Foot & Ankle Surgery in Des Moines, IA

 


1. Ankle Fracture Causes

When you stress an ankle joint beyond the strength of its elements, you injure the joint.

  • If only the ligaments give way and tear, you have sprained the ankle
  • If a bone gives way and breaks, you have an ankle fracture can occur with simultaneous tears of the ligaments. You can do this in several ways:
    • Rolling the ankle in or out
    • Twisting the ankle side to side
    • Flexing or extending the joint
    • Applying severe force to the joint by coming straight down on it as in jumping from a high level

2. How to Care for Your Diabetic Feet

1. Do not smoke. Smoking decreases the blood supply to your feet.
2. Never walk barefoot, neither indoors or out.
3. Examine your feet daily for redness, warmth, blisters, ulcers, scratches, cuts and nail problems from shoes or other sources. Look at the bottom of your feet and between the toes. Use a mirror or have someone else look for you.
4. Call your doctor immediately if you experience any injury to your foot. Even a minor injury is an emergency for a patient with diabetes.
5. Examine your shoes for foreign objects, protruding nails and rough spots inside before putting them on. Look and feel.
6. Buy shoes late in the day when your feet have the most swelling. Never buy shoes that need "breaking in." They should be immediately comfortable. Request shoes with deep toe boxes and shoes made of leather or other flexible upper material.
7. Do not wear new shoes more than two hours at a time. Rotate your shoes. Do not wear the same ones every day.
8. Never wear sandals or flip flops.
9. Lubricate your entire foot if your skin is dry, but avoid putting cream between your toes. Try Curel, Lubriderm, olive oil, vitamin E oil, lanolin or Eucerin cream.
10. Do not soak your feet. Skin can break down and won't heal well.
11. Keep feet away from heat sources (heating pads, hot water bottles, electric blankets, radiator, fireplaces). You can burn your feet without knowing it. Water temperature should be less than 92 degrees. Estimate the temperature with your elbow or bath thermometer (you can get one in any store that sells infant products).
12. Don't use any tape or sticky products such as corn plasters on your feet. They can rip your skin.
13. Do not file down, remove or shave calluses or corns yourself. These should be taken care of by your physician or someone your physician recommends.
14. Do not use any chemicals or strong antiseptic solutions on your feet. Iodine, salicylic acid, corn/callus removers and hydrogen peroxide are potentially dangerous.
15. Trim your toenails straight across, or have a medical provider do it for you.
16. Do not wear stockings or socks with tight elastic backs and do not use garters. Wear only light-colored socks and do not wear any socks with holes. Always wear socks with your shoes.
17. In the winter, wear wool socks and protective footwear. Avoid getting your feet wet in the snow and rain and avoid letting toes get cold.
18. If the circulation in your feet is impaired, tell your medical doctor so he/she can take this into account when prescribing medication for high blood pressure or heart disease.

3. What is Arthritis?

Arthritis is a broad term for a number of conditions that destroy the workings of a normal joint.

Arthritis may occur in your back, neck, hips, knees, shoulders or hands, but it also occurs in your feet and ankles. Almost half of people in their 60s and 70s have arthritis of the foot and/or ankle that may not cause symptoms.

There are many different types of arthritis. The most common type, osteoarthritis (OSS-tee-oh-ar-THRI-tiss), results from the "wear and tear" damage to joint cartilage (the soft tissue between joint bones) that comes with age. The result is inflammation, redness, swelling and pain in the joint.

Also, a sudden and traumatic injury such as a broken bone, torn ligament or moderate ankle sprain can cause the injured joint to become arthritic in the future. Sometimes a traumatic injury will result in arthritis in the injured joint even though the joint received proper medical care at the time of injury.

Another common type, rheumatoid arthritis, is an inflammatory condition caused by an irritation of the joint lining (the synovium). People with rheumatoid arthritis for at least 10 years almost always develop arthritis in some part of the foot or ankle.

Other types of inflammatory arthritis include gout, lupus, ankylosing spondylitis and psoriatic arthritis.

4. Pain Beneath the Heel

If it hurts under your heel, you may have one or more conditions that inflame the tissues on the bottom of your foot:

Stone bruise: When you step on a hard object such as a rock or stone, you can bruise the fat pad on the underside of your heel. It may or may not look discolored. The pain goes away gradually with rest.

