Foot & Ankle

Surgeons who specialize in foot and ankle surgery like to solve complex problems. With 26 bones, 33 joints, and numerous nerve endings in the foot, there is a lot that can go wrong with your feet. If you are on your feet most of the day, there is a greater risk for problems. Thus, it is even more important to take care of your feet. Wear supportive shoes, keep your toenails trimmed, and seek medical attention if you experience pain, instability, weakness, swelling, or stiffness.

Pain in your foot or ankle can quickly interfere with your life, and you need equally quick relief. Whether it’s heel pain, toe pain, or an ankle fracture, foot and ankle surgeon the doctors at Southeast Michigan Center for Orthopedics can give you a proper diagnosis and treatment plan.

If you have a foot or ankle injury, Southeast Michigan Center for Orthopedics is THE medical office to see in the Detroit area, especially if you need surgery.

The surgeons are fellowship trained to perform a wide range of foot and ankle procedures, ranging from bunion surgery to ankle replacement. They are also fellowship trained in sports medicine, giving them additional expertise to provide comprehensive care for athletes with foot and ankle injuries.

Call now: (248) 792-9881 

Achilles Tendonitis/Rupture

The Achilles tendon is the most powerful tendon in the human body. Tendons are strong tissues that connect muscles to bone. The Achilles tendon is located in the lower back part of the leg and works with the calf muscles to provide forceful foot movements. Achilles tendon ruptures most commonly occur as a result of sports injuries from activities such as basketball, football, or tennis. They can also result from a condition called Achilles tendonitis. Individuals with Achilles tendonitis have weakened and inflamed tendons that are susceptible to injury.

ANATOMY

The Achilles tendon is a large, strong fibrous cord that connects the calf muscles in the back of the leg to the back of the heel bone (calcaneus). The Achilles tendon and the calf muscles work together to allow individuals to point the foot downward and to raise the heel upward. People rely on it virtually every time they move their foot. This motion enables individuals to walk, jump, stand on their toes, and climb stairs. Individuals with Achilles tendon ruptures will most often not be able to perform such movements.

CAUSES

Achilles tendon ruptures most commonly occur in men between the ages of 30 and 50 years old that participate in sports. Sports such as basketball, football, and tennis require quick forward and backward leg movements, jumping, and cutting that can create an imbalance of pressure on the leg and foot. The Achilles tendon can rupture when the flexed foot sustains a sudden strong force and the calf muscles powerfully shorten. Achilles tendon rupture can also result from tendons weakened over time by Achilles tendonitis (chronic inflammation of the tendon).

SYMPTOMS

A loud “pop” may be heard when the Achilles tendon ruptures. Most individuals feel a sudden painful “snap” in the back of the calf or lower leg followed by sharp severe pain. Swelling and skin discoloration in the back of the calf will often develop because of bleeding beneath the skin. Individuals are unable to point their feet downward or raise their heels upward making it difficult to walk, jump, stand on their toes, and climb stairs.

DIAGNOSIS

In order to diagnose an Achilles tendon rupture, a physician will perform an examination and review the individual’s medical history. The Thompson Test is the most reliable physical examination to confirm a suspected Achilles tendon rupture. The test is simple to perform. The individual lies face down with the leg straight. The physician squeezes the calf muscles in the leg. If the foot does not point, the Achilles tendon may have ruptured. The foot will not be able to point because the tendon connecting the calf muscles at the heel is torn. Some physicians may order medical imaging tests, such as ultrasound or Magnetic Resonance Imaging (MRI), to determine the location and type of tendon tear. An ultrasound uses sound waves to create an image when a device is gently placed on the skin. An MRI provides a very detailed view of body structures. The MRI equipment focuses on the leg area while the individual remains very still. In some cases, x-rays are ordered to assess if the leg or heel bone was injured when the Achilles tendon ruptured.

TREATMENT

Each case of Achilles tendon rupture must be evaluated on an individual basis. It is important for the individual and physician to discuss and determine which treatment options are most appropriate. Treatment for Achilles tendon ruptures can be surgical or nonsurgical.

Surgery is not recommended for inactive individuals or those who are at high risk for complications or cannot tolerate surgery. Treatment for these individuals includes approximately six weeks of casting to allow the tendons to heal, followed by physical therapy. Physical Therapists focus on improving physical functioning by addressing muscle strength, flexibility, endurance, balance, and coordination. This method can be effective, and it avoids the risks, such as infection, associated with surgery

SURGERY

For individuals with active lifestyles and who want to return to strenuous recreational activities, physicians recommend surgery to reattach the torn Achilles tendon. Surgery is generally very effective and the risk of complication is typically low. The surgery will require anesthesia, but can also be performed on an out-patient basis. The surgeon makes a three to four inch opening behind the ankle and reattaches the tendon ends to each other or to the bone. The foot is placed in a pointed position in a splint or short leg cast. The splint or cast is worn for four to six weeks. The individual participates in physical therapy when the healing is complete.

