Achilles tendon injury is a common reason for an office visit. Tendons connect muscles to bones, the Achilles tendon connects the calf muscles to the heel bone (calcaneus). Acute and chronic injuries related to the Achilles tendon. The three common causes for pain in the back of the heel including Achilles tendonitis, Achilles paratendonitis, and Achilles rupture (tear).

Conservative treatment related to Achilles injury includes activity modification, adding a heel lift to in a shoe, anti-inflammatories, and physical therapy. Corticosteroid injection is not recommended because steroids can weaken the tendon predisposing the tendon to tear or rupture. Surgical treatment includes debriding and repairing the Achilles tendon. Achilles tendon surgery requires a 4 week period of nonweightbearing post-operatively.

Ankle and foot arthritis is a common reason for an office visit. Arthritis can be caused as a result of “wear and tear” on the joint (degenerative arthritis) or as the result of a prior injury (post-traumatic arthritis).

Conservative treatment includes shoewear modifications, anti-inflammatories, bracing, and injections.

Surgical treatment includes removing the painful joint and fusing the remaining two bones together (arthrodesis). Arthrodesis surgery requires a period of 4-6 weeks of non-weight bearing post-operatively followed by a return to weight-bearing over time in a CAM (controlled ankle motion) boot or shoe. Additionally, some patients are candidates for total ankle replacement surgery. Total Ankle Replacement surgery requires a period of 4-6 weeks of non-weight bearing post-operatively followed by a return to weight-bearing over time in a CAM (controlled ankle motion) boot or shoe. Dr. Smith can help you to determine if you are a candidate for total ankle replacement.

Ankle fractures can occur along with a wide range of patterns. Ankle fractures often involve both soft tissues (such as tendons or ligaments) as well as bone. Many fracture patterns can be treated conservatively with a period of nonweightbearing in a CAM (controlled ankle motion) boot or with a cast. Surgical treatment of ankle fractures requires a period of 4-6 weeks of nonweightbearing post-operatively.

Ankle Sprain

A bunion is often described as a painful “bump” on the side of the big toe. Bunions are caused by a deformity of the big toe joint.

Conservative treatment of bunions includes appropriate shoe wear and anti-inflammatories.

Surgical treatment of bunions involves correcting both the bone and soft tissues of the great toe joint. Bunion surgery requires a 4 week period of nonweightbearing post operatively.

A ganglion cyst is a fluid filled cyst that occurs commonly on the foot. A ganglion cyst is located over a joint or a tendon and will often get larger and smaller.

Conservative treatment of a ganglion cyst includes in-office aspiration of the cyst, however, aspiration alone often results in recurrence of the cyst.

Surgical treatment of a ganglion cyst involves removing the cyst as well as the stalk. Weight Bearing status post operatively depends on the location and depth of the cyst.

Metatarsalgia (MET-ah-tar-SAL-gee-ah) is a term used to describe pain in the ball of the foot. The pain usually centers on one or more of the five bones (metatarsals) in this area under the toes. A patient will sometimes describe a sensation of “walking on a marble” or “a stone bruise”. Metatarsalgia can be caused by hammertoe toe deformities and improper shoewear.

Conservative treatment includes shoewear modification, Hapad metatarsal cushions, and shoe inserts that take the pressure off of the wear.

If metatarsalgia is caused by a toe deformity it can be treated with surgery to correct the hammertoe.

Hammertoes and clawtoes are deformities of the small toes that can involve both the soft tissues and the joints in the toe. These deformities can be caused by a variety of things including improper shoe wear, systemic disease such as Rheumatoid arthritis, hereditary conditions and prior trauma to the toe.

Conservative treatment of hammertoes and clawtoes includes shoewear modification, taping or splinting the toe.

Surgical treatment involves correcting the deformity and placing a wire in the toe that is removed after 4 weeks. After surgery, most patients are allowed to walk immediately In a specialty post operative shoe.

A Jones fracture involves a fracture of the base of the 5th metatarsal bone This can be a difficult fracture to treat because of the lack of blood supply to this area. Jones fractures can be caused by repetitive stress to the bone or from an acute injury.

Conservative treatment includes 6 weeks of nonweightbearing in a cast or CAM (controlled ankle motion) boot, a bone stimulator, and a bone health workup.

Surgical treatment includes a period of 4 weeks of non-weight bearing post-operatively followed by a gradual return to weight-bearing in a CAM (controlled ankle motion) boot. 

Morton’s neuroma is a common cause of pain in the front of the foot between the bones of the ball of the foot that shoots into the toes. A Morton’s neuroma occurs as the result of inflammation of the interdigital nerve or a thickened tissue around the nerve. Symptoms usually include a sharp, burning sensation that most commonly affects the 2-3 or 3-4 intermetatarsal space.

Conservative treatment includes shoe wear modifications such as a shoe with a wider toe box and an injection of steroid and numbing medication around the nerve.

Surgical treatment includes removal of the neuroma. After Morton’s neuroma excision surgery the patient is usually allowed to walk right away in a specialty shoe.

The ankle joint is lined with cartilage. Cartilage provides a smooth gliding surface when the ankle joint moves. Damage to the cartilage and underlying bone is called an osteochondral lesion. Osteochondral lesions can cause painful motion and catching of the ankle joint. Large or unstable lesions are treated with surgery. After surgery, there is a 6 week period of non-weight bearing followed by a transition to weight-bearing in a CAM (controlled ankle motion) boot.

