Foot & Ankle
Diagnosis, Treatment & Rehabilitation
Orthopaedic Associates of Central Maryland’s board-certified, fellowship-trained orthopaedic surgeons have extensive training in the diagnosis, treatment, and prevention of foot and ankle disorders, as well as state-of-the-art surgical techniques.
Foot and Ankle Care
Our on-site diagnostic imaging services and ambulatory surgical center allow us to promptly evaluate and treat foot and ankle injuries. We provide complete foot care for people with diabetes and participate in the diabetic shoe program.
CONDITIONS WE TREAT
The Achilles tendon is a large, strong fibrous cord that connects the calf muscles in the back of the leg to the back of the heel bone (calcaneus). You rely on it virtually every time you move your foot. If the Achilles tendon is torn, you may be unable to walk, jump, stand on your toes, and climb stairs.
Many Achilles tendon tears occur during sports or as a result of weakening over time due to tendonitis. If you rupture your Achilles tendon, you may hear a loud pop or feel a sudden painful snap in the back of your calf or lower leg, followed by sharp, severe pain.
The condition may be treated with or without surgery. If you lead an active lifestyle and want to return to strenuous recreational activities, your physician will likely recommend surgery to reattach the torn Achilles tendon.
Osteoarthritis is a degenerative joint disease that typically occurs as you age, although it can also develop after some kind of trauma, such as a fracture or dislocation.
There are more than 30 joints in the foot and ankle. As weight-bearing structures, these joints are highly susceptible to osteoarthritis. The ones most commonly affected include the joints of the ankle, midfoot, and big toe. As the cartilage that lines these joints begins to wear away, the bones begin to rub against each other, causing pain and stiffness. Walking becomes more difficult as the condition progresses.
Bunions are a common foot deformity, especially in females. They most frequently result from wearing shoes that are too small, narrow, pointed, or have a high heel. Abnormal pressure from poorly fitting shoes causes the bones in the big toe and foot to move out of position. This results in a large, painful bump on the side of the foot at the big toe. Bunions can also run in families.
If nonsurgical treatments fail, surgery may be necessary to restore normal alignment, pain-free movement, and function. Bunion surgery is used to realign the bones, joints, tendons, ligaments, and nerves. The toes are placed in their correct positions and the bony bump is removed. There are numerous surgical techniques for treating bunions. Your doctor will discuss the most appropriate options for you.
Acquired flatfoot, or posterior tibial tendon dysfunction, results when the tendon at the back of the ankle is inflamed or torn. Sports injury and overuse can contribute to posterior tibial tendon dysfunction. Certain medical conditions, such as obesity, hypertension, diabetes, and arthritis increase the risk of the condition.
Acquired flatfoot is a progressive condition that can eventually lead to a fallen arch or flatfoot. Advanced cases, or those that do not respond to nonsurgical treatments, may require surgery. There are various surgical procedures for posterior tibial tendon dysfunction, and it is common to need more than one.
Your forefoot, which contains five long metatarsal bones, acts as a springboard with each step you take, and a cushion when your foot touches the ground. The metatarsal bones help distribute your body weight and maintain balance when you walk or stand. Jumping, twisting, dancing, and running add even more force to the forefoot, making the bones vulnerable to fracture from trauma and overuse. The majority of metatarsal fractures heal with nonsurgical treatment. Fractures that require surgery have highly successful outcomes.
In all, there are 28 bones in the foot, including the ankle and heel (hindfoot), midfoot, and forefoot, which includes the toes. All are susceptible to fractures from various accidents such as a car crash, fall from a significant height, twisting the foot during sports, or dropping something heavy on the foot or toes.
Your heels bear tons of pressure each day when you stand and walk. It’s no wonder that heel pain is a common complaint. Heel pain occurs for various reasons. Common causes of pain beneath the heel include bruising from stepping on something hard, inflamed connective tissue from overuse (plantar fasciitis), and irritated nerves under the heel. Rubbing from poorly fitted shoes, inflamed connective tissue (bursitis), or an inflamed tendon (Achilles tendon) most frequently cause pain behind the heel.
In many cases, rest, physical therapy, pain relievers, injections, proper shoes, and orthotics can relieve symptoms. Surgery may be used to relieve pressure from a nerve, remove an abnormal bone growth, or treat an inflamed tendon.
Heel spurs are abnormal bony growths that develop at the back of or under the heel. Inflammation around a spur, more so than the spur itself, can cause significant pain.