RECOVERY

Individuals with surgical and non-surgical repair have good to excellent rates of returning to full activity levels with proper treatment and rehabilitation. The length of time for healing is highly variable. Generally, individuals with surgical repair can return to walking and swimming at six weeks, and gradually return to sports several months from the surgery. They have a lower risk of repeated tendon rupture and a better chance of regaining full strength in the leg. Individuals with non-surgical repair will often participate in rehabilitation for a longer period of time. They have a higher risk of repeated tendon rupture and loss of strength.

Ankle Replacement

Total ankle replacement surgery, or ankle arthroplasty, can improve ankle function and relieve severe pain caused by arthritis and other conditions. As more FDA-approved ankle implants have become available, ankle replacement has become the preferred alternative to ankle fusion. People with severe ankle pain from injuries or arthritis are ideal candidates for ankle replacement surgery.

ANATOMY

Your feet and ankles are extremely complex, including 26 bones, 33 joints, 107 ligaments, and 19 muscles. The ankle joint is where the leg and foot bones meet. The bones are coated with a smooth material called cartilage, and surrounded by strong ligaments. The cartilage minimizes friction as the bones glide on each other. The ligaments are bands of supportive tissue that provide stability and flexibility for range of motion, which is necessary for walking, running, and other activities.

CAUSES

The need for ankle replacement is usually severe arthritis or injury. When cartilage is damaged because of injury or arthritis, the result is pain and swelling in the ankle area. According to the American Academy of Orthopedic Surgeons, about 2 million Americans visit the doctor for ankle pain caused by arthritis or fractures every year. Thousands of people suffer from disabling ankle arthritis, where the cartilage is worn away almost completely. Ankle injuries are common in sports or exercise, because of the added stress on the joint. A history of ankle fractures, osteoarthritis, rheumatoid arthritis, and even obesity can increase your risk for ankle replacement.

SYMPTOMS

Common symptoms of ankle arthritis or injury include pain, swelling, stiffness, and tenderness around the ankle. You may also notice weakness or instability when you try to put weight on the ankle or foot, making it difficult to stand or walk. In cases of arthritis, the symptoms usually get progressively worse over time. In cases of injury, the symptoms may appear immediately or within a few hours.

DIAGNOSIS

A physical examination of your ankle is the first step in diagnosis. The doctor will evaluate your range of motion and the amount of pain and swelling you are experiencing. Gentle pressure may be applied to pinpoint the source of your pain. An x-ray will be used to look for fractures, bone spurs, and damage to the cartilage. MRI or CAT scans are sometimes needed to gain more information on the condition of your ankle. Your primary doctor can do a basic evaluation, but a certified foot/ankle surgeon is the most qualified to diagnose these conditions.

TREATMENT

If rest, heat/ice therapy, physical therapy, and anti-inflammatory medication do not improve your symptoms, consulting with an orthopedic surgeon who specializes in foot/ankle conditions is recommended. If the surgeon finds evidence of a poorly healed complex fracture or advanced (end-stage) arthritis, you may need ankle arthroscopy, ankle fusion, or a total ankle replacement.

Ankle arthroscopy can treat soft tissue injuries and minor arthritis, but severe ankle arthritis should be addressed by fusion or replacement. Ankle fusion will reduce the range of motion in your ankle, but for many cases of ankle arthritis, total ankle replacement is appropriate.

Ankle replacements have been around for decades, but early designs had limited success due to the complexity of the anatomy. Modern ankle replacements have made the surgery more successful. Orthopedic surgeons can match patients with an implant specifically designed to fit their ankle, which leads to better surgical outcomes and quality of life after ankle replacement surgery.

SURGERY

Total ankle replacement is also known as total ankle arthroplasty, or TAA. The procedure involves rebuilding the ankle joint with metal and plastic components. Additional surgery on tendons may also be done to improve the range of motion in your ankle. The surgery can sometimes be performed as an outpatient. Surgery is followed by post-operative rehabilitation.

You might be a candidate for ankle arthroplasty if you have osteoarthritis or rheumatoid arthritis that does not respond to conservative management; or if you need an ankle fusion but want to maintain full range of motion in your joint.

RECOVERY

After surgery, you will work with a physical therapist to gradually strengthen and condition your ankle and return to your desired activity level. Most people make a full recovery within 6 to 12 months after surgery. Ankle replacement surgery enables you to achieve range of motion, increase function, and return to a more active lifestyle, with little or no pain. Thanks to improvements in modern ankle implants and techniques, ankle replacement surgery results have greatly improved.

