Ankle Fracture: 

. A broken ankle can involve one or more of the bones, as well as injury to the surrounding connecting tissues or ligaments. There are a wide variety of causes for broken ankles, most commonly a fall, an automobile accident, or sports-related trauma. Because a severe sprain can often mask the symptoms of a broken ankle, every ankle injury should be examined by a physician. 

What Is an Ankle Fracture? 

According to the American Academy ofOrthopaedicSurgeons, doctors have noticed an

increase in the number and severity of broken ankles since the 1970s, due, in part, to the

Baby Boomer generation being active throughout every stage of their lives. 

A fracture is a partial or complete break in a bone. Fractures in the ankle can range from

the less serious avulsion injuries (small pieces of bone that have been pulled off) to

severe shattering-type breaks of the tibia, fibula, or both. 

Ankle fractures are common injuries that are most often caused by the ankle rolling

inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they

are quite different and therefore require an accurate and early diagnosis. They

sometimes occur simultaneously. A person may still be able to walk or put weight on

their foot.  If you put weight or walk on a fractured or broken ankle, it is possible to

cause more damage or fracture the bone(s) further. 

Symptoms 

An ankle fracture is accompanied by one or all of these symptoms: 

• Pain at the site of the fracture, which in some cases can extend from the foot to the knee. No pain does not mean it isn’t a fracture.  

• Significant swelling, which may occur along the length of the leg or may be more localized. 

• Blisters may occur over the fracture site. These should be promptly treated by a foot and ankle surgeon. 

• Bruising that develops soon after the injury 

• Inability to walk—however, it is possible to walk with less severe breaks, so never rely on walking as a test of whether a bone has been fractured 

• Change in the appearance of the ankle – it will look different from the other ankle 

• Bone protruding through the skin—a sign of an emergency. Fractures that pierce the skin require immediate attention because they can lead to severe infection and prolonged recovery. 

Diagnosis 

Following an ankle injury it is important to have the ankle evaluated by a foot and ankle surgeon for proper diagnosis and treatment. If you are unable to do so right away, go to the emergency room and then follow up with a foot and ankle surgeon as soon as possible for a more thorough assessment. 

The affected limb will be examined by the foot and ankle surgeon by touching specific areas to evaluate the injury. In addition, the surgeon may order x-rays and other imaging studies, as necessary. 

Non-Surgical Treatment 

Treatment of ankle fractures depends upon the type and severity of the injury. At first, the foot and ankle surgeon will want you to follow the R.I.C.E. protocol: 

• Rest: Stay off the injured ankle. Walking may cause further injury. 

• Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again. 

• Compression: An elastic wrap should be used to control swelling. 

• Elevation: The ankle should be raised slightly above the level of your heart to reduce swelling. 

Additional treatment: 

The treatment for a broken ankle usually involves a leg cast or brace if the fracture is stable. If the ligaments are also torn, or if the fracture created a loose fragment of bone that could irritate the joint, surgery may be required to secure the bones in place so they will heal properly or repair soft tissue injuries, if present. The foot and ankle surgeon will select the procedure that is appropriate for your injury. 

Follow-up Care 

It is important to follow your surgeon’s instructions after treatment. Failure to do so can lead to infection, deformity, arthritis, and chronic pain. 

Foot Fracture: There are two types of foot fractures: stress fractures and general bone fractures. Stress fractures usually occur in the bones of the forefoot extending from the toes to the middle of the foot. Stress fractures are like tiny cracks in the bone surface. They can happen with sudden increases in exercise (such as running or walking for longer distances or times), improper training techniques, or a change in surfaces. 

Stress Fractures: Incomplete cracks in bone caused by overuse. With complete rest, stress fractures in toes or any bones of the foot heal quickly. Extra padding in shoes can help prevent the condition. Left untreated, stress fractures may become complete bone fractures, which require casting and immobilization. 

General Bone Fracture: Most other types of fractures extend through the bone, and are called bone fractures. They may be stable, in which there is no shift in bone alignment, or displaced, in which the bone ends no longer line up properly. Bone fractures usually result from trauma, such as dropping a heavy object on your foot, or from a twisting injury. If the fractured bone does not break through the skin, it is called a closed fracture. If the fracture does break through the skin, it is called an open fracture. 

Foot Fracture: Nearly one-fourth of all the bones in your body are in your feet. A broken (fractured) bone in your forefoot or in one of your toes is often painful, but rarely disabling. Most of the time, these injuries heal without operative treatment. 

Most other types of fractures extend through the bone, and are called bone fractures. They may be stable, in which there is no shift in bone alignment, or displaced, in which the bone ends no longer line up properly. Bone fractures usually result from trauma, such as dropping a heavy object on your foot, or from a twisting injury. If the fractured bone does not break through the skin, it is called a closed fracture. If the fracture does break through the skin, it is called an open fracture. 

