Foot and Ankle Pain and Injury

The Achilles tendon is the largest tendon in your body. It is used pretty much whenever you move your leg, but perhaps most notably during jumping. This is when it is most vulnerable to injury.

A rupture of the tendon typically happens when there is an acute action or event that stresses the tendon on top of prolonged overuse. A rupture is when the tendon fibers are so torn that the tendon can no longer support running, jumping or even walking sometimes.

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The Achilles tendon is the largest tendon in the body. When it becomes irritated and inflamed from overuse or wear and tear as we age, it can get painful and stiff.

Achilles tendinitis is the most common Achilles tendon condition. It is often caused by any of the following:

• Sudden increase in the amount or intensity of exercise versus easing into the increase.
• Neglecting to loosen tight calf muscles before an aggressive exercise.
• The presence of a bone spur where the Achilles tendon attaches to your heel.

You may be experiencing Achilles tendinitis if you have any of these symptoms:

• Pain and stiffness along the Achilles tendon, especially in the morning
• Pain along the tendon or the back of the heel that seems to worsen during activity
• Severe pain the day after exercising
• Thickening of the tendon
• Bone spur
• Swelling that is always present and gets worse throughout the day

Generally, pain relief can be achieved through non-surgical treatment options. It may take just days, or months and your treatment plan could include:

• Rest
• Ice
• Anti-inflammatory medications
• Exercises to strengthen your calf muscles
• Physical therapy
• Injections
• Orthotics or other supportive devices or shoes
• Shockwave therapy

If your pain lasts six months or longer, a surgical treatment might be recommended. The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the most appropriate treatment plan.

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A broken ankle can be a simple break of one bone or several bones that make up your ankle. The more bones that break, the more difficult it is to walk or put any pressure on the joint.

Ankle fractures occur most often from:

• twisting or rotating your ankle,
• rolling your ankle
• tripping or falling
• from impact during a car accident

You might have an ankle fracture if you’re experiencing any of the following symptoms:

• Immediate and severe pain
• Swelling
• Bruising
• Tender to the touch
• Unable to put weight on the injured foot
• Appears a bone is out of place (dislocated or a deformity)

Your treatment plan will vary by the type(s) of bones that are broken and the severity of the injury. If the broken bone is not out of place, nonsurgical treatment may be an option. These range from wearing a high-top tennis shoe for added stability to a short leg cast.

If the ankle fracture is more complex, surgery may be recommended. The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Ankle sprains are common injuries that range from mild to severe. They are the result of tiny tears in the fibers that make up the ligaments of your ankle or can be complete tears through the tissue.

The causes of sprained ankles can include:

• Walking or exercising on an uneven surface
• Falling down
• Sports that require cutting actions (trail running, basketball, tennis, football)
• Any activity where someone could step on your foot while you’re running

You may have a sprained ankle if any of the following symptoms are present:

• Swelling
• Bruising
• Tenderness to the touch
• Instability of the ankle

Ankle sprains are graded by severity but nearly all are treated without surgery. Nonsurgical treatment may include:

• The RICE method (rest, ice, compression and elevate)
• Protecting the ankle (brace, wrap, etc.)
• Physical therapy to improve range of motion and strength
• Anti-inflammatory medications
• Crutches and/or cast-boot or other immobilization devices

Repeated or severe ankle sprains may lead to chronic ankle instability. While somewhat unusual, surgery may be recommended if your injury does not improve. The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Bunions are an often painful bony bump that develops over time when pressure on the big toe joint causes the big toe to lean toward the second toe. While anyone can get a bunion, women are generally more susceptible because of the tighter, narrow shoes they typically wear. If not treated a bunion can lead to bursitis or chronic pain and arthritis.

The causes of bunions include:

• Wearing poorly fitting shoes over time
• Heredity
• Pre-existing inflammatory conditions (rheumatoid arthritis, polio)

You may be experiencing a bunion if you have any of these symptoms:

• Pain and tenderness
• Redness and inflammation
• Hardened skin on the bottom of the foot
• Callus or corn on the bump
• Stiffness and restricted motion of the big toe

Bunions are typically treated using non-surgical methods:

• Change in footwear
• Protective pads
• Orthotics and other devices
• Icing
• Anti-inflammatory medications

If nonsurgical methods are ineffective, surgery may be recommended. The OrthoNebraska team will work collaboratively with you to determine the appropriate treatment plan.

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Corns are calluses that form on the toes due to pressure from bones pushing up against shoes. They can be caused by ill-fitting shoes, high heels, socks that don’t fit properly and rubbing from seams or stitches inside the shoe. Calluses can occur anywhere on the body, including other parts of the foot and ankle, but are treated much the same.

