Often called ‘carpel tunnel of the foot,’ tarsal tunnel syndrome occurs when the posterior tibial nerve, which runs through the tarsal tunnel behind the bony bump on the inside of the ankle, is compressed and therefore irritated. Any activity that repetitively requires the inside of the sole of the foot to be weight bearing, such as long-distance running and cycling, can cause inflammation of the tarsal tunnel. A variety of other factors can also cause problems, such as benign tumors, varicose veins, bone spurs, and posttraumatic adhesion (immobilization intended to heal a fracture or sprain causes the nerve to attach itself to another structure to which it is not supposed to be attached). Basically, the nerve doesn’t have the space it needs, so it becomes irritated and consequently irritates the person whose foot it occupies. 

This irritation can include sensations such as burning, tingling and a zinging pain on the bottom of the heel, and sometimes slight numbness in the toes. With tarsal tunnel syndrome, the patient usually experiences tenderness directly over the posterior tibial nerve, which helps to distinguish it from other nerve entrapment syndromes.

There are both operative and non-operative means of treating tarsal tunnel syndrome. A heel wedge placed on the inside of the heel decreases tension on the nerve and can provide relief. A steroid injection into the tarsal tunnel can be helpful but will often bring only temporary ease of symptoms. Especially in athletes, surgical release of the nerve and removal of any tumors or spurs can become necessary for pain relief. If surgery is the only option to alleviate the pain, a qualified orthopedic foot surgeon will speak with you and select the appropriate procedure or procedures based on your individual situation and condition.

A turf toe injury is essentially a sprain of the first joint of the toe (where the toe meets the foot), usually because of hyperextension (over-extension) of the big toe.  This injury was inconsequential prior to the use of artificial turf for playing fields, since the sprain is caused by a flexible shoe on a harder surface. Before the use of turf, real grass was used, providing a softer and more forgiving playing surface. Football players, especially running backs, lineman, and receivers, are the athletes most likely to injure their toes this way because of the prominence of artificial turf on football fields.

This injury is easily missed in athletes because a fracture isn’t present. Turf toe injuries usually result in straining of the ligament in the joint, damage to soft tissue, and bruising of the bone. 

Symptoms of a turf toe injury include swelling, pain under the joint and limited range of motion.  Depending on the severity of the sprain, treatment options can range from shoe wear modification and icing to toe casts and crutches, and recovery time can range from three days to six weeks. Happily, surgery is only needed in the most severe cases. No matter the grade of the injury, it should not be ignored and should be treated by an orthopedic foot specialist.

In order to prevent turf toe injuries, ensure that shoes (football cleats especially) are rigid enough to provide stability and protection for the toes.  If possible, train and condition on softer sod instead of artificial turf. If these guidelines are followed, hopefully big toes around the country can serve a happy, sprain-free career.

The AOFAS goes onto explain, “The mechanics of your foot are extremely complex. Each foot contains 26 major bones and 30 joints, along with tendons, nerves and skin that all interact to allow you to walk or run without pain.  When a patient undergoes orthopedic reconstructive foot surgery, it is done to provide pain relief, improve function, or enhance the quality of life during normal activities of daily living.”

Common reconstructive foot surgery performed by orthopedic surgeons includes correction of painful bunions, hammertoes, flat foot deformities, cavus foot and lesser toe deformities. Some of these conditions are hereditary, but more often than not these deformities are a result of poorly fitting shoes.

If you are suffering from foot pain and/or deformities, try following these simple guidelines:
• Judge the shoe by how it fits on your foot not by the size marked in the shoe.
• Select a shoe that conforms as nearly as possible to the shape of your foot.
• Have your feet measured regularly. The size of your feet change as you grow older.
• Most people have one foot larger than the other. Select a shoes size that fits the largest foot.
• Measure your feet at the end of the day when they are the largest.
• Check that there is adequate space (3/8″ to 1/2″) for your longest toe at the end of each shoe.
• Make sure the ball of your foot fits well into the widest part of the shoe.
• Do not purchase shoes that feel too tight, expecting them to “stretch” to fit.
• Your heel should fit comfortably in the shoe with a minimum amount of slippage.
• Walk in the shoe to make sure it fits and feels right.