Because of the complex structures in the foot, there are some other, more specific types of fractures that can occur. For example, the fifth metatarsal, known as the little or pinky toe, is susceptible to a variety of different fractures. The relationship between the ankle and the foot can be compromised by an ankle-twisting injury, which may tear the tendon that attaches to this bone and pull a small piece of the bone away. A more serious injury in the same area is known as a Jones fracture, which occurs near the base of the bone and disrupts its blood supply. This injury may take longer to heal or require surgery. 

Common symptoms for any type of foot fracture includes pain, swelling, and sometimes bruising. Be sure to seek medical attention for any suspected foot fracture. 

Sports related Injuries:

Ankle Sprains, Achilles tendon disorders, heel pain, Morton’s Neuroma, Turf Toe, Stress fractures 

From the repeated pounding that runners’ feet receive on paved surfaces to the side-to-side motion seen in court sports, there’s no question that athletes’ feet and ankles are prime candidates for injuries.  

Ankle sprains – These are one of the most common sports injuries. Prompt evaluation and treatment by a foot and ankle surgeon is important… sometimes that “sprain” is actually an ankle fracture and treatment for these two conditions are very different. And don’t skimp on rehab! An ankle that has not been properly healed and strengthened is more likely to suffer repeated sprains, leading to chronic ankle instability. 

Achilles tendon disorders – Athletes are at high risk for developing disorders of the Achilles tendon. Achilles tendonitis, an inflammation of the tendon that runs down the back of the lower leg, can progress into a degeneration of the tendon (Achillestendonosis). A sudden increase of a repetitive activity, leading to micro-injury of the tendon fibers, can cause these conditions. 

Heel pain – This condition is most often caused by plantar fasciitis, although it may also be due to other causes including stress fractures. Although faulty foot structure is the most common cause of plantar fasciitis, it can also result from wearing shoes that are worn out or not designed for the sport in which you’re participating. Keeping the Achilles tendon stretched can help get rid of this pain, but continued pain should be checked out to rule out a fracture or other cause. 

Morton’s neuroma – Also called “intermetatarsalneuroma,” this is a thickening of nerve tissue in the ball of the foot resulting from compression and irritation of the nerve. Causes include activities that involve repetitive irritation to the ball of the foot, such as running or court sports. Symptoms start gradually and may come and go when the nerve is irritated due to activity. But it’s important to have it treated early on before the damage becomes more severe. 

Plantar Warts: 

Most foot warts are harmless, even though they may be painful. They are often mistaken for corns or calluses, which are layers of dead skin that build up to protect an area which is being continuously irritated. A wart, however, is caused by a viral infection which invades the skin through small or invisible cuts and abrasions. Foot warts are generally raised and fleshy and can appear anywhere on the foot or toes. Occasionally, warts can spontaneously disappear after a short time, and then, just as frequently, they recur in the same location. If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of warts. Children, especially teenagers, tend to be more susceptible to warts than adults.  

Plantar warts, also known asverrucas, appear on the soles of the feet and are

one of several soft tissue conditions that can be quite painful. Unlike other foot

warts, plantar warts tend to be hard and flat, with a rough surface and well-

defined boundaries. They are often gray or brown (but the color may vary),

with a center that appears as one or more pinpoints of black. Plantar warts

are often contracted by walking barefoot on dirty surfaces or littered ground.

The virus that causes plantar warts thrives in warm, moist environments, making

infection a common occurrence in public pools and locker rooms.  

Like any other infectious lesion, plantar warts are spread by touching, scratching,

or even by contact with skin shed from another wart. The wart may also bleed,

another route for spreading. Plantar warts that develop on the weight-bearing

areas of the foot (the ball or heel of the foot) can cause a sharp, burning pain.

Pain occurs when weight is brought to bear directly on the wart, although pressure

on the side of a wart can create equally intense pain. 

To prevent the spread of warts, follow these tips: 

• Avoid direct contact with warts, both from other persons or from other parts of the body. 

• Avoid walking barefoot, except on sandy beaches. 

• Change your shoes and socks daily. 

• Check your children's feet periodically. 

• Keep your feet clean and dry. 

It is important to note that warts can be very resistant to treatment and have a tendency to recur. Over-the-counter foot wart treatments are usually ineffective because their use can inadvertently destroy surrounding healthy tissue. Please contact our office for help in effectively treating warts. Our practice is expert in recommending the best treatment for each patient, ranging from prescription ointments or medications to, in the most severe cases, laser cautery. 

What is a Plantar Wart? 

A wart is a small growth on the skin that develops when the skin is infected by a virus. Warts can develop anywhere on the foot, but typically they appear on the bottom (plantar side) of the foot. Plantar warts most commonly occur in children, adolescents, and the elderly. 

There are two types of plantar warts: 

• A solitary wart is a single wart. It often increases in size and may eventually multiply, forming additional “satellite” warts. 

• Mosaic warts are a cluster of several small warts growing closely together in one area. Mosaic warts are more difficult to treat than solitary warts. 

Causes 

Plantar warts are caused by direct contact with the human papilloma virus (HPV). This is the same virus that causes warts on other areas of the body. 

Symptoms 

The symptoms of a plantar wart may include: 

• Thickened skin. Often a plantar wart resembles a callus because of its tough, thick tissue. 