Treatment involves trimming away dead layers of skin with a scalpel, using a pumice stone or callus file to soften and reduce size of corns, wearing a foam pad over the corn for relief, placing lamb’s wool between toes to cushion soft corns, and wearing shoes that fit properly with roomy toe area. Our team can also address any underlying issues, such as toe deformities.

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People with diabetes need to be extra vigilant about foot care, as poor circulation and nerve damage can lead to small blisters becoming serious infections quickly. To prevent this, daily inspection of the feet is necessary and it is important to never walk barefoot, regularly wash your feet with mild soap and warm water, use lotion on the skin, trim toe nails straight across, avoid antiseptic solutions and heating pads, keep your feet warm, and not smoke.

Additionally, it is important to buy shoes that fit well and wear them for a short as possible at a time. Insurance companies often cover the cost of orthotics to help minimize the risk of ulcers. Following these guidelines can help prevent diabetic foot problems.

Overall, prevention is the best way to prevent problems. The most effective way to prevent them is through strict blood sugar control and daily foot inspections.

A typical complication from diabetic feet are diabetic neuropathies, the most common of which is known as Charcot neuroarthropathy or Charcot foot. This is caused by undetected injuries to the bones of the foot due to the loss of feeling, which can cause significant deformity and disability if left untreated.

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A fallen arch with the foot pointed out is considered to be flat feet. Damage to the tendon located on the inside of the foot and ankle is the main cause of flat feet. Women and athletes participating in high-impact sports are at greater risk for developing flat feet, in addition to those with obesity, diabetes and hypertension.

You may have flat feet if you have any of these symptoms:

• Pain along the course of the posterior tibial tendon (inside of the foot and ankle)
• Pain that worsens with activity
• Pain on the outside of the ankle
• Painful, bony bumps on the top and inside of the foot
• Swelling or a large bump on the bottom of the foot

Treatment for flat feet ranges from nonsurgical methods such as orthotics and braces to surgery. The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Fractures of your toes and forefoot are relatively common and often the result of a direct blow to the foot or overuse and repetitive stress from high-impact sports like running and basketball.

Symptoms of a toe or forefoot fracture include:

• Bruising or discoloration that extends to nearby parts of the foot
• Pain when walking or putting weight on that foot

If you feel you may have a foot fracture, apply ice immediately, elevate your foot, do not put weight on that foot and add light compression by wrapping your foot. Seek medicare care right away, or at the least after a couple days if you symptoms do not improve.

If a fracture is confirmed, treatment will depend on the location of the injury and the type of fracture. For broken toes, “buddy taping” might be recommended. When the fracture is in the forefoot, elevation and limited weight-bearing are likely treatments with the possibility of a cast or walking boot. Surgery is not often recommended for foot fractures, but may be if it is complex or at risk for improper healing.

The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Inflammation in one or more of your foot or ankle joints is likely considered to be arthritis. Arthritis takes several forms in the foot or ankle:

• Osteoarthritis (wear and tear)
• Rheumatoid arthritis (autoimmune disease)
• Post-traumatic arthritis (post-injury).

You may be suffering from foot or ankle arthritis if you have one or more of the following symptoms:

• Pain with motion
• Pain that flairs up with vigorous activity
• Tenderness when pressure is applied
• Joint swelling, warmth or redness
• Increased pain and swelling in the morning or after sitting
• Difficulty walking

While there is no cure for arthritis, treatment is typically non-surgical and could include: lifestyle changes, physical therapy, devices such as a brace or orthotics or anti-inflammatory medications. If your pain causes disability and is not significantly improved by nonsurgical treatments, surgery may be recommended. The OrthoNebraska team will work collaboratively with you to determine and the appropriate treatment plan for your individual needs.

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Gout is an autoimmune disease characterized by intense bouts of intense pain and swelling. It is caused by a high concentration of uric acid in your blood that forms crystals in your joints and your body attacks as if an infection. People with diabetes are more at risk.

Gout typically but not always starts in the big toe before affecting other joints. The pain is so intense and sudden that you may not even be able to tolerate light touches to the affected joint. If left untreated, gout tends to progress quickly throughout the body.

Gout is typically treated nonsurgically using a combination of medications and injections. They craft treatment plans after determining the specifics of your diagnosis. Lifestyle changes can also play a huge role in helping prevent gout attacks. Rarely, surgery with an orthopedic surgeon can be recommended.

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Hammer toe typically occurs in the second, third or fourth toes. It’s a deformity in which the middle joint is bent, resembling a hammer. If treatment is sought out early, hammer toes can be corrected; however if left untreated, a correction will require surgery. The most common cause of hammer toes is wearing shoes that don’t fit properly (too tight/narrow).

