Best Foot and Ankle Specialist Doctor - Dr. Kiran Reddy Chennuri

Fractures are breaks or cracks in the bones, and dislocations are when the bones move out from their original place or connecting joint. Both fractures and dislocations are very painful.

Foot and ankle fractures in the bone occur in different places, some of them are ankle fractures, heel bone fracture, metatarsal fracture, 5th metatarsal fracture, Pilon fracture, lisfranc fracture, and snowboarder’s fracture. Overusing of bones will cause stress fracture; these fractures are more seen in runners or actions that involve repetitive strain.

Fractures usually happen from hard falls, sudden twists, and unexpected collisions. There are 26 bones in the foot and 3 in the ankle joint. Fractures in these bones may happen due to stress fractures that may require rest and time to heal; other fractures may need surgery to repair.

Ankle fracture and dislocation:

An ankle fracture may happen in one or more of the three bones -ankle bones- the tibia, fibula, and talus. The two ankle joints where the tibia, fibula, and the talus meet and syndesmosis joint which are located between the tibia and fibula are also affected. A simple fracture in the ankle occurs when the bone breaks but does not protrude through the skin. A compound fracture in the ankle happens when the bone breaks and protrudes from the skin.

Ankle dislocation happens when the ligaments that hold your ankle bones are torn or pulled out of place mainly because of injury. Dislocations usually happen due to fractures or severe sprains.

Foot fracture:

Though dislocations of the foot are rare, any bone in the feet may break or crack. There are two common types of fractures:

• A fracture in the long bone along the outside of the foot that connects to the little toe (fifth metatarsal fracture)
• A small bone chip is pulled away from the main bone due to a tendon or ligament injury (avulsion fracture).

• Falling
• Severe impact
• Stress from overuse
• Twisting or rolling the ankle

Ankle and foot fractures have similar symptoms:

• Bone protruding through the skin
• Bruising that develops after the injury
• The appearance of the ankle or foot may change
• Difficulty in walking
• Pain and tenderness at the site of the fracture
• Swelling around the fracture location

Factors that increase the risk of fractures are

• Activities that involve running, jumping, or sudden changes in movement
• Loose ligaments
• Previous ankle sprain or fracture
• Walking or running on uneven surfaces

Treatments for the fracture will depend on the severity of the injury.

• If the broken bone has not moved out of the place, then it doesn’t need any surgery
• If the bone is dislocated then surgery is required
• If the broken bone is protruded out of the skin, then it is an emergency that needs immediate care.

Treatments may include:

• Immobilization with a cast, brace or walking boot is recommended to keep the ankle or foot from moving while the fracture heals.
• Arthroscopic ankle surgery is done to repair the broken bone by making small incisions, and the surgeon will remove small bone chip fragments that may cause arthritis and pain if it is not removed.
• Surgical repair using plates or screws that are specially designed for some parts of the foot or ankle.
• Suture-button implants use two metallic buttons and wire that hold the bone pieces together while they heal.

Bursas are small, fluid-filled sacs that secrete a lubricating liquid called synovial fluid which gives cushioning between the bones and other body parts like muscles, tendons, or skin. When a bursa becomes injured or inflamed, it is called bursitis. Bursitis causes muscle deterioration and limited movement in your ankles or feet.

There are 33 joints in the foot, bursae can cause in multiple areas. Most commonly found at the ball of the foot mainly at the metatarsophalangeal joints, fifth metatarsal, and the back of the heel, near the insertion of the Achilles tendon.

Bursa inflammation could be the result of direct force or repetitive action. It can get worsen by an underlying foot deformity or health issues that include Haglund’s deformity, gout, or arthritis.

It can be caused due to wearing tight shoes or high heels, running, jumping, etc

• If you have undergone any surgery previously,
• Injury or trauma, such as a hard blow to the heel or ankle
• Due to bacterial infection, called septic bursitis
• Inflammatory autoimmune conditions like rheumatoid arthritis, scleroderma, lupus, and gout
• Health issues related to thyroid conditions or diabetes
• Bone spurs from osteoarthritis
• Weak and inflexible calf muscles
• Improper stretching before exercising, or playing sports
• Age: anyone can develop bursitis, but it becomes more common with aging
• Obesity
• Haglund's deformity (where a bony enlargement forms on your heel from rubbing against your shoes).

Symptoms of bursitis include:

• Pain while walking and running
• Severe pain when you try to walk on tip-toe.
• Swelling, redness, or stiffness of a joint
• Pain when you move the joint
• Pain when you touch the joint area.
• A lump on the back of the heel

A podiatric doctor will examine the foot and ankle. The doctor will ask questions related to the symptoms and what type of sports or work the patient does to understand if the patient’s work involves standing or repetitive motions.