Heel Pain

Your heels bear tons of pressure each day when you stand and walk.  It’s no wonder that heel pain is a common complaint. Heel pain occurs for a variety of reasons, from wearing the wrong type of shoes to abnormal growths or tendon problems. Fortunately, most cases of heel pain can be treated without surgery. Talk to you doctor if you have heel pain. Early diagnosis and treatment can help prevent bigger problems.

ANATOMY

Your heel bone is called the calcaneus. It helps to bear and distribute your body weight across your foot when you stand or walk. Many soft tissues that help move and shape the foot are attached to the calcaneus.

CAUSES

Heel pain occurs for various reasons. Common causes of pain beneath the heel include bruising from stepping on something hard, inflamed connective tissue from overuse (plantar fasciitis), and irritated nerves under the heel. Rubbing from poorly fitted shoes, inflamed connective tissue (bursitis), or an inflamed tendon (Achilles tendon) most frequently cause pain behind the heel.

SYMPTOMS

Symptoms of heel pain vary depending on the cause. It may develop gradually or occur suddenly. It may be accompanied by redness, thickened skin, or swelling.

DIAGNOSIS

Your doctor will review your medical history and examine your heel to determine the cause of your pain. X-rays will be taken to check for bone abnormalities.

TREATMENT

Treatment for heel pain depends on several factors, including the cause and extent of the underlying condition. In many cases, rest, physical therapy, pain relievers, injections, proper shoes, and sole inserts can relieve symptoms. When such treatments fail, surgery may be recommended.

SURGERY

Surgery may be used to relieve pressure from a nerve, remove an abnormal bone growth, or treat an inflamed tendon. Most surgeries for heel pain are performed as outpatient procedures. Following surgery, you will most likely participate in physical therapy to regain strength and motion.

RECOVERY

Recovery is an individualized process and depends on your condition and the treatment you received. Your doctor may recommend that you wear customized shoe inserts or orthopedic shoes. Your doctor will let you know what to expect.

Heel Spurs

Heel spurs are abnormal bony growths that develop at the back of or under the heel. Inflammation around a spur, more so than the spur itself, can cause significant pain. Fortunately, symptoms can be eased with non-surgical treatments for the vast majority of people.

ANATOMY

Your heel bone is called the calcaneus. It helps to bear and distribute your body weight across your foot when you stand or walk. Soft tissues that help move and shape the foot are attached to the calcaneus. One such tissue, the plantar fascia, forms the arch in the foot.

CAUSES

Heel spurs develop in some people that have a condition called plantar fasciitis, inflammation of the plantar fascia. Heel spurs form when the plantar fascia separates from the calcaneus. An abnormal bone growth, a hook-like spur, forms from calcium deposits that grow at the site of inflammation.

Heel spurs are more common in middle-aged adults and people that have had plantar fasciitis for a long time. People with flat feet or high arches are vulnerable to heel spurs. Women who wear high-heeled shoes are more susceptible, as well.

SYMPTOMS

Heel spurs may or may not cause symptoms. Symptoms are usually related to the plantar fasciitis. You may experience significant pain. Your heel pain may be worse in the morning when you first wake up or during certain activities.

DIAGNOSIS

Your doctor will review your medical history and examine your foot. X-rays are used to identify the location and size of the heel spur.

TREATMENT

The majority of heel spurs are treated with non-surgical interventions. These can relieve pain, but may take from about 3 months to up to a year for symptoms to resolve. Rest, icing, and over-the-counter anti-inflammatory or prescription medications can help ease symptoms. Cortisone injections may also be used.

You may be instructed to perform stretching exercises to help relax the tissues in the heel. Your doctor may recommend custom orthotics or shoe inserts to position and cushion your heel. Night splints can help position the heel and arch of the foot while you sleep.

Some doctors may recommend extracorporeal shock wave therapy (ESWT). This treatment uses energy pulses to start the repair process in the heel tissues. ESWT is recommend when other non-surgical treatments have failed.

SURGERY

Surgery is used a very small percentage of the time. It is usually considered after trying non-surgical treatments for at least a year. Plantar fascia release surgery is use to relax the plantar fascia. This surgery is commonly paired with tarsal tunnel release surgery. Surgery is successful for the majority of people.

RECOVERY

Recovery from non-surgical heel spur treatment can take considerable time, usually from three months to a year. However, most doctors agree that non-surgical treatments should be tried for at least one year before considering surgery.

PREVENTION

You can help prevent heel spur symptoms from returning by wearing the proper shoes. Customized orthotics and insoles can help relieve pressure. It is important to perform your exercises to help keep your foot stretched and relaxed.

Plantar Fasciitis

Plantar fasciitis is a painful foot condition. It occurs when connective tissue at the bottom of the foot, called the plantar fascia, is irritated and inflamed. The condition commonly occurs among people who spend a lot of time on their feet. Heel pain that occurs in the morning upon wakening is a hallmark sign of plantar fasciitis. Fortunately, for the majority of people, symptoms are relieved without surgery.