The peroneal tendons connect the muscles of the lateral lower leg to the bones of the foot. The peroneal tendons help to stabilize the outside (lateral) of the ankle and assist with pointing the ankle down (plantarflexion) and outward (eversion). The Peroneal tendons are subject to “wear and tear” and damage from repetitive trauma or from a high arched foot which causes more weight to be placed on the outer (lateral) edge of the heel.. Hereditary conditions including Charcot-Marie-Tooth is another risk factor.

Conservative treatment of peroneal tendon injuries include anti-inflammatory medication, bracing, activity modification, physical therapy and a shoe insert.

Surgical treatment involves repairing the damaged tendon and in some cases correcting the curved (varus) shape of the heel bone (calcaneus).

Some people have an extra bone in their foot called an accessory bone. An os (bone) trigonum is located posterior (behind) the ankle bone (talus). The flexor hallucis longus tendon is also located here and connects a muscle of the lower leg to the great toe bone. Patients will often describe pain when pointing the ankle or big toe down (plantarflexion). Pain in the back of the ankle is caused when the os trigonum is impinged between the ankle (talus) and a bone in the lower leg (tibia). Additionally, patients will have pain behind the ankle when the big toe is pointed because the flexor hallucis longus becomes irritated by the os trigonum.

Conservative treatment of os trigonum syndrome includes immobilization in a CAM (controlled ankle motion) boot, anti-inflammatory medication and in some instances a corticosteroid injection.

Surgical treatment of os trigonum involves removing the os trigonum. Surgical treatment requires a period of 2 weeks of non-weight bearing post operatively.

The inside (medial arch) of the foot is supported by the posterior tibialis tendon. Tendons connect muscles to bones. The posterior tibialis tendon connects the leg muscle to the navicular bone in the foot. Overtime, the Posterior Tibialis Tendon is subject to “wear and tear” and stretching which results in a foot that begins to change shape and flatten the arch over time.

Conservative treatment includes altered weight-bearing, immobilization, bracing, anti-inflammatories, heel cord stretching and shoe wear with good arch support. Surgical treatment of posterior tibialis tendon dysfunction includes either a surgery to repair and strengthen the tendon or a surgery to eliminate the side-to-side motion of the subtalar joint (subtalar arthrodesis).

Surgical treatment requires a period of 4-6 weeks of non-weight bearing followed by a gradual return to weight-bearing in a CAM (controlled ankle motion) boot and then a supportive shoe.

Rheumatoid arthritis is a chronic inflammatory autoimmune disorder.

The sesamoid bones are two small bones on the bottom (plantar surface) of the big toe joint (1st metatarsal joint). The sesamoid bones assist the tendon that flexes the big toe joint down to glide smoothly. Sesamoiditis occurs when the sesamoid bones can become inflamed causing pain. Sesamoiditis is treated conservatively with shoewear modification, dancer’s pad and activity modification.

The heel bone contains a growth center (apophysis) that fuses together. In active children, the apophysis can become inflamed, especially with repetitive stress from sports and activities. Children will present with heel pain and in some cases a limp. Sever’s Disease is self-limiting and will resolve when the apophysis fuses to the heel bone (calcaneus). Treatment of Sever’s Disease including anti-inflammatory medication, a heel cup, and weight-bearing/activity modifications.

Sinus Tarsi Syndrome occurs when the joint below the ankle becomes inflamed. The subtalar joint is located under the ankle and allows the ankle to move side to side. Pain in the sinus tarsi can also be caused by compression due to a flat foot deformity.

Conservative treatment of Sinus Tarsi Syndrome includes anti-inflammatory medication, a corticosteroid injection, and the use of shoe insert or a brace to correct the alignment of a flatfoot deformity.

A stress fracture is a fracture in a bone of the foot from repetitive loading. Stress fractures can be caused by repetitive stress on weak bones (insufficiency fracture) or from repetitive stress related to the shape of a person’s foot (fatigue fracture). A stress fracture causes pain with every step.

Conservative treatment includes weight-bearing modification while wearing a CAM (controlled ankle motion) boot or a very stiff post-operative shoe. A bone health workup is also part of the treatment plan in the setting of an insufficiency stress fracture.

The joint underneath the ankle is called the subtalar joint. The subtalar joint allows the ankle to move side to side. The joint is lined with cartilage that allows the joint to glide smoothly. Subtalar arthritis occurs when then cartilage is lost and can be caused by “wear and tear” on the joint (degenerative arthritis), prior trauma or fractures to the ankle (post-traumatic arthritis), and inflammatory conditions such as rheumatoid arthritis.

Conservative treatment includes anti-inflammatory medication, bracing, and corticosteroid injection.

Surgical treatment involves fusing the joint together. Surgery requires a 4-6 week period of non-weight bearing post-operatively and then a gradual return to weight-bearing in a CAM (controlled ankle motion) or brace.

Turf Toe is a common description used to describe an acute injury of the soft tissues of the Big Toe joint. Typically, a patient will describe “jamming” the toe against a hard surface and pain on the bottom of the big toe.

Conservative treatment includes immobilizing the joint in a very rigid shoe and anti-inflammatories.

Surgical treatment includes repairing the soft tissues and requires a period of 4 weeks non-weight bearing post-operatively.