Treatments

The tibia (shin bone) and the fibula are the bones of the lower leg. Pilon fractures are injuries that occur at the lower end of the tibia and involve the weightbearing surface of the ankle joint. The fibula also may be broken. These injuries were first described more than 100 years ago and remain one of the most challenging problems for orthopaedic surgeons to treat. Common causes of pilon fractures are falls from a height and car accidents. 

The goals of pilon fracture surgery are to restore alignment and stability and allow healing of the tibia and fibula at the ankle joint. Once the fractures are healed, your foot and ankle orthopaedic surgeon's goals are to restore movement and strength at the patient’s ankle. 

The plantar fascia (PF) is a thick band of tissue that connects your heel bone to your toes. It helps support the overall shape of your foot, especially when standing, and helps with shock absorption. Irritation and scarring of the plantar fascia, known as plantar fasciitis, is one of the most common causes of heel pain.

Ten percent of people have pain in the bottom of the heel at some point in their life. The most common cause is plantar fasciitis, which can result from overactivity, improper shoes, flat feet or excessive weight on the feet.

The plantar fascia is a thick band of tissue that connects your heel bone to your toes. It helps support the overall shape of your foot, especially when standing. Irritation and scarring of the plantar fascia, known as plantar fasciitis, is one of the most common causes of heel pain.

Often there is no one event that triggers heel pain. It generally develops over time and can become extremely painful, especially with the first few steps in the morning. It is more common in women, those who walk a lot and people who are overweight. Risk factors include your natural foot shape (flat or high arch), your activities (walking, running) and improper shoes.

Posterior ankle endoscopy/arthroscopy is a technique used to look at and treat problems in the back of the ankle. 

First, it’s important to understand ankle anatomy. The ankle joint is the joint between the lower leg bones (tibia and fibula) and the ankle bone (talus). The joint below the ankle joint is called the subtalar joint; it lies between the ankle bone and the heel bone (calcaneus). The talus has a bony prominence in the back next to the flexor hallucis longus (FHL) tendon. This is the tendon that moves the big toe downward toward the floor.

The bony posterior prominence might be the cause of ankle pain in some people if it is large (called a trigonal process) or it is not completely fused with the talar bone (called an os trigonum).

The flexor digitorum longus (FDL) is one of the tendons responsible for bending the toes down to the floor. The goals of a FDL tendon transfer surgery are to relieve pain and to help restore the arch in patients with painful fallen arches. A fallen arch occurs when the foot loses its support and flattens out, generally due to weakening of tendons and ligaments in the foot.

Bone grafts may be needed for various orthopaedic surgeries of the foot and ankle. Bone grafts provide bony support and/or fill in areas where bone is missing. Bone grafts are either taken from the patient (autograft), or taken from a bone donor (allograft). The best bone graft provides enough bone and healing with minimal problems for the patient.

Proximal tibial bone graft (PTBG) is a type of autograft. The proximal tibia is the upper portion of the leg or shin bone that is just below the knee joint. Getting bone graft from this body part usually is less painful than from other areas like the pelvis.

Regional anesthesia makes a specific body part numb so that surgery can be performed. The goals are to make the foot and ankle numb during surgery and relieve pain after surgery. This helps patients need less medicine during and after surgery. 

Regional anesthesia may be considered for almost any surgery of the foot and ankle. It is not allowed in patients with certain medical conditions like blood clotting problems or active infections. Some surgeons prefer their patients not have this type of anesthesia. 

Many foot and ankle procedures require insertion of metal plates, screws, rods or similar implants for stabilization of the bones while they heal. There are a number of reasons why a foot and ankle orthopaedic surgeon will chose to remove this hardware. Hardware can be removed if it is painful, associated with an infection, or if your bone didn’t heal as hoped, which may require new hardware to be placed.

The goal of the procedure is to safely remove the hardware without causing damage to the surrounding soft tissues. These tissues often are scarred from previous surgery. Nerves and blood vessels and other soft tissue structures in this area may be at greater risk than at the time of the original surgery. A larger incision than the original surgical incision may be required to safely remove the hardware.

The metatarsals are the long bones in the foot that connect the toes to the midfoot. The metatarsals are numbered one through five, starting with the big toe. So the second metatarsal is the long bone of the second toe.

A second metatarsal shortening osteotomy is a procedure that cuts and shortens the second metatarsal. The goal of shortening the metatarsal is to decrease pain at the base of the second toe (in the ball of the foot) and/or help straighten out the second toe. 

The subtalar joint is located just below the ankle joint between the talus and the calcaneus (heel bone). The main job of the subtalar joint is to allow for side-to-side movement of the foot and ankle. This movement aids in walking, especially on uneven surfaces.

When there is a problem in the subtalar joint, the location of pain is described as being deep. The exact location may be hard to describe. Pain may be felt in the soft spot on the outside of the ankle or in a horseshoe distribution behind and below the ankle.