Ankle arthritis usually presents with aching pain and stiffness. Usually a degenerative ankle joint is caused by repetitive or significant trauma. Deformities above or below the ankle can also cause arthritis. Longstanding instability has been shown to generate ankle arthritis as well. The pathology of ankle arthritis involves the loss of normal cartilage, the creation of abnormal exostoses (spurs), and frequently angular deformity. Spurs usually cause early symptoms and deformity is seen with long-standing arthritis. Achy pain is usually improved with anti-inflammatories like ibuprofen or bracing. Surgeries like ankle fusions and replacements are discussed in the “treatment” section of this website.
In the early stages of ankle degeneration symptoms are sometimes localized to specific areas. In other cases small abnormalities such as spurs, ligaments, scar tissue, or synovial tissue can get caught or impinge in the ankle mechanism. This can cause significant pain. This impingement syndrome can occur without warning but usually follows injuries. Ankle sprains and fractures are the most common causes. Occasionally loose bodies and cartilage defects can cause impingement as well. Anterior and posterior impingement syndromes have been described, and are treated commonly by our foot and ankle team.
Ankle instability is usually caused by multiple sprains and can be encouraged by specific scenarios. The improperly or insufficiently treated ankle sprain has a much higher rate of leading to instability. Additionally certain foot-shapes such as cavo-varus foot posture can predispose to instability. Patients feel uneasy about their ankle, don’t trust its strength, and have frequent sprains. Anterolateral pain is also consistent with this problem. Diagnosis is made with history, physical exam, anterior draw tests, and radiology such as X-ray and MRI.
Achilles tendonitis is classified as insertional (at the heel attachment) or midsubstance (in the tendon itself). This problem seems to be more common in athletes but occurs in most age groups and activity levels. The problem usually occurs insidiously and without an obvious cause. Patients complain of localized pain and swelling that persists permantly. Some swelling and pain can fluctuate and is probably related to pure immflamation; however, most of the symptoms are caused by degeneration of the tendon and its surrounding structures. Diagnosis is made by history and physical exam, occasionally MRI or ultrasound. Treatment options include non-surgical and surgical procedures.
BUNIONS (HALLUX VALGUS) AND HAMMERTOES
A bunion is an angular deformity that occurs between the metatarsal and the phalanx of the great toe. Inflammation of the medial eminence contributes to the deformity, however, the majority of the medial “bump” is caused by this angle change. Pain typically occurs over this bump, but can also occur at the adjacent toes and under the ball of the foot. The angular deformity of the bunion changes foot mechanics and contributes to other diagnoses such as metatarsalgia and hammertoes. As the weight bearing surface of the great toe changes , forces are abnormally redistributed to the ball of the foot and the adjacent toes. This “transfer metatarsalgia” causes painful calluses and hammertoes. Once hammer toes form pain and problems with shoeing become amplified. Hallux rigidus (great toe arthritis) also causes a prominence at the great toe joint but without the angulation. These problems are usually treated differently, but shoe modifications and orthotics may help both.
The opposite of a pes plano-valgus (flatfoot) deformity is a cavo-varus (high arch) deformity. High-arched feet are not pathologic per se, however, they predispose to a number of foot and ankle conditions. Ankle instability, ankle impingement, stress fractures, and peroneal tendonitis are all more common when cavo-varus deformities are present.
Diabetes is a complex disease that affects every body system. Diabetes causes vascular insufficiency and neuropathy both of which are particularly destructive to the feet. Sensory neuropathy increases the chance of unrecognized injury and relative ischemia prevents normal heeling. The effects of diabetes are cumulative and related to sugar control. Diabetics suffer from; plantar ulcers, infections, ischemic gangrene, foot deformities, nail disorders, and charcot arthropathy. Almost any of the above problems can lead to limb-threatening problems, especially if left untreated. Prevention is paramount. Our specialists are adept at treating all aspects of diabetic foot and ankle disorders.
The most common cause of and adult acquired flatfoot deformity is posterior tibial tendon insufficiency. This tendon is an important stabilizer of foot structure and function. Tendonitis of this tendon causes its dysfunction and subsequent pain and deformity. Patients often complain of medial hindfoot pain, swelling, and loss of stability or strength during standing and walking. This problem usually occurs around age 50-60. The pathology of this disease is poorly understood and usually occurs without warning, however, some congenital problems such as accessory navicular bones and tarsal coalitions can precipitate posterior tibial tendonitis and flatfeet.
The midfoot is a common location for degenerative arthritis. Sometimes an old injury can be linked to the problem, but frequently no cause can be identified. Swelling on the dorsal surface of the midfoot (top of the foot) associated with aching pain is the hallmark. Arch collapse is possible in severe cases. Pain is usually exacerbated by activity and may be relieved with anti-inflammatories, rest, or arch- support orthotics.
Heel pain is very common and plantar fasciitis is the most common diagnosis. This occurs in middle-aged people and usually occurs without injury. Predisposing factors include; Achilles tightness, hindfoot malposition, obesity, and diabetes. Symptoms include morning heel pain and burning medial heel pain that increases with standing. Treatment is usually non-surgical but unfortunately minimally successful. Plantar fasciitis usually lasts less than three months but severe cases can persist for years and occasionally require surgery.