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As the leading foot and ankle program in Wisconsin and the upper Midwest, our staff provide comprehensive care for problems ranging from the commonplace to the complex.
Forefoot reconstruction (Bunionectomy)A bunion (hallux valgus) is the lateral deviation of the great toe (hallux). Bunions can be caused by foot wear, heredity, flat feet, soft tissue laxity due to rheumatoid arthritis, gout or trauma.
A number of procedures can correct a hallux valgus deformity.
Morton's NeuromaA neuroma is a benign growth or inflammation of nerve tissue that can be caused by compression of the nerves. Morton's Neuroma occurs in a nerve in the foot and may be caused by overuse, restrictive shoes, weight gain or direct trauma. Often, a specific cause is not found. The patient may feel burning or shooting pain that radiates into the toes. Relief is found with rest and removal of shoes. Often neuromas can be treated with orthotics, shoe modifications and occasionally, medication. If these treatments are ineffective, surgery may be considered.
Ankle ArthritisArthritis of the ankle joint may be caused by fracture, dislocation, inflammatory disease, osteoarthritis or congenital deformity. Patients may feel pain that is relieved by rest, stiffness after periods of inactivity, swelling and pain at the end of the day, and diminished or loss of motion through the ankle joint. Conservative treatments for ankle arthritis include bracing and shoe modifications to support the ankle joint and limit the amount of motion and stress. Bracing may involve using an Arizona gauntlet brace, an ankle-foot arthrosis (AFO) or a double upright brace. Shoe modifications include a rocker sole bottom with a cushioned heel (SACH). If these support measures are ineffective, surgery is the next option.
Distraction Ankle Arthroplasty
This treatment for ankle arthritis involves using an external frame on the joint, which is distracted (stretched) in hopes of maintaining the joint space. Even a slight stretching of the joint may rest the ankle's cartilage cells. This may help the joint form the type of cartilage needed to lubricate the joint appropriately.
Ankle Fusion and Total Ankle Replacement
Surgery for ankle arthritis may be ankle fusion or total ankle replacement, depending on a patient's age, weight, activity level and other medical conditions. During an ankle fusion procedure, arthritic bone is removed to create good bony surfaces for fusion. Two permanent screws are placed across the joint to secure the fusion.
Total ankle replacement involves removal of arthritic bone and removal of bone from the tibia and talus to allow for fit of the total ankle components. The Foot and Ankle Program is the only site in the state that regularly performs the two different methods of ankle replacement surgery.
Rheumatoid Forefoot ReconstructionRheumatoid arthritis creates inflammation of the synovium, a thin layer of tissue that lines the joint space. There may be weakening of the supporting structures of the joints, and bunions, claw toes, hammer toes or rheumatoid nodules may develop. The sensation can feel like walking on marbles.
Surgery for rheumatoid arthritis involves fusion of the joint in the great toe (hallux). It is supported with a screw that remains in the foot. The prominent metatarsal heads are removed to relieve inflammation in the joints, reduce the dislocated toes and relieve discomfort under the ball of the foot (the metatarsus, the middle part of the foot, is composed of five long bones). Pins are placed in the toes to maintain proper alignment. Hammer toes or claw toes can also be corrected by removal of the joint (knuckle) and release of the contracted tendons.
Adult Acquired Flat FootAdult acquired flat foot, also called pes planovalgus or pes planus, occurs more often as people age. It is commonly caused by posterior tibial tendon dysfunction or PTTD. This tendon is primarily responsible for maintaining the arch as well as inverting the foot. The tendon may lose its supportive function as a result of degenerative changes or acute rupture. When the tendon weakens, the arch may collapse and the foot may turn outward. As the deformity progresses, patients may suffer from symptoms of lateral impingement (friction of joint tissues) or hindfoot arthritis.
If the posterior tibial tendon is actively inflamed, immobilization with a boot or cast may be recommended. Other conservative treatments may include physical therapy, use of anti-inflammatory medicines, and/or orthotics. In some cases, bracing may be necessary. If conservative treatments are ineffective, surgical treatment may be considered.
In patients with a flexible deformity and minimal arthritic changes, a posterior tibial tendon transfer may be performed, usually in combination with a corrective cut in the heel bone called a medial displacement calcaneal osteotomy and/or a subtalar arthroereisis implant.
In patients with a fixed deformity or primarily arthritic complaints, a triple arthrodesis may be performed which involves fusing joints of the hindfoot. This may be combined with other midfoot fusions to maintain optimal alignment.
Haglund's DeformityHaglund's deformity or "pump bump" is a bony enlargement at the back of the heel. Pain is aggravated by shoe wear, especially pumps (shoes with higher heals) worn by women, and certain activities. Patients may wear open back shoes to avoid pressure to the posterior heel. Treatment options depend on each patient's symptoms and condition. A heel lift in the shoe along with a gel sleeve to protect the posterior heel may be used in mild cases. For more advanced cases, boot immobilization with a heel lift may be used along with an anti-inflammatory medication. If conservative treatment does not reduce the inflammation, the next choice is surgical removal of the deformity and possible debridement (removal of dead tissue and foreign material) or reattachment of the Achilles tendon.
Hallux Rigidus (Stiff Big Toe)The metatarsophalangeal (MTP) joint of the big toe (hallux) is important because it has to bend with each step. If it stiffens due to arthritis, injury or other factors, walking can become painful.
The first line of treatment is an orthotic, a support used to align, prevent or correct the function of movable body parts. An orthotic with a rigid portion underneath the big toe can prevent motion through the joint. If this is ineffective, surgery is the next option.
The type of surgery depends on the extent of arthritis and how it affects the joint space. If the joint space is well preserved but bone spurs (osteophytes) are restricting motion, a cheilectomy will be done. This involves removing the bone spurs around the joint.
If the arthritis is extensive, a MTP fusion may be necessary. Arthritic bone is removed from the joint to create good bony surfaces for fusion. Two screws are placed in the foot to secure. The screws remain in the foot.
Lesser Toe CorrectionLesser toe deformities are contracted joints that are either rigid or flexible. They are classified as hammer toes, claw toes, or mallet toes and are caused by improper foot wear, arthritis, loss of intrinsic muscle function or trauma.
The correction of the deformity requires removal of the joint of the involved toe. It may also be necessary to lengthen or release contracted tendons. A pin is placed through the toe to stabilize it while it heals. The pin is removed about four to six weeks after surgery, and recovery continues from there.
Last Review Date: April 29, 2008 Online Editor(s): Rich Petre |
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