Symptoms of hammer toes include:

• Pain when wearing shoes in particular
• Swelling or redness
• Inability to straighten the toe
• Difficulty walking
• Corn or callus on the top of the middle joint

If treated early on, hammer toes can be corrected by:

• Changes in footwear
• Exercises to straighten and strengthen the muscles in your foot
• Straps, cushions or nonmedicated corn pads for pain relief

If the toe joint is rigid and nonsurgical treatment does not alleviate symptoms, surgery may be recommended. The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Heel pain is the most common foot and ankle health complaint. If ignored, it is likely to worsen and become a chronic condition. Typically heel pain is either located beneath the heel or behind the heel. For those with plantar fasciitis, the risk of developing a heel spur is greater. A heel spur is a calcium deposit that forms where the fascia tissue band connects to your heel bone.

Treatment for heel issues may include some combination of

• rest
• specific exercises
• pain medication
• wearing open-back shoes

Your OrthoNebraska team will work with you to discuss the severity of your pain and will develop a treatment plan that is most effective based on your condition, needs and lifestyle.

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Ingrown toenails occur when the nail or skin grows over the edges of the nail, which is often caused by tight shoe wear and improper grooming. Prevention involves protecting feet from trauma and wearing fitting shoes with enough room for toes while also keeping nails trimmed straight across without rounding corners. Keeping feet clean and dry can also help reduce the risk of ingrown toenails.

Symptoms include hard, swollen and tender toes, redness, pain and swelling at the corner of the nail, as well as possible infection and pus drainage from the area.

Treatment includes soaking your foot in warm water 3-4 times daily, wearing comfortable shoes with adequate room for toes, taking ibuprofen/acetaminophen for pain relief if needed, and possibly surgical removal of part or all of the toenail if infection persists.

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Morton’s Neuroma is a thickening of the tissue that surrounds the digital nerve leading to your toes. It typically develops between the third and fourth toes, following irritation, trauma or excessive pressure.

You may be experiencing Morton’s Neuroma if you have any of these symptoms:

• Burning pain in the ball of the foot that might radiate into the bones
• Numbness in the toes
• Pain from “pushing off” or from wearing narrow shoes

Generally, nonsurgical treatment will provide relief:

• Changes in footwear
• Orthotics
• Injections
• Anti-inflammatory medications

If the non-surgical treatments do not prove to help, your orthopedic specialist might recommend surgery. The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Sprains and strains are often caused during sports activities or daily tasks. Sprains are ligament injuries and strains are muscle or tendon injuries.

Most acute (sudden) injuries of this type can be treated using the RICE method:

• Rest
• Ice the injury site for 20 minutes at a time, several times a day
• Compression bandage
• Elevate the injury site above your heart

However, moderate sprains usually result in a pretty loose joint. While rarely requiring significant treatment, bracing or other equipment may be helpful. Severe sprains are torn ligaments, which typically require medical attention. They may be treated by home exercises or physical therapy or in the case of tears, surgery would sometimes be recommended. At OrthoNebraska, we believe in working together to arrive at a treatment plan that balances the risks and benefits.

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Turf toe injuries are the name used to referring to a sprain of the primary joint in the big toe. Although probably most common in American football, it can happen to anyone who hyperextends their toe as the result of a bent (think of a sprinter start) motion and lots of force.

You may be experiencing a bunion if you have any of these symptoms in your big toe:

• Swelling
• Bruising
• Pain when trying to move the toe around (range of motion)

X-rays and less commonly MRIs may be ordered to further confirm the diagnoses if deemed important. For surgery to be required for turf toe is extremely rare. RICE (rest, ice compression and elevation), bracing or taping, a walking boot, and physical therapy will most likely be used in some combination depending on the severity of your injury and how your recovery is progressing.

Again surgery is extremely rare, but may be recommended if there is additional damage surrounding the turf toe injury such as bony chips or cartilage damage. The OrthoNebraska team will work collaboratively with you to determine the appropriate treatment plan that fits your needs, activities and schedule.

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Infections

Skin infections are common, and while most can occur anywhere on the body, a few are exclusive or most commonly found on the feet. They can be spread through skin-to-skin contact or indirectly through contaminated objects.

Symptoms of a skin infection may include lesions, blisters, or sores. Infections include molluscum contagiosum and herpes simplex virus, as well as bacterial infections such as staph, which is the most commonly transmitted. Dermatophyte fungus or tinea pedis (Athlete’s Foot) infections are also commonly seen in sports with close contact such as wrestling.

Warts

Caused by the human papilloma virus (HPV), warts can be acquired by anyone, but most commonly are transmitted in locker rooms or other shared areas. Warts typically don’t have any non-aesthetic symptoms unless they are located in an area that can cause pain from wear.

Treatments include:

• Topical medications
• Cryotherapy
• Cutting the wart out
• Laser therapy

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