Plantar fasciitis (subcalcaneal pain): Doing too much running or jumping can inflame the tissue band (fascia) connecting the heel bone to the base of the toes. The pain is centered under your heel and may be mild at first but flares up when you take your first steps after resting overnight. You may need to do special exercises, take medication to reduce swelling and wear a heel pad in your shoe.

Heel spur: When plantar fasciitis continues for a long time, a heel spur (calcium deposit) may form where the fascia tissue band connects to your heel bone. Your doctor may take an X-ray to see the bony protrusion. Treatment is usually the same as for plantar fasciitis: rest until the pain subsides, do special stretching exercises and wear heel pad shoe inserts. Having a heel spur may not cause pain and should not be operated on unless symptoms become chronic.

5. Pain Behind the Heel

If you have pain behind your heel, you may have inflamed the area where the Achilles tendon inserts into the heel bone (retrocalcaneal bursitis). People often get this by running too much or wearing shoes that rub or cut into the back of the heel. Pain behind the heel may build slowly over time, causing the skin to thicken, become red and swell.

You might develop a bump on the back of your heel that feels tender and warm to the touch. The pain might flare up when you first start an activity after resting. It often hurts too much to wear normal shoes. You may need an X-ray to see if you also have a bone spur.

Treatment includes resting from the activities that caused the problem, doing certain stretching exercises, using pain medication and wearing open-back shoes.
• Your doctor may want you to use a 3/8" or 1/2" heel insert.
• Stretch your Achilles tendon by leaning forward against a wall with your foot flat on the floor and heel elevated with the insert.
• Use nonsteroidal anti-inflammatory medications for pain and swelling.
• Consider placing ice on the back of the heel to reduce inflammation.

6. Arch Pain Treatment

Stretching is the best treatment for plantar fasciitis. It may help to try to keep weight off your foot until the initial inflammation goes away. You can also apply ice to the sore area for 20 minutes three or four times a day to relieve your symptoms. Often a doctor will prescribe a non-steroidal anti-inflammatory medication such as ibuprofen or naproxen. Home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treatment and reduce the chance of recurrence.

In one exercise, you lean forward against a wall with one knee straight and heel on the ground. Your other knee is bent. Your heel cord and foot arch stretch as you lean. Hold for 10 seconds, relax and straighten up. Repeat 20 times for each sore heel. It is important to keep the knee fully extended on the side being stretched.

In another exercise, you lean forward onto a countertop, spreading your feet apart with one foot in front of the other. Flex your knees and squat down, keeping your heels on the ground as long as possible. Your heel cords and foot arches will stretch as the heels come up in the stretch.
Hold for 10 seconds, relax and straighten up. Repeat 20 times.

About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with an off-the-shelf shoe insert device like a rubber heel pad. Your foot may be taped into a specific position.

If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medication.

If you still have symptoms, you may need to wear a walking cast for two to three weeks or a positional splint when you sleep. In a few cases, surgery is needed for chronically contracted tissue.

Plantar Fascia-Specific Stretching Program
1. Cross your affected leg over your other leg.
2. Using the hand on your affected side, take hold of your affected foot and pull your toes back towards shin. This creates tension/stretch in the arch of the foot/plantar fascia.
3. Check for the appropriate stretch position by gently rubbing the thumb of your unaffected side left to right over the arch of the affected foot. The plantar fascia should feel firm, like a guitar string.
4. Hold the stretch for a count of 10. A set is 10 repetitions.

Perform at least three sets of stretches per day. You cannot perform the stretch too often. The most important times to stretch are before taking the first step in the morning and before standing after a period of prolonged sitting.

7. Anti-inflammatory Medication

Anti-inflammatory medications can help decrease the inflammation in the arch and heel of your foot. These medications include Advil®, Motrin®, Ibuprofen, and Aleve®.
1. Use the medication as directed on the package. If you tolerate it well, take it daily for two weeks then discontinue for one week. If symptoms worsen or return, resume for two weeks, then stop.
2. You should eat when taking these medications, as they can be hard on your stomach.

Arch Support
1. Over the counter inserts (Spenco® Cross Trainers®) provide added arch support and soft cushion.
2. Based on the individual needs of your foot, you may require custom inserts.

Additional Stretch: Achilles Tendon Stretch
1. Place a shoe insert under your affected foot.
2. Place your affected leg behind your unaffected leg with the toes of your back foot pointed towards the heel of your other foot.
3. Lean into the wall.
4. Bend your front knee while keeping your back leg straight with your heel firmly on the ground.
5. Hold the stretch for a count of 10. A set is 10 repetitions.
6. Perform the stretch at least three times a day.