• Pain. Walking and standing may be painful. Squeezing the sides of the wart may also cause pain. 

• Tiny black dots. These often appear on the surface of the wart. The dots are actually dried blood contained in the capillaries (tiny blood vessels). 

Plantar warts grow deep into the skin. Usually this growth occurs slowly, with the wart starting small and becoming larger over time. 

Diagnosis and Treatment 

To diagnose a plantar wart, the foot and ankle surgeon will examine the patient’s foot and look for signs and symptoms of a wart. 

Although plantar warts may eventually clear up on their own, most patients desire faster relief. The goal of treatment is to completely remove the wart. 

The foot and ankle surgeon may use topical or oral treatments, laser therapy, cryotherapy (freezing), acid treatments, or surgery to remove the wart. 

Regardless of the treatment approaches undertaken, it is important that the patient follow the surgeon’s instructions, including all home care and medication that has been prescribed, as well as follow-up visits with the surgeon. Warts may return, requiring further treatment. 

If there is no response to treatment, further diagnostic evaluation may be necessary. In such cases, the surgeon can perform a biopsy to rule out other potential causes for the growth. 

Although there are many folk remedies for warts, patients should be aware that these remain unproven and may be dangerous. Patients should never try to remove warts themselves. This can do more harm than good. 

Osteoarthritis of the Foot and Ankle 

What Is Osteoarthritis? 

Osteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. Cartilage (the connective tissue found at the end of the bones in the joints) protects and cushions the bones during movement. When cartilage deteriorates or is lost, symptoms develop that can restrict one’s ability to easily perform daily activities. 

• Osteoarthritis is also known as degenerative arthritis, which may develop as part of the aging process.. 

• Osteoarthritis appears in the foot, most frequently, in the big toe, although it is also often found in themidfootand ankle. 

Causes 

• Repeated stress and use of the affected joint over time. As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually may rub together, causing pain and inflammation of the joint. 

• A previous fracture or soft tissue injury around the joint 

• Abnormal foot mechanics such as flat feet or high arches.  

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

Symptoms 

People with osteoarthritis in the foot or ankle experience, in varying degrees,

one or more of the following: 

• Pain and stiffness in the joint 

• Swelling in or near the joint 

• Difficulty walking or bending the joint 

• New unwanted bone growth from shoe pressure. Can result in calluses,

         corns or blisters. Bone spurs can also limit the movement of the joint. 

Diagnosis 

In diagnosing osteoarthritis, the foot and ankle surgeon will examine the foot thoroughly, looking for swelling in the joint, limited mobility, and pain with movement. In some cases, deformity and/or enlargement (spur) of the joint may be noted. X-rays may be ordered to evaluate the extent of the disease. 

Non-surgical Treatment 

• To help relieve symptoms, the surgeon may begin treating osteoarthritis with one or more of the following non-surgical approaches: 

• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the inflammation and pain. Occasionally a prescription for a steroid medication is needed to adequately reduce symptoms. 

• Orthotic devices. Custom orthotic devices (shoe inserts) are often prescribed to provide support to improve the foot’s mechanics or cushioning to help minimize pain. 

• Bracing. Bracing, which restricts motion and supports the joint, can reduce pain during walking and help prevent further deformity. 

• Immobilization. Protecting the foot from movement by wearing a cast or removable cast-boot may be necessary to allow the inflammation to resolve. 

• Steroid injections. In some cases, steroid injections are applied to the affected joint to deliver anti-inflammatory medication. 

• Physical therapy. Exercises to strengthen the muscles, especially when the osteoarthritis occurs in the ankle, may give the patient greater stability and help avoid injury that might worsen the condition. 

Surgical Treatment: 

When osteoarthritis has progressed substantially or failed to improve with non-surgical treatment, surgery may be recommended. In advanced cases, surgery may be the only option. The goal of surgery is to decrease pain and improve function. The foot and ankle surgeon will consider a number of factors when selecting the procedure best suited to the patient’s condition and lifestyle. 

Gout: 

What Is Gout? 

Gout is a disorder that results from the build-up of uric acid in the tissues or a joint.

It most often affects the joint of the big toe. 

Causes 

Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is

present in the blood and eliminated in the urine, but in people who have gout, uric

acid accumulates and crystallizes in the joints. Uric acid is the result of the break-

down of purines, chemicals that are found naturally in our bodies and in food. Some

people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid. 

Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since the toe is the part of the body that is farthest from the heart, it’s also the coolest part of the body – and, thus, the most likely target of gout. However, gout can affect any joint in the body. 

The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. For example, the body’s ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medications (“water pills”), and the vitamin niacin (also called nicotinic acid). While gout is more common in men aged 40 to 60 years, it can occur in younger men as well as in women. 

Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat. 

Symptoms 

An attack of gout can be miserable, marked by the following symptoms: 

• Intense pain that comes on suddenly – often in the middle of the night or upon

         arising 

• Signs of inflammation such as redness, swelling, and warmth over the joint.