Deformity Correction with Internal Fixation and/or External Fixation

Deformities of the ankle and foot can be extremely debilitating. Often times deformation can be caused by post-traumatic changes (i.e. old injury, arthritis), genetic predisposition (metatarsal adductus, tarsal coalition, brachymetatarsia), and medical conditions (i.e. diabetes with neuropathy, charcot osteoarthropathy, tumors of the foot/ankle, flat feet, cavus (high arch) feet). When the leg, ankle, and foot are not in anatomic alignment this can create secondary changes affecting surrounding joints and difficulties with walking or normal day-to-day activities.

Post-Traumatic Injury (i.e. old injury, arthritis)

Deformities include improper alignment from previous fractures of the leg, ankle, and foot. Once arthritis in adjacent joints begins the pathology will progress until treatment is initiated. Every joint in the foot and ankle has specific motion and alignment to allow a pain free gait. When specific joint axis and anatomy is not correctly aligned this creates stress throughout the ankle and foot. When arthritis begins in specific joints it tends to spread unless the exact issue is addressed.

Symptoms of Post-Traumatic Injury

It may take months to years to develop active symptoms.

Chronic pain deep in the ankle or foot
Mal-alignment of joints
Walking on the inside or outside of the foot
Continuous ankle sprains on level and unlevel terrain
Occasional clicking or catching feeling in the ankle when walking/running.
Swelling to the foot/ankl
Limited range of motion to the foot/ankle

Sequela (long term changes) of Post-Traumatic Injury

As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually rub together losing their normal contact forces leading to pain and inflammation.

An injury may also lead to osteoarthritis, causing the pathologic condition to develop over months and years. Examples include but are not limited to:

Osteoarthritis in the big toe is typically caused by kicking or jamming the toe, or by dropping something on the toe.
Osteoarthritis in the midfoot is often caused by dropping something on it, or by a twist, sprain or fracture.
Osteoarthritis in the ankle is usually caused by a fracture and occasionally by a severe sprain.

Diagnosis of Post-Traumatic Injury

In diagnosing Post Traumatic Injuries, your surgeon will examine the foot/ankle, the amount of swelling in the joint, the limited mobility, and the pain with movement will be assessed as well as your surgeon gently pressing on problem areas determine the extent of the discomfort.

X-rays will be ordered to evaluate pathology. At times a CT scan will be ordered to further evaluate the extent of the disease as well as for surgical planning should surgery be warranted.

Non-surgical Treatment of Post-Traumatic Injury

When Post Traumatic Injury has progressed or failed to improve with non-surgical treatment, surgery may be recommended. In some advanced cases, surgery may be the only option. The goal of surgery is to decrease pain, improve function, and alignment. Your surgeon will consider a number of factors when selecting the procedure best suited to the your condition and lifestyle.

Surgery of Post-Traumatic Injury

Treatment approaches for arthritic joints are based on how long the pathology has been present and the amount of damage to the joint and surrounding structures. Conservative treatment options are encouraged prior to surgical intervention.

Ice. Putting an ice pack on your foot/ankle for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and the area of discomfort; do not apply ice directly to the skin.
Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
Orthotic devices. Custom or over the counter orthotic devices that fit into your shoe help improve the underlying mechanical structure of the foot/ankle.
Bracing. May reduce pain during walking and help prevent further deformity.
Physical therapy. Exercises to strengthen the muscles may provide greater stability and help avoid injury that might worsen the condition.
Stretching exercises. Exercises that stretch out the calf muscles as well as muscles surrounding the arthritis.
Avoid barefoot. When you walk without shoes, you put increase strain and stress on your arthritis.
Limit activities. Reduce extended physical activities
Shoe modifications. Wearing supportive shoes that have a rigid heel and a good arch support and a slightly raised heel reduces stress on the foot/ankle.
Injection therapy. Injections of corticosteroids in the joint may reduce inflammation and pain.

Metatarsal Adductus

Metatarsal Adductus is when the metatarsals (bones behind toes) grow inward. This abnormal growth occurs during fetal development and has to do with position of the feet in utero. This may lead to abnormal gait or pain in the middle or front part of the foot. At times a bunion deformity can be noted.

Many patients who have Metatarsal Adductus are born with this condition, the symptoms generally do not appear until the bones begin to mature. At times there are no symptoms during childhood or even as a young adult. However, pain and symptoms may develop later in life.

Symptoms of Metatarsal Adductus

Pain when walking and/or standing
Limited motion when walking
Stiffness due to arthritis
Limp
Increasing bunion deformity
Pain under the lesser digits
Hammertoes/digits that move towards the outside of the foot

Diagnosis of Metatarsal Adductus

Diagnosis includes obtaining information about the duration and development of the symptoms as well as a thorough examination of the foot/ankle.

X-rays will be ordered to assess the condition. Specific angles of the foot will be measured as well as coordinating these to the clinical picture. At times advanced imaging such as a CT scan or MRI will be ordered to determine the extent of the pathology to the soft tissue and bone as well as determine surgical planning should surgery be warranted.

Non-Surgical Treatment

The goal of non-surgical treatment of metatarsal adductus is to relieve the symptoms.

