The foot is often overlooked in its importance and complexity, but that can all become too clear when acute or chronic pain makes simply walking a burden and any distance a challenge. At Sauk Prairie Healthcare, our Orthopedic surgeons can find the source of your foot and ankle pain and provide the foot surgery you need for better movement and long-term pain relief.

Foot Anatomy

The foot is generally split into three parts: the forefoot, the midfoot and the hindfoot. The three parts are composed of a network of soft tissue connecting the bones to each other and the calf muscles. The network of vessels and nerves within the foot are not only critical in their own right, but can also be symptomatic of greater health issues throughout the body. 

This makes foot health not only an issue of underappreciated importance, but also of often underestimated complexity. 

Common Foot Conditions

Foot Fracture

Breaking one of the 26 bones in the foot is a common injury and usually heals relatively easily with wrap, a splint or a boot, but there are conditions in which a foot fracture may require surgical repair. 

If parts of a bone are displaced during a fracture, an Orthopedic surgeon may need to reset the damaged parts of the foot so they can heal properly, often securing the bones with pins or a metal plate. A doctor may also recommend surgery if the bones in the foot are not displaced, but appear to be at risk of instability or blood loss during the recovery process. 

A fracture of the fifth metatarsal, the mid-foot bone on the outside of the foot, often requires surgical repair either to ensure secure union of the broken bone, or to speed the healing process. These injuries are at times referred to as a Jones fracture, although the term can be imprecise, with doctors sometimes using the same term to describe similar, but different injuries. 

Although a Jones fracture may look bad at first, often the foot is able to heal over time. 

Metatarsal fractures are described in part based upon the location of the fracture and how close the fracture is to the cuboid at the base of the foot, between the metatarsals and the ankle. Zone 1 injuries are closest to the cuboid, while Zone 2 injuries slightly farther, and Zone 3 further into the metatarsal bone. 

Fractures in Zones 2 and 3 more often require surgery. Zone 3 injuries are frequently caused by a stress fracture, common among runners and people who walk on the sides of their feet. Between about 15% and 30% of Zone 2 and Zone 3 fractures go on to be non-union fractures. Treatment of these kinds of fractures by orthopedic surgeons have also become more common. Previously, a surgical approach was largely reserved for elite athletes who needed to heal quickly. Now, surgical metatarsal repair is more commonly requested by ordinary patients who wish to get back to work wearing a supportive boot, allowing mobility during recovery. 

A stress fracture in the foot is often secured by an Orthopedic surgeon with one pin or screw inserted to hold the sections of the broken bone in alignment. 

For many, the recovery process is comparatively short with complete recovery within about four months. 

Bunion

Bunions are a common chronic foot condition in which an inherited defect in the mechanics of the foot results in the misalignment of the great toe. The bunion develops over time, with a bump swelling on the outside of the foot and the toe gradually turning inward. 

Symptoms of a bunion include: 

  • A bump on the outside of the big toe
  • Swelling, redness and soreness around the joint at the base of the toe
  • Corns and calluses developing where the toes begin to overlap
  • Sporadic or persistent pain
  • Restricted movement of the toe 

Use of cushioning foot pads, insoles and comfortable footwear can reduce bunion pain, though they cannot stop development of the condition. If a bunion results in persistent pain and begins to interfere with quality of life even after non-surgical treatment options have been attempted, an Orthopedic surgeon may be able to provide long-term relief. 

Several surgical procedures have been developed to correct bunions such as tightening or loosening the tendons surrounding the affected toe. A surgeon may cut away portions of the bone in order to realign the toe or fix the joint in place with a bone fusion. 

Although bunion surgery is relatively common it is not recommended for cosmetic purposes or as a preventative measure, but as treatment for significant day-to-day pain and loss of mobility. Recovery time depends upon how extensive surgery may be, ranging from three to four weeks following simpler procedures, and between six and 12 weeks for more complicated surgery.  

Hammertoe

Hammertoe is a condition in which the second, third and fourth toes bend toward the bottom of the foot, which can cause chronic pain, but is also often preventable. 

The condition can be caused by a number of intersecting factors including arthritis, diabetes, neuromuscular disorders and posture issues. In determining treatment, your surgeon may start by determining whether the condition is a form of flexible hammertoe or fixed hammertoe. 