If these guidelines do not help alleviate foot pain and disfigurement, then you should consult with an orthopedic foot surgeon to determine if surgery is the next viable treatment option.  However, always remember  that all surgical procedures contain risks, such as infections, nerve damage, post-surgical pain, scar formation… to name a few. In deciding when to proceed with surgery, a patient and their orthopedic surgeon must consider all the risks and benefits of a procedure.  When the potential benefits outweigh the potential risks, then surgical intervention may be warranted.

From baseball to soccer to football, everyday millions of children and young adults participate in sports activities. These activities teach children team work and improve their physical fitness, coordination and self-discipline.  It also increases their chance of experiencing sports-related injuries such as concussions, sprains, fractures, muscle tears, and back and neck injuries. However, there are measures that can be taken to help prevent these types of injuries, such as:
• Undergoing medical exams prior to the sport’s season, which should include concussion screenings and physical evaluations;
• Using proper protective gear, such as shin guards for soccer and helmets for football and baseball;
• Staying hydrated and always warming up before practice or a game;
• Never playing through pain or an injury.

If an athlete does experience an injury it is important that it is not ignored or taken lightly.
Sports-related injuries in children are of great concern because their bones, muscles, tendons and ligaments are still growing. To avoid long-term damage, young athletes should seek immediate care for any minor or serious injury.

Following are several signs to help determine if immediate care is needed:
• Inability to play following a sudden injury;
• Decreased ability to play due to a chronic or long-term complication following an injury;
• Visible deformity of the athlete’s arms or legs;
• Severe pain from a sudden injury, which may prevent the use of an arm or leg.

Sometimes, sports-related injuries occur after office hours or on the weekends.  If and when this happens I recommend that my patients visit the emergency room or an orthopedic walk-in clinic like the one we have at Methodist Sports Medicine / The Orthopedic Specialists. One of our fellowship-trained orthopedic surgeons is available to treat patients with sudden or recent sports or active lifestyle-related injuries.  Patients can visit our Avon or Greenwood locations Monday through Friday from 8 a.m. to 10 a.m., or our Carmel location Monday through Saturday from 8 a.m. to 10 a.m. For more information, please visit www.methodistsports.com or call 317-817-1200.

The article goes on to explain that each year about two million Americans visit the doctor for ankle pain due to arthritis or a fracture.  An estimated 50,000 people a year experience end-stage ankle arthritis, in which the ankle cartilage has worn away completely, causing painful bone-on-bone contact and some level of disability. 

Until recently, a patient’s primary treatment option was ankle fusion surgery, which involves removing part of the joint and permanently locking the bones together with screws and plates.  The procedure helps to reduce pain but decreases a patient’s ankle mobility.

A secondary option was a total ankle replacement.  This procedure has been around for over 30 years.  However, vast improvements have recently been made, making it a more desirable option for physicians and their patients.

Today’s total ankle replacements offer patients an improved recovery time and overall outcome, as well as decreased severity of complications. Another overall benefit of a total ankle replacement is that it offers patients more mobility and movement compared to an ankle fusion. Unfortunately, unlike total knee and hip replacement procedures, a large number of patients are not ideal candidates for a total ankle replacement.

People who should consider an ankle replacement procedure include:
• A patient that has a destroyed ankle, meaning the surfaces of the ankle is gone
• A patient that has advanced arthritis of the ankle
• A patient that has an ankle that is interfering with daily activities and causing pain

If a patient meets any or all of these descriptions, I would recommend that they speak with an orthopedic foot and ankle specialist to determine if a total ankle replacement procedure would be an ideal treatment option. Great care must go in to selecting the ideal patient and implant that should be used. Only a specialized orthopedic surgeon can make that assessment.

We hope to do this again next year and expect we can do even more.

Jacques Lisfranc de St. Martin was a surgeon in Napoleon’s army that developed a method of amputation across the midfoot as a treatment for gangrene.  Eventually the midfoot joint became known as the Lisfranc joint (a complicated arch made up of many bones and ligaments).  Today, when someone experiences a complete rupture of the midfoot ligaments, it’s known as a Lisfranc injury.

Classically, this injury took place when a rider fell off his horse with his foot caught in the stirrup, twisting and injuring the joints in the midfoot. Nowadays, the occurrence of this injury is most commonly seen in American football players.  However, a Lisfranc injury can occur in any sport or from virtually any physical activity associated with the foot or ankle. The most common everyday causes are twisting your foot from stepping in a hole or missing a stair.

