Getting around to do daily tasks is highly dependent on the performance of your feet and ankles for many people. When something goes wrong, simply going for a walk could be taxing if pain emerges. Symptoms, risk factors, and treatment for five common conditions are explained below.
Plantar Fasciitis
What are the Causes and Risk Factors for Plantar Fasciitis?
This condition is recognized by a sharp stabbing pain which is caused by inflammation of the ligament that supports the bottom of the foot, connecting the heel to the toes. The inflammation can occur anywhere in the foot but is usually felt in the heel or arch of the foot. People who have plantar fasciitis commonly notice the pain when they first get out of bed in the morning that may subside or be felt throughout the day.
Plantar fasciitis is a common cause of foot pain and many people develop this condition at some point in their life. If tension and stress on the ligament is repeated it can cause irritation and inflammation of the fascia. Often this condition is triggered by long periods of standing or when you get up after sitting.
What are the Causes and Risk Factors for Plantar Fasciitis?
- Overly tight Achilles tendon (the tendon that connects the heel and the calf muscle)
- Trauma to the foot (common for runners)
- Fallen arch or a high arch
- Arthritic diseases from wear and tear
- Obesity
- Age (Usually common in those over the age of 35)
- Improperly fitted shoes
- Occupations that require you to be on your feet for extended periods of time
Treatment for Plantar Fasciitis
There are several treatment options for this condition, both non-surgically and surgically. In over 90 percent of cases, patients can be treated successfully without the need for surgery.
Non-Operative Treatments:
- Ice
- Stretching
- Night splint
- Anti-inflammatory medications prescribed by your doctor
- Arch supports
- Cortisone injections
- Regenerative Medicine (Stem cell injections, PRP)
- Immobilization
Operative Treatments:
If all non-surgical treatments have been tried without success, some patients may benefit from surgery to help relieve the pain associated with plantar fasciitis. The procedure to fix plantar fasciitis involves a small incision in the plantar fascia (the thick band of tissue on the bottom of the foot that connects the heel to the toes). This incision or cut releases the tension in the ligament and relieves the pain. It is important to discuss the procedure at length with your orthopedic or foot and ankle surgeon, so you understand all of the risks and benefits.
Hallux Rigidus
What is Hallux Rigidus?
Hallux rigidus, otherwise known as a stiff big toe, is a progressive arthritis disease of the great (big) toe joint. In its early stages, Hallux rigidus may cause moderate pain in the big toe when it is flexed upward. As the condition progresses, patients will notice swelling, increased pain, and limited motion. In some cases, a bump may appear on top of the foot around the big toe joint.
Stiff Big Toe (Hallux Rigidus) Causes and Risk factors
- Family history of hallux rigidus
- Foot structure/abnormalities
- Trauma or injury to the big toe
- Athletes or those with a high activity level
Treatment for Hallux Rigidus
Treatment for this condition depends on how far the disease has progressed.
Non-Surgical Treatment:
- Anti-inflammatory medication prescribed by your doctor
- Cortisone injections
- Limit high intensity activities such as running
- Splints/braces
Surgical Treatment:
Early stage Hallux rigidus can be treated to preserve the joint and hopefully stop the progression of arthritis. Late stage Hallux rigidus is best treated with a fusion of the big toe joints together after removing cartilage or replacement of the first metatarsophalangeal joint (the great “big” toe joint).
Determining when to have surgery and which procedure is the best for you is an individual decision made alongside your foot and ankle specialist. Age, activity level, and occupation all need to be considered as part of the decision to have surgery.
Posterior Tibial Tendonitis
What is Posterior Tibial Tendonitis?
Posterior tibial tendonitis (PTT) or posterior tibial tendonitis dysfunction (PTTD) is inflammation and pain associated with the posterior tibial (PT) tendon. The PT tendon is a large tendon that begins in the leg and attaches to the bones and muscles in the foot. The PT tendon can become overly strained, inflamed, and even torn if overused, resulting in pain and swelling around the ankle. It can even lead to a fallen arch or be caused by an arch that has already fallen.
Causes and Risk Factors of PTT
- Family history of the condition
- Flat foot
- Improperly fitted shoes
- Trauma to the area
- Rheumatoid arthritis
Treatment for Posterior Tibial Tendonitis
Non-Surgical Treatment:
- Immobilization (4-6 weeks in a walking boot)
- Anti-inflammatory medication prescribed by your doctor
- Arch supports
- Bracing
- Cortisone injections
- Regenerative medicine such as stem cell injections or PRP
- Physical therapy
Surgical Treatment:
Surgical treatment is always the last resort. It is primarily reserved for patients who have not seen results from non-surgical treatment. “In my practice, less than 10% of people with PTT require surgery,” said Benjamin R. Proto, DPM, FACFAS of TPMG Orthopedics in Williamsburg and Newport News. When surgery is needed, extensive consideration must be given to not only the PT tendon, but also the deformity of the foot due to the condition. Both must be addressed, or the patient may have recurrence of the tendonitis or tear.
