventing Ingrown ToenailsMany cases of ingrown toenails may be prevented by following these two important tips:Trim your nails properly & Avoid poorly-fitting shoes

The Truths & Myths About Home Treatment of Ingrown Toenails

The Myths

• Cutting a notch (a “V”) in the nail will reduce the tendency for the nail to curve downward
• Repeated trimming of the nail borders is a good way to treat ingrown toenails
• Cotton placed under the nail will relieve the pain
• You can buy effective ingrown toenail treatments at the drug store

The Truths

• Cutting a “V” does not affect the growth of the toenail. New nail growth will continue tocurve downward
• Repeated nail trimming fails to correct future nail growth and can make the condition worse
• Cotton placed under the nail can be harmful. It can easily harbor bacteria and encourage infection
• Over-the-counter topical medications may mask the pain, but they fail to address the underlying problem

 Symptoms

• Pain on the bottom of the heel or arch
• Pain that is usually worse upon arising
• Pain that increases over a period of months
• Pain with first step in the morning or after rest
• Pain decrease with activity

Causes

The most common cause of plantar fasciitis relates to faulty structure of the foot such as overly flat feet or high-arched feet.

Overuse syndrome such as wearing non-supportive footwear on hard, flat surfaces for prolong periods puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis.

Obesity also contributes to plantar fasciitis.

Diagnosis

To arrive at a diagnosis, Premier Podiatry Group will obtain a thorough medical history and examine your foot.

Diagnostic imaging studies such as x-rays, a bone scan, or magnetic resonance imaging (MRI) or Ultrasound may be used to distinguish the different types of heel pain.

 Treatment

• Stretching exercises
• Avoid going barefoot
• Ice
• Shoe modifications
• Medications
• Lose weight
• Padding and strapping
• Orthotic Devices
• Injection therapy
• Removable walking cast
• Night splint – Can be purchased at our online store
• Physical Therapy – Rehabilitation program

Although most patients with plantar fasciitis respond to non-surgical treatment, if after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered.

Long-Term Care

For all patients, wearing supportive shoes and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

Pediatric Heel Pain Conditions

Heel pain is a warning sign that a child has a condition that deserves attention. Heel pain in children is often caused by injury to the growth plate commonly referred to as Calcaneal Apophysitis orSever’s Disease. A growth plate is an area of growing tissue within the bone that determines the future length and shape of the bone. Growth plate injuries of the heel are usually caused by overuse. However, pediatric heel pain may be the sign of many other problems, and can occur at younger or older ages.

Symptoms

• Pain in the back or bottom of the heel
• Limping
• Walking on the toes
• Difficulty participating in normal activities or sports

Why Does Pediatric Heel Pain Differ From Adult Heel Pain?

During these ages (8 to 14 years old), the bones are growing faster than the tendons. This means that the heel cord is relatively short when compared to the leg bone, causing the tendon to pull on the growth plate of the heel. When this is the case, a great deal of tension is put on the heel bone causing irritation and pain. Also, during this time frame the bone is still immature and is more prone to injury.

Pediatric heel pain usually does not improve with activity. In fact, walking around typically makes the pain worse. Where adult heel pain improves with activity.

 Causes

• Calcaneal Apophysitis is heel pain in children caused by injury to the growth plate in the heel bone
• Tendo-Achilles Bursitis – Inflammation of the fluid-filled sac (bursa) located between the Achilles tendon (heel cord) and the heel bone. Can be associated with certain diseases such as juvenile rheumatoid arthritis
• Overuse Syndrome
• Fractures – Sometimes heel pain is caused by a break in the bone such as Stress Fractures

Diagnosis

To diagnose the underlying cause of your child’s heel pain, Premier Podiatry Group will first obtain a thorough medical history and ask questions about recent activities. A thorough examine of the child’s foot and leg. X-rays are often used to evaluate the condition, and in some cases the surgeon will order a bone scan, a magnetic resonance imaging (MRI) study, or a computerized tomography (CT or CAT) scan. Laboratory testing may also be ordered to help diagnose other less prevalent causes of pediatric heel pain.