Symptoms of this injury include pain in the midfoot, mild swelling in the midfoot and forefoot, and inability to run. Treatment and severity depend on whether the injury is stable or unstable. If the Lisfranc is stable (meaning the main ligament is intact), treatment will usually include the R.I.C.E. method (rest, ice, compression, and elevation), crutches, and/or a walking boot. If the ligament is torn, then the Lisfranc is unstable and surgery is needed to reverse the injury. The procedure usually includes repair of the ligament and placing screws across each of the disrupted joints.

For athletes, recovery from a Lisfranc injury can take five to eight months. Ultimately, the athlete’s ability to return to play depends on pain level, stability of the foot, endurance and agility. Athletes may need to limit activity early on, and use a custom shoe insert when they initially return to the field.  With proper treatment, patients can usually have a complete recovery from the Lisfranc injury.

If you believe you’ve experienced a Lisfranc injury, you should seek medical attention immediately from an experienced orthopedic foot specialist.  Doing so will make sure you’ll be on your road to recovery in no time.

The tendon connects the bone of the heel to the muscle of the calf, which makes it important when pushing off of the foot. Injury to the Achilles tendon is most commonly seen in athletes between the ages of 30 and 55, but younger competitive athletes can injure this tendon as well.

A common and potentially devastating injury to the Achilles occurs when the tendon ruptures (tears completely) after it has become progressively tighter overtime and with activity. Many patients feel a “pop” when this occurs and sometimes feel as though they’ve been “kicked in the leg” or “shot in the heel”, and observe mild to moderate swelling over the tendon with an inability to continue with their sport or activity.

An Achilles injury can be treated either with surgery or with prolonged immobilization in a boot or cast. With immobilization there is a 12-14 percent chance of re-rupture, and patients usually regain about 60-80 percent of their original strength. However, the preferred method of treatment for the active athlete is surgical repair. Surgery offers patients an 80-100 percent chance of regaining their original strength and only has a two percent chance of re-injury. Surgery also decreases a patient’s recovery time, allowing them to return to their daily activities and chosen sport quicker.

Through our research we have discovered several interesting facts about surgical treatment of the Achilles tendon. Although patients regained 85-95 percent of their former strength one year after surgery, the calf muscle of the operative leg was up to two centimeters smaller in circumference than before the injury.  This could be because the patient favors the operative leg after injury. Also, there is a higher rate of tendon rupture in the other leg (5-10 percent) than there is of re-rupture in the repaired leg (two percent), which could also be caused by slight overworking of the uninjured leg in favor of the operative leg. These discoveries emphasize the need for equal strength recovery in both limbs during postoperative therapy.

Happily, the treatment of Achilles ruptures has progressed through the years, so that the injury is not quite as menacing as the warrior who gave the tendon its name.

The word ‘ankle fracture’ is used when bones in the ankle are broken.  This definition does not identify the specific location of the injury, so there are many different structures that can be involved in an ankle fracture. There are two bones that make up the ankle: the weight-bearing shinbone called the tibia, and the non-weight-bearing fibula bone. There are two rounded projections, one on each side of the ankle, called malleoli (single: malleolus). The medial (inner) malleolus is formed by the end of the tibia, and the lateral (outer) malleolus is formed by the end of the fibula. Fractures frequently occur across these structures, but a fracture can occur anywhere along either bone.

Depending on the severity of the injury, ankle fractures can be treated non-operatively with immobilization and rest but the preferred method of treatment, especially for athletes, is surgical. The method used to surgically fix an ankle fracture is called Open Reduction and Internal Fixation or ORIF. ‘Open’ refers to a surgical incision that allows the surgeon to see the fractured bone in order to fix it. ‘Reduction’ refers to correcting the placement of the bone, and ‘internal fixation’ refers to placing screws through the bone, across the fracture in order to keep the fragments in place so the bone can heal itself. Sometimes a metal plate is also used for further stabilization.

Our research shows that this method, coupled with early weight-bearing and range of motion exercises during rehab, usually results in a complete return to activities with little strength or agility lost. Patients can expect to wear a walking boot and be on crutches for a few weeks after surgery, and then progress into a brace. Athletes can get back to play in as little as two to four months after surgery.