Heel spurs develop in some people that have a condition called plantar fasciitis, or inflammation of the plantar fascia. Heel spurs form when the plantar fascia separates from the calcaneus (heel bone). A hook-like spur forms from calcium deposits that grow at the site of inflammation.
Heel spurs are more common in middle-aged adults and those who have had plantar fasciitis for a long time. People with flat feet or high arches are also vulnerable to heel spurs, as are women who wear high-heeled shoes. Fortunately, symptoms can be eased with nonsurgical treatments for the vast majority of people.
Plantar fasciitis is a painful foot condition. It occurs when connective tissue at the bottom of the foot, called the plantar fascia, is irritated and inflamed. The plantar fascia extends from the heel to the ball of the foot and maintains the arch of the foot.
Plantar fasciitis is caused by structural problems in the foot, such as flat feet or high arches. Sudden weight gain, obesity, and prolonged standing or walking on hard surfaces contributes to the condition. Heel pain that occurs in the morning upon awakening is a hallmark sign of plantar fasciitis. Fortunately, for the majority of people, symptoms are relieved without surgery.
Your lower leg contains two bones: the larger bone is the tibia (shinbone), and the thinner bone is the fibula. Shin splints is a term to describe pain at the front or lower inside edge of the tibia. The pain occurs when the edge of the tibialis muscles pull away from the bone from repeated stress or overuse, which causes the muscles and the covering of the bone (periosteum) to become inflamed.
Shin splints commonly occur in athletes who play sports that involve a lot of running and jumping and require quick starts and stops, such as basketball or tennis. The pain is most frequently caused by muscle overuse, improper form when exercising, or wearing the wrong type of athletic shoes.
Most cases of shin splints resolve with rest. In rare cases, surgery may be necessary to treat complications from shin splints.
Toe deformities commonly develop because of structural changes that take place over time in the muscles and tendons that bend the toes. People with certain medical conditions, such as diabetes, osteoarthritis, and rheumatoid arthritis, are at risk for developing toe deformities. For some people, the condition can be inherited. Other causes include trauma and wearing shoes that are too tight, too narrow, or have high heels.
Hammertoe is the most common toe deformity. Most often it affects the second toe on the foot, next to the big toe. It causes the middle joint of the toe to bend, leading to curling of the toe resembling a hammer. It is important to diagnose and treat hammertoe early because the condition tends to become worse over time. If left untreated, hammertoe can require surgery. Other toe deformities include claw toe and mallet toe.
If you have torn your Achilles tendon and want to return to sports or strenuous recreational activities, then your orthopaedic surgeon will most likely recommend surgery to reattach the torn Achilles tendon. Surgery is generally very effective and the risk of complications is typically low. The surgery will require anesthesia, but can be performed on an outpatient basis.
The surgeon makes a 3- to 4-inch opening behind the ankle, reattaches the tendon ends to each other or to the bone, and places the foot in a pointed position in a splint or short leg cast. You will wear the splint or cast for 4-6 weeks and participate in physical therapy when the healing is complete.
Most people who undergo surgical repair can return to walking and swimming at 6 weeks, and gradually return to sports several months after the surgery. They have a lower risk of repeated tendon rupture and a better chance of regaining full strength in the leg.
People who have diabetes with uncontrolled blood glucose frequently experience foot problems. High levels of blood glucose over long periods of time can lead to nerve damage (peripheral neuropathy) and poor blood circulation (peripheral vascular disease). Either of these can cause foot complications such as infections, ulcers or sores, and toe deformities.
With diabetes, minor skin problems on the feet can quickly worsen. If left untreated, these problems may lead to hospitalization and possibly amputation of the foot or leg. That’s why it’s so important to have regular visits with a podiatrist if you have diabetes. At Orthopaedic Associates of Central Maryland, podiatrist Dr. Marc Lipton wants to prevent these serious complications and keep your feet as healthy as possible.
Toes affected by a deformity may be painful or irritated, especially when you wear shoes. Corns and calluses may develop on the toes or bottom of the foot. Surgery is used when other types of treatment fail to relieve symptoms or for advanced cases of hammertoe.
There are several types of surgeries to treat hammertoe. A small piece of bone may be removed from the joint (via arthroplasty). The toe joint may be fused to straighten it (via arthrodesis). Surgical hardware, such as a pin, may be used to hold the bones in place while they heal. Other types of surgery involve removing skin (wedging) or correcting muscles and tendons to balance the joint.