In most cases, the patient will require a repair of the tendon in addition to a transfer of the FDL tendon (the tendon that connects to 2nd, 3rd, 4th, and 5th toes to the foot) and a realignment of the foot by performing an osteotomy (removal of a piece of bone).
This combination not only repairs the tendon but changes the architecture of the foot so the repair will stand up to time.
Bunion
What is a Bunion?
A bunion, or hallux valgus, is a deformity of the big toe joint causing a bump to appear at the base of the big toe. A bunion is a bony deformity that usually worsens with age. For some a bunion can be quite painful, but for others, it is fairly unproblematic.
Risk Factors and Causes of Bunions
Bunions are usually due to an underlying muscle imbalance in the foot, but the exact cause is unknown. However, there are several other contributing factors including:
- Family history
- Ill-fitting shoes
- Trauma to the foot
- Rheumatoid Arthritis
- Flat foot
- Activity level
Treatment for Bunions
The only way to truly correct a bunion deformity is through a surgical procedure. Non-surgical treatments can help reduce pain and discomfort, but they will not result in the bunion disappearing.
With that said, not all bunions require surgery. Whether or not correcting the deformity is the right decision depends on pain level, progression of the deformity, and ability to wear reasonable shoes comfortably. Many patients elect to wait until the bunion is severe before correcting it surgically. Others prefer to address the deformity before it gets to that point. There are risks and benefits to both approaches. “In my practice, I work with each patient to determine the best course of action,” said Dr. Proto.
Non-Surgical Treatment:
- Wider shoes
- Anti-inflammatory medication prescribed by your doctor
- Cortisone injections
Surgical Treatment:
Surgical correction involves removing the bump, straightening the toe, and reducing the underlying problem of the first metatarsal (joint). There are dozens of different ways to do so. The procedure is almost always performed as an outpatient in a surgery center or hospital with the patient returning home the same day and within hours of the procedure.
“At TPMG Orthopedics, we utilize any and all methods to correct the deformity and minimize recovery time as much as possible. Choosing the correct procedure is a very personal one that can be made with the help of a well-trained foot and ankle surgeon,” said Dr. Proto.
Procedures utilized include:
- Osteotomy
- Fusion
- Minimal incision techniques
- Soft tissue rebalancing procedures
Hammertoes
What is a Hammertoe?
A hammertoe deformity is the abnormal contracting or flexing of any of the toes at the middle joints causing the toe to have a curved or bent appearance.
Causes and Risk Factors of Hammertoes:
- Family history
- Improper shoe gear
- Trauma
- Arthritis
- Flat foot
- Activity level
Hammertoe Treatment
Hammertoe deformities are usually only corrected through surgical procedures. However, many hammertoes do not have symptoms and can be accommodated with a simple change in shoe type.
If surgical correction is the best course of action, there are multiple options to correct the deformity and prevent it from recurring.
Non-Surgical Treatment
Some hammertoe deformities can be corrected very easily in an office setting with very little recovery time needed.
- Shoes with a wider or higher toe box
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Padding (in shoes)
Surgical Treatment
Other situations, however, require surgical correction involving pinning of the toes together. Determining the correct procedure is crucial in providing an acceptable outcome and achieving patient goals. Common procedures include:
- Tendon release
- Tendon rebalancing
- Fusion of the toe
- Osteotomy
In conclusion, many of these conditions can be treated successfully without having to go into the operating room. If you are experiencing pain in your foot or ankle, contact a foot and ankle specialist to help you find relief and the right treatment for your needs. Often, delaying treatment for these conditions leads to more damage and potentially the need for more extensive and invasive interventions later.
TPMG Orthopedics in Newport News and Williamsburg has in-person and telemedicine appointments available. Rest assured our offices are adhering to CDC guidelines and protocols for infection control and sanitation to keep our patients and staff safe during the COVID-19 pandemic. Many conditions can be seen with a telemedicine visit from the comfort of your home if you would prefer. If you are unsure which visit type is best for you, call our office or contact us through the Patient Portal and we will be happy to help.
About Benjamin R Proto, DPM, FACFAS
Board certified foot and ankle surgeon, Benjamin R. Proto, DPM, FACFAS has extensive experience in foot and ankle care. Favoring a conservative approach to treatment, Dr. Proto is, in many cases, able to provide treatment of foot and ankle pain without the need for surgical intervention. He joined TPMG Orthopedics in 2007 and sees patients in the Newport News and Williamsburg locations.