In addition to the above examination, a range of motion test, as well as radiographs will help to determine if the patient has any underlying deformity that may be exacerbating the symptoms.

Other tests include:

• Blood test
• MRI
• Ultrasound
• Arthrocentesis –done if any infection /gout is suspected

Treatments for bursitis include:

• Resting the foot, apply ice to the foot, and avoiding activities that are causing more pain.
• Physiotherapy
• Medications
  • Topical medications like creams, gels, sprays, or patches
  • Non-steroid anti-inflammatory drugs
  • Antibiotics: if it is caused due to infection
• Draining the fluid from the swelled bursa with a needle or syringe, which is then tested to check if it is caused due to infection
• To relieve pain and inflammation corticosteroid injections are given
• Surgery is very rare to remove the bursa. It is done only if other less invasive treatments are of no help.

Bursitis can go away or can get better on its own with home treatments and lifestyle modifications- that include:

• By applying heat and cold therapy
• Resting your foot in between the work or repetitive activities.
• Avoid sports that give pressure on your foot
• Switch to walking instead of jogging or running
• Use crutches to relieve the pressure on the foot

Taking certain precautions can prevent or reduce your chances of developing foot bursitis such as:

• Exercise regularly at least for 30 minutes daily.
• Swimming is an excellent activity for reducing stress on the ankle joint and heel
• Warm-up exercises are important before playing sports
• Avoid eating processed foods and sugar
• Maintain a healthy diet that increases mobility and energy
• Wear proper shoes, avoid high heels
• Practice good posture

Both sprains and strains are very common injuries that occur during sports, accidents, falls, or any other traumas. The difference between sprains and strains are:

Sprains affect the ligaments, ligaments are like thick bands of tissue that connect bones and stabilize the joints by binding them together. They give stability to the ankle and foot joints. Along with the lower leg, they form a complex supporting structure for the body. They expand to a certain limit and return back to their normal position. If they are overstretched they may tear.

Strains affect the muscles and tendons. Tendons are thick bands that attach muscle to bone.

Sprains occur due to a fall or pressure on the body that knocks out the joint from its actual position, in some cases ruptures the supporting ligaments. A sprain mostly occurs in the ankle when the joint twists or turns. The severity of the pain may depend upon the ligament that is stretched or torn. Instability may happen if the ligament is torn completely or if the joint dislocates.

Strains also occur because of twisting, tearing a muscle or tendon during overstretching or over contraction.

Both sprains and strains have similar symptoms, such as pain, swelling, weakness, bruising, difficulty while walking, and spasming.

To diagnose the severity of the foot and ankle injury the doctor will perform tests to understand the extent of the injury. Such as:

• MRI scans: these scans are very helpful for identifying stress fractures and soft tissue injuries like ankle ligament sprains
• CT scans: if the person has an ankle or foot fracture CT scan is done to view the bones and joints.
• Ultrasounds
• X-rays are taken to confirm the diagnosis and to rule out any other problems like bone fractures.

If you have a mild sprain or strain, it can be managed at home with anti-inflammatory medication along with rest, ice, compression, elevation therapies. For some cases, mild stretching exercises may help.

For severe cases, complete immobilization with a cast is required.

For moderate cases, you may be given a brace. People who have mild to moderate sprains heal slowly in two to eight weeks depending on the injury.

In case of severe sprains and strains, surgery is performed in which the recovery may take up to three months.

Tendons are hard, flexible, fibrous bands of tissue that connect muscles to bones. When any inflammation, tears, or irritation happens to the tendon, the condition is known as tendonitis. Tendonitis is an inflammation surrounding a tendon that gives pain while moving and reduces by taking rest.

The most common type of tendonitis are:

• Peroneal tendonitis causes pain and inflammation along the outer edge of the heel.
• Achilles tendonitis causes heel and calf pain, usually due to overuse, typically felt when walking or running, extending up to the middle of the calf.
• Extensor tendonitis causes pain on the top of the foot, and it is a very rare type of ankle tendonitis.
• Anterior tibial tendonitis causes pain in the front of your foot, typically felt when walking downstairs or on sloped surfaces.
• Posterior tibial tendonitis — pain and swelling along the inside of the ankle and arch along the course of the tendon. There will be constant pain inside of the foot while walking or standing.

The common symptoms of tendonitis are pain, swelling, and stiffness. The pain reduces when you give rest to your foot and ankle, but later it comes back when you start moving.