In the case of flexible hammertoe, the issue can often be corrected with a soft tissue procedure such as a tendon transfer. Options for correcting fixed hammertoe include joint removal and joint fusion, in which after loosening of the surrounding tissue, the two parts of the joint are fixed together with pins or screws, allowing the toe to heal as a single bone. 

Due to the number of factors involved in hammertoe conditions, surgeons and patients need to be aware of potential complications of surgery such as non-union of a joint after surgery, infection and vascular compromise, in which blood flow to the area can been interrupted.  

Hammertoe treatments make up roughly half of all forefoot procedures done by Orthopedic surgeons each year, making up about half a million procedures every year in the US. Following surgery it usually takes several weeks for a person to recover, though swelling can be an ongoing, lasting up to a year.  

Arch Deformity

Arch deformity, such as flat feet and cavus foot are common foot problems that in the extreme can cause ongoing pain and disfigurement. 

Flat feet is a condition made famous by formerly being a disqualifier from military service, a rule that has since become less strict. The symptoms of walking without an arch in the foot can often be alleviated with shoe insoles and other aides, but in some cases the imbalanced mechanics of walking on flat feet can cause a buildup of stress and pain in other parts of the body. 

Several surgical techniques have been used to correct flat feet, including: 

  • Making an incision and moving part of the heel
  • Insertion of a bone tissue graft in the heel area 
  • Joint fusion

Tendon and ligament procedures 

Correction can require a series of surgeries. Double or triple arthrodesis is one approach in which two or three joints are fused using pins or screws to create an arch in the foot. In many cases, shifts in bone and joint structure are accompanied by soft tissue surgery, shortening the ligaments and tendons to an appropriate length for the foot’s new position. 

Surgical cavus foot treatment includes a similar range of approaches with the difference of reducing a painfully overly-arched foot, and lengthening the corresponding tissue. 

Initial recovery can be a painful process, lessening after a few days, and the stitches often coming out at a two-week follow-up. After about a month, many patients have a cast taken off, to be replaced with a walking boot. Physical therapy is part of recovery and the process of becoming accustomed to moving around with a feeling as if having a flat or overly-arched foot compared to before the correction.  

Plantar Fasciitis

Plantar fasciitis is one of the most common causes of heel pain. It happens when the plantar fascia, a ligament supporting the arch of your foot, becomes inflamed and irritated. 

At least one in 10 people will develop plantar fasciitis in their lifetime and plantar faciitis will account for at least 1 million doctor’s visits annually, according to a 2003 survey published in the Journal of Bone and Joint Surgery. 

Although the plantar fascia is designed to handle the weight and stress we place on our feet, repeated strain can irritate the ligament over time. Many people who have plantar fasciitis also have bone spurs in their heel, but bone spurs do not cause it. However, activity with repetitive impact on the heel can cause plantar fasciitis, especially with new or increased activity. 

Plantar fasciitis symptoms include: 

  • Pain near the heel
  • Pain after getting out of bed or standing after a long period of rest
  • More intense pain after exercise or activity 

The single greatest risk factor for developing plantar fasciitis is equinus, a condition in which a person has limited ability in their ankle to point their foot upward. This condition marks a roughly 20-fold increased likelihood of developing plantar fasciitis. 

After examining your foot and diagnosing your plantar fasciitis, your Orthopedic surgeon will likely try to exhaust other treatment options before considering surgery. Aside from resting your foot and applying ice to treat plantar fasciitis, calf muscle stretches may also help relieve the pain of plantar fasciitis. Another treatment includes freezing a bottle of water and rolling your foot across the bottle to stretch and ice the foot at the same time. You may also need plantar fasciitis inserts to protect your heel. 

If you still have persistent pain after nine months to a year of aggressive treatment, your Orthopedic surgeon may consider surgery to lengthen the calf muscle, which can relieve plantar fasciitis pain within three to six months. If you undergo this surgery, you will have to wear a boot for two weeks and limit any high-impact activities for two months.  

How Sauk Prairie Healthcare Treats Foot Conditions

Orthopedic surgeons at Sauk Prairie Healthcare treat a range of foot and ankle conditions ranging from common issues like bunions, hammertoe and plantar fasciitis to complicated surgery. 

Fellowship-Trained Foot and Ankle Surgeon:
Andrew M. Ertl, MD

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