Foot Ankle
Arthritis
Anatomy: The foot and ankle have complex bony anatomy.
Injury: Arthritis may occur from overuse or after trauma or fracture.
Diagnosis: X-rays are the best means of diagnosing arthritis of the ankle and foot. MRI can be a valuable adjunct in diagnosing arthritis of some of the smaller joints of the foot.
Treatment
- Protected Weight Bearing: A short period of partial weight bearing using two crutches (a cane is inadequate) or a walker is invaluable. Arthritic joints crave decrease weight bearing and acute pain subsides almost immediately when this is done. It is also very important to avoid pain or anti-inflammatory pills (e.g. advil, motrin, aleve) because they mask pain and allow worsening with the patient being unaware. They also interfere with healing and have dangerous side effects. If weight bearing is restricted and pain medicines, as well as pain creams, pain patches, ice and other modalities that mask pain are also avoided, your body will tell you when you can again increase your weight bearing. In many cases this all that is necessary. Cortisone injections should also be avoided as their results are usually temporary and they help accelerate joint degeneration.
- PRP-STEM Cell Injection: If pain persists, PRP or stem cell injection in our hands has a high rate of success for arthritis of the ankle, foot and Great toe. With thousands of injections performed we are one of the most experienced Orthopaedic Centers in the world in the use of this treatment.
- Surgical Treatment: Surgical treatment of arthritis is generally not effective in relieving pain unless surgical joint fusion is performed. While joint fusion can be an effective salvage procedure if non-surgical treatment fails, it permanently eliminates motion of the joint and can result in pain from transfer of stresses to adjacent joints. Foot and ankle joint replacement surgery has a lower success rate and higher complication rate than knee and hip replacement. In fact I had one patient who I treated for a different problem who had failed ankle replacement elsewhere followed by failed ankle fusion elsewhere who eventually had to have below knee amputation of her leg to regain the ability to walk. This is a rare complication, but she is not the only one who has had it.
Bunion
Anatomy: Bunion is a bump at the side of the base of the big toe. It occurs in conjunction with the Big Toe being pushed toward the lesser toes (Hallux Valgus), usually in people with wide feet. The problem is entirely caused by shoes that are too narrow for the patient’s foot.
Diagnosis: The problem is obvious from simple observation. X-rays confirm deformity of the joint.
Treatment: While surgery is often performed, it is almost never necessary and the incidence of unsatisfactory results is relatively high. Simple stretching combined with wearing a light brace at night only will correct the deformity, although it will take several months to achieve. It is critical however to wear wider shoes since the problem is entirely caused by too narrow shoes. New Balance gym shoes are often useful since, unlike many other brands, they make many models in wide widths, up to double or quadruple E and the salespeople at their dedicated stores are usually quite knowledgeable. Wide stylish dress shoes are harder to find but are available. It is important that the shoe not feel at all snug or tight from the time of purchase. There should be no period of “breaking in” of the shoe required, it should be immediately comfortable. If the patient is motivated and patient almost all bunions can be satisfactorily treated without surgery.
Achilles Tendinitis & Partial Tear
Dr Prodromos has a high rate of success using Platelet Rich Plasma (PRP) for the treatment of this problem. Surgery has almost never been necessary. Here is a link to a video about the use of PRP for hand and foot problems including a testimonial from one patient with severe Achilles tendon damage.
Achilles Tendon Complete Tear
Dr Prodromos has excellent success treating complete ruptures of the Achilles tendon. Unlike partial tears described above, surgery is usually indicated for complete tears. In these cases Dr Prodromos reinforces the repair with tissue from the area to make a much stronger repair that allows immediate weight bearing and removal of postoperative immobilization in only a few days. This contrasts with the postoperative routine after a simple repair, in which immobilization and non weight bearing are usually required for four to six weeks.
Sprain
Most sprains heal well with only protected weight bearing, and then physical therapy. For athletes who need faster return to play, PRP injection has been shown to accelerate healing and is available at our clinic.
Plantar Fasciitis
This problem usually resolves with only protected weight bearing. If it does not, our high quality Weber laser – which produces no heat or pain – can often relieve symptoms. If laser does not help, we have had even greater efficacy using PRP, Platelet Rich Plasma, injection.