Treatment

• Reduce activity
• Cushion the heel
• Medications – Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Physical Therapy – Rehabilitation program with Robbins Rehabilitaion
• Custom Foot Orthotic Devices
• Immobilization
• Surgery – There are some instances when surgery may be required to lengthen the tendon or correct other problems

Haglund’s Deformity A Heel Pain Condition

Haglund’s deformity is a bony enlargement on the back of the heel that most often leads to painful bursitis (heel Pain), which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone). In Haglund’s deformity, the soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes.

Haglund’s deformity a heel pain condition is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, the deformity is most common in young women who wear pumps.

 Symptoms

• A noticeable bump on the back of the heel
• Pain in the area where the Achilles tendon attaches to the heel
• Swelling in the back of the heel
• Redness near the inflamed tissue

Causes

• Heredity may play a role in Haglund’s deformity. People can inherit a type of foot structure that makes them prone to developing this condition.
• High arches can contribute to Haglund’s deformity. The Achilles tendon attaches to the back of the heel bone, and in a person with high arches, the heel bone is tilted backward into the Achilles tendon. This causes the uppermost portion of the back of the heel bone to rub against the tendon. Eventually, due to this constant irritation, a bony protrusion develops and the bursa becomes inflamed. It is the inflamed bursa that produces the redness and swelling associated with Haglund’s deformity.
• Tight Achilles tendon, causing pain by compressing the tender and inflamed bursa. In contrast, a tendon that is more flexible results in less pressure against the painful bursa.

Diagnosis

• X-Rays will be ordered to help us evaluate the structure of the heel bone
• MRI or Ultrasound may also be ordered if further evaluation is needed

Treatment

The goal is to reduce the inflammation of the bursa. While these approaches can resolve the bursitis, they will not shrink the boney protrusion.

Non-Surgical Approaches:

• Medication – Anti-inflammatory medications may help reduce the pain and inflammation
• Ice – 20 minutes of each waking hour. Do not put ice directly against the skin
• Exercises – Stretching exercises help relieve tension from the Achilles tendon
• Heel lifts
• Heel Pads
• Shoe Modifications
• Physical Therapy – Rehabilitation program with Robbins Rehabilitaion
• Orthotic devices – These custom arch supports are helpful because they control the motion in the foot, which can aggravate symptoms
• Immobilization – In some cases, casting may be necessary to reduce symptoms

When Is Surgery Needed For A Heel Condition?

If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. The foot and ankle surgeon will determine the procedure that is best suited to your case. It is important to follow the surgeon’s instructions for post-surgical care.

Prevention

• Wearing appropriate shoes; avoid pumps and high-heeled shoes
• Using arch supports or orthotic devices
• Performing stretching exercises to prevent the Achilles tendon from tightening
• Avoiding running on hard surfaces and running uphill

• A solitary wart is a single wart. It often increases in size and may eventually multiply, forming additional “satellite” warts.
• Mosaic warts are a cluster of several small warts growing closely together in one area. Mosaic warts are more difficult to treat than solitary warts.

Plantar Wart | Symptoms

• Thickened skin
• Pain
• Tiny black dots on the surface of the wart

Causes

The plantar wart virus is acquired in public places where people go barefoot, such as locker rooms, swimming pools, and karate classes. It can also be acquired at home if other family members have the virus. Plantar warts are caused by direct contact with the human papilloma virus (HPV); a benign virus.

Treatment

To diagnose a plantar wart, Premier Podiatry Group will examine the patient’s foot and look for signs and symptoms of a wart as noted above.

The goal of treatment is to completely remove the wart.

At Premier Podiatry Group we use topical and oral treatments or surgery to remove the wart.

Although there are many folk remedies for warts, patients should be aware that these remain unproven and may be dangerous. Patients should never try to remove a wart themselves—this can do more harm than good.

PTTD is often called “adult acquired flatfoot” because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn’t treated early.

Causes

Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.