The most common cause of tendonitis is overuse. Other causes may include – infection, rheumatic diseases such as gout or arthritis, or a sprain.

Risk factors include

• Sports that involve repetitive motions
• Running
• Age above 40 are most likely to have tendonitis
• Men are more likely to get than women
• Obesity
• Improper shoes that do not support the feet
• Prior injuries to the tendons in the foot and ankle

The doctor will ask for your medical history and will order X-rays or MRI scans to check if you have any fracture, calcification, or tendon rupture. A torn tendon may require immobilization with a cast, boot, or sometimes surgery is required.

If the symptoms are repetitive, a podiatric evaluation can help identify any abnormality in the foot.

To prevent and manage tendonitis the treatment could be shoe recommendations, arch supports, and braces may help.

Depending on the severity, the treatments vary from rest, injections, and surgery.

• Orthotics
• Splint or brace
• Physical therapy & rehabilitation
• Medication
• Steroid injection
• Tendon transfer surgery
• Ultrasound-guided nerve hydrodissection
• Ultrasound-guided percutaneous needle tenotomy (PNT)

Tendonitis can go away by itself if it is treated properly at home. If it’s not treated properly, then tendonitis can turn into tendonosis (also called tendinosis). Tendonosis is a long-lasting chronic and recurring condition that occurs due to repetitive strain or an injury that did not heal properly. You will not have much inflammation, redness, and swelling. Instead, you have more degenerative changes to the tendon such as abnormal blood vessel growth.

If you have an increased risk of tendonitis, you can take certain steps to prevent tendonitis such as:

• Do warm-up exercises before heading into sports or play
• Do stretching after exercising
• Do not suddenly start intense exercises
• Wear good supportive shoes
• Take frequent breaks from repetitive work
• Practice good posture

Diabetic foot is a common problem in people who have prolonged periods of diabetes. People who have diabetes are prone to many health issues, especially their feet get damaged. Diabetic neuropathy and peripheral vascular disease are the two main foot problems that have serious complications.

Diabetic neuropathy- when diabetes is not controlled for a longer period it can damage nerves in the legs and feet. The person may lose sensitivity towards heat, cold, or pain. This condition is called sensory diabetic neuropathy. If the patient is unable to feel the cut or wound on the foot, then it may become infected. Due to this condition, the muscles of the foot may not work properly due to the damaged nerves.

Peripheral vascular disease- diabetes affects the blood flow, veins and arteries become blocked with fatty deposits that restrict the blood flow and cause infections and slow healing.

These foot problems can happen to anyone, but for diabetic patients, they can lead to infection and complications, such as amputation.

• Athlete's foot causes itching, redness, and cracking, which leads to infection
• Fungal infection of nails- infected nails may become discolored, yellowish, thick, and brittle. For some, the nail may crumble. Fungal infections can happen due to an injury.
• Calluses are a build-up of hard skin underside of the foot. It occurs due to the uneven distribution of weight, shoes, or skin problems.
• Corn is a build-up of hard skin near a bony part of a toe or in-between toes.
• Blisters are formed when the shoes rub in the same place on the foot.
• A bunion is formed when the big toe bends to the second toe.
• Dry skin
• Diabetic foot ulcers are the cracks in the skin that can become infected. Foot ulcers can be caused due to minor scrapes, cuts that heal slowly.
• Hammertoe is a toe that is bent because of weak muscle.
• Ingrown toenails happen when the edges of the nail grow into your skin.
• Warts

The signs may vary from person to person:

• Temperature changes in the feet
• Numbness
• Pain or tingling in the feet
• Swelling in the foot
• Fungal infections in the feet
• Dry or cracked skin

• Skin and bone infections
• Abscess
• Gangrene
• Deformities
• Charcot's foot
• Amputation

Diabetic foot is caused by the side effects of diabetics, mainly high levels of sugar that restrict blood flow to the body’s extremities and nerve damage.

The foot is often numb due to nerve damage. Problems like ulcers and sores may get infected without the knowledge of the diabetic patient.

There are various surgical and non-surgical treatments available; treatment may vary according to the severity.

Non - surgical treatment treatments involve:

• Keep wounds and clean and dressed
• Wearing immobilization devices like cast boot or total contact cast
• Observe if any gangrene is developing in the foot until self-amputation happens

If these non-surgical treatments are ineffective, then surgery may be required

• The removal of decaying or dead tissue
• Amputation of toes or even the leg in some severe cases
• An arterial bypass for peripheral vascular disease helps the blood flow to the area.
• The placement of stents to open the blood vessels