Ice. Putting an ice pack on your foot for 20 minutes several times a day helps reduce inflammation.
Limit activities. Reduce extended physical activities.
Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
Physical therapy. Physical therapy may include strengthening exercises, mobilization, ambulation education, and stretching.
Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain in the midfoot joints. Sometimes more than one injection is necessary.
Orthotic devices. Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint and relieving pain.
Immobilization. Sometimes the foot is immobilized to give the affected area a rest.

Surgery of Metatarsal Adductus

If the patient’s symptoms are not adequately relieved with nonsurgical treatment, surgery is an option. Your surgeon will select the best procedure to address the deformity, based upon the extent of the pain, the patient’s age and activity level, and other factors.

Tarsal Coalition

A tarsal coalition is an abnormal connection between two bones in the hindfoot. This abnormal connection can be composed of bone, cartilage, or fibrous tissue, and may lead to limited motion and pain in one or both feet.

About Tarsal Coalition

Tarsal coalition typically occurs during fetal development, resulting in the individual bones not forming properly.

Many patients who have a tarsal coalition are born with this condition, the symptoms generally do not appear until the bones begin to mature. At times there are no symptoms during childhood. However, pain and symptoms may develop later in life.

Symptoms of Tarsal Coalition

Pain when walking and/or standing
Tired and/or fatigued legs
Muscle spasms in the leg, causing an outward turn to the foot
Limp
Stiffness of the foot/ankle

Diagnosis of Tarsal Coalition

Tarsal coalition is difficult to identify until bones begin to mature. At times it is not discovered until adulthood. Diagnosis includes obtaining information about the duration and development of the symptoms as well as a thorough examination of the foot/ankle.

X-rays will be ordered to assess the condition. At times advanced imaging such as a CT scan or MRI will be ordered to determine the extent of the pathology to the soft tissue and bone as well as determine surgical planning should surgery be warranted.

Non-Surgical Treatment

The goal of non-surgical treatment of tarsal coalition is to relieve the symptoms and reduce the motion at the affected joint.

Ice. Putting an ice pack on your foot for 20 minutes several times a day helps reduce inflammation.
Limit activities. Reduce extended physical activities.
Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
Physical therapy. Physical therapy may include strengthening exercises, mobilization, ambulation education, and stretching.
Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain. Sometimes more than one injection is necessary.
Orthotic devices. Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint and relieving pain.
Immobilization. Sometimes the foot is immobilized to give the affected area a rest.

Surgery of Tarsal Coalition

If the patient’s symptoms are not adequately relieved with nonsurgical treatment, surgery is an option. Your surgeon will select the best procedure to address the coalition, based upon the extent of the pain, the patient’s age and activity level, and other factors.

Brachymetatarsia

Brachymetatarsia is an abnormal condition in which one of the bones in the forefoot is shorter than the others. This typically causes the associated toe to be shortened as well. The 4th metatarsal and digit are the most common. At times the toe may be raised up or touch the other toes. The toe has an abnormal appearance and does not contact the ground in the correct way. This causes issues with the other toes taking too much weight and may become uncomfortable.

Symptoms of Brachymetatarsia

Abnormal appearance of the digit
Pain in the front part of the foot
Pain on the bottom or top of the foot where the toes meet the rest of the foot
Abnormal walking due to the bone growth
Irritation of the digit due to rubbing on shoes

Diagnosis of Brachymetatarsia

Brachymetatarsia is discovered when the digit is abnormally short compared to surrounding digits.. Diagnosis includes obtaining information about the duration and development of the symptoms as well as a thorough examination of the foot.

Non-Surgical Treatment

The goal of non-surgical treatment of Brachymetatarsia is to relieve the symptoms and create a normal foot for pain free weight bearing purposes.

Ice. Putting an ice pack on your foot for 20 minutes several times a day helps reduce inflammation.
Limit activities. Reduce extended physical activities.
Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
Physical therapy. Physical therapy may include strengthening exercises, mobilization, ambulation education, and stretching.
Orthotic devices. Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint and relieving pain.
Immobilization. Sometimes the foot is immobilized to give the affected area a rest.

Surgery of Brachymetatarsia

If the patient’s symptoms are not adequately relieved with nonsurgical treatment, surgery is an option. Your surgeon will select the best procedure to address the brachymetatarsia, based upon the extent of the pain, the patient’s age and activity level, and other factors. Surgery may require a bone graft, cut in the shortened bone and an external fixator device to promote slow regenerate healing of the bone to the normal length of the remaining bones

Tumors of the Foot/Ankle

Tumors are caused by cells in the foot/ankle growing abnormally. They can be either benign (not cancerous) or malignant (cancerous). Tumors rarely occur in the foot/ankle. If tumors occur primarily they originate in the bone and/or soft tissue of the foot/ankle. If tumors occur secondary they originate in another part of the body and secondary lesions and/or symptoms develop in the foot/ankle.

Symptoms of Tumors of the Foot/Ankle

Pin point pain to the foot/ankle
Fracture of bone from a mild injury or normal daily activities (pathologic fracture)
Bone pain throughout the day and at night
Swelling or growth in certain areas of the foot/ankle
Pain extending to other areas of the foot/ankle from growth of the tumor

Diagnosis of Tumors of the Foot/Ankle

Bone tumors of the foot/ankle are first diagnosed with X-rays. Advanced imaging are also used to evaluate the extent of the tumor.