Symptoms

The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change.
For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen.
Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward.
As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.

Non-surgical Treatment

Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested.
In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.
In many cases of PTTD, treatment can begin with non-surgical approaches that may include:

• Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle brace or a custom orthotic device that fits into the shoe.
• Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while.
• Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization.
• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
• Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and may provide special inserts designed to improve arch support.

When Is Surgery Needed?

In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.

Tarsal tunnel syndrome is irritation to the posterior tibial nerve causing pain, numbness and tingling along the path of the nerve in the foot and leg.

Tarsal tunnel syndrome is compared to carpal tunnel syndrome occurring in the wrist.  Both are caused by compression of a nerve in a small confined space causing pain and discomfort.

Symptoms

• Tingling, burning sensation (“electrical shock”)
• Numbness
• Shooting pain to the leg or toes
• Swelling of the ankle with above symptomsIf left untreated this condition can lead to permanent nerve damage of the nerve involved

Causes

• Flat feet
• Varicose veins
• Ganglion cyst
• Inflammation of a tendon
• Bone spur
• Trauma or injury (ie: Ankle Sprain)
• Systemic diseases such as diabetes or arthritis can cause swelling, thus compressing the nerve

Diagnosis

• MRI – If a mass is suspected
• Electromyography and Nerve Conduction Velocity (EMG/NCV)

Treatment

• Rest
• Ice
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Immobilization
• Physical Therapy
• Injection Therapy
• Custom Orthotic Devices
• Shoes
• Bracing
• Surgery

A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.

Traumatic fractures (also called acute fractures) are caused by a direct blow or impact, such as seriously stubbing your toe. Traumatic fractures can be displaced or non-displaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated).

Signs and symptoms of a traumatic fracture include:

• You may hear a sound at the time of the break.
• “Pinpoint pain” (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
• Crooked or abnormal appearance of the toe.
• Bruising and swelling the next day.
• It is not true that “if you can walk on it, it’s not broken.” Evaluation by a foot and ankle surgeon is always recommended.

Consequences of Improper Treatment

Some people say that “the doctor can’t do anything for a broken bone in the foot.” This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:

• A deformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes
• Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn’t been properly corrected
• Chronic pain and deformity
• Non-union, or failure to heal, can lead to subsequent surgery or chronic pain.

Treatment of Toe Fractures

Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options:

• Rest. Sometimes rest is all that is needed to treat a traumatic fracture of the toe.
• Splinting. The toe may be fitted with a splint to keep it in a fixed position.
• Rigid or stiff-soled shoe. Wearing a stiff-soled shoe protects the toe and helps keep it properly positioned.
• “Buddy taping” the fractured toe to another toe is sometimes appropriate, but in other cases it may be harmful.
• Surgery. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins.

Treatment of Metatarsal Fractures

Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.

For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. Since the big toe is used so frequently and bears more weight than other toes, arthritis in that area can make it painful to walk, bend, or even stand.

Another type of break, called a Jones fracture, occurs at the base of the fifth metatarsal bone (behind the little toe). It is often misdiagnosed as an ankle sprain, and misdiagnosis can have serious consequences since sprains and fractures require different treatments. Your foot and ankle surgeon is an expert in correctly identifying these conditions as well as other problems of the foot.

Treatment of metatarsal fractures depends on the type and extent of the fracture, and may include:

• Rest. Sometimes rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone.
• Avoid the offending activity. Because stress fractures result from repetitive stress, it is important to avoid the activity that led to the fracture. Crutches or a wheelchair are sometimes required to offload weight from the foot to give it time to heal.
• Immobilization, casting, or rigid shoe. A stiff-soled shoe or other form of immobilization may be used to protect the fractured bone while it is healing.
• Surgery. Some traumatic fractures of the metatarsal bones require surgery, especially if the break is badly displaced.
• Follow-up care. Your foot and ankle surgeon will provide instructions for care following surgical or non-surgical treatment. Physical therapy, exercises and rehabilitation may be included in a schedule for return to normal activities.