ANATOMY

The plantar fascia is a thick connective tissue located on the bottom of the foot. It extends from the heel to the ball of the foot. The plantar fascia maintains the arch of the foot.

CAUSES

Plantar fasciitis is caused by structural problems in the foot. People with flat feet have an extra long plantar fascia, and people with high arches have a short plantar fascia, which makes them prone to plantar fasciitis. Sudden weight gain, obesity, and prolonged standing or walking on hard surfaces contributes to the condition.

SYMPTOMS

Plantar fasciitis can cause significant heel pain. The pain is usually worse in the morning upon awakening, following rest, or after being on your feet for long periods of time. The pain may subside after walking or stretching, which helps relax the plantar fascia.

Many people with plantar fasciitis develop heel spurs. Heel spurs are abnormal bony growths that form under the heel. They occur as a result of ongoing plantar fascia inflammation or if the plantar fascia pulls away from the bone.

DIAGNOSIS

Your doctor will review your medical history and examine your foot. You should tell your doctor about your symptoms and the amount of time that you spend on your feet. X-rays, bone scans, or magnetic resonance imaging (MRI) scans may be used to give more information about your foot structure and identify the location and size of a heel spur.

TREATMENT

In the majority of cases, plantar fasciitis is treated non-surgically. Rest, ice, and over-the-counter anti-inflammatory or prescription medications can help ease symptoms. Cortisone injections may also be used. It can be helpful to lose weight and not go barefoot.

You may be referred to a physical therapist to learn exercises to stretch and help relax the tissues in the heel. Your doctor may recommend custom orthotics, shoe inserts, or a removable walking cast to help position your foot and cushion your heel. Night splints can help while you sleep.

SURGERY

Surgery is necessary a very small percentage of the time. It may be considered after non-surgical treatments have failed. Plantar fascia release surgery is used to relax the plantar fascia. This surgery is commonly paired with tarsal tunnel release surgery. Surgery is successful for the majority of people.

RECOVERY

The majority of people with plantar fasciitis improve after a few months of non-surgical treatment. It is important to follow your doctor’s instructions. Let your doctor know if your symptoms do not improve after a few months so that your treatment plan can be reassessed.

PREVENTION

Customized orthotics and insoles can help relieve foot pressure. It is important to perform your exercises to help keep your foot stretched and relaxed. Maintaining a healthy weight can help as well.

Morton’s Neuroma

Morton’s Neuroma is a painful foot condition. It occurs when a nerve near the toes becomes compressed and inflamed. If diagnosed early, most cases of Morton’s Neuroma can be treated without surgery. However, surgery for the condition has a high success rate.

ANATOMY

In medical terms, your toes are called digits. They are numbered one through five. The big toe is the first digit, and your little toe is the fifth digit. Nerves travel through your foot to your toes to control movement and sensation.

Morton’s Neuroma develops most often between the third and fourth digits of the foot. This is the area where two nerves join together and become thicker. A ligament (deep transverse metatarsal ligament) holds the bones in the foot together and covers the nerve. Symptoms occur when the nerve is compressed between the ligament and the bottom of the foot.

CAUSES

The exact cause of Morton’s Neuroma is unknown. It results when the tissue surrounding the nerve between the third and fourth toes thickens, swells, and puts pressure on the nerve. Inflammation then develops.

People with bunions, flat feet, and hammertoes are susceptible to developing Morton’s Neuroma. Pressure from standing, walking, jumping and running or wearing high heeled, pointed toe, or tight-fitting shoes can contribute to the condition. High impact sports, such as racquetball, squash, or tennis, can lead to Morton’s Neuroma.

SYMPTOMS

Morton’s Neuroma can cause sharp pain, tingling, numbness, stinging, and burning between the third and fourth toes and the ball of the foot. It may feel as if a lump is inside the ball of your foot or that you have stepped on a bump. Your symptoms may be worse when you stand, walk, or put weight on your foot. Symptoms typically start gradually, come and go, and become worse over time.

DIAGNOSIS

You should contact your doctor if you have the symptoms of Morton’s Neuroma. Early treatment can help avoid future surgery. Your doctor can diagnose Morton’s Neuroma by reviewing your medical history, examining your foot, and taking x-rays.

Your doctor will feel your foot to determine if there are any bumps or masses, and to pinpoint the symptoms. X-rays may be used to rule out other conditions, such as a fracture or arthritis. A magnetic resonance imaging (MRI) scan may be used to learn more about the size and location of the neuroma. 

TREATMENT

There are a variety of treatments for mild to moderate Morton’s Neuroma. The treatment you receive will depend on the severity of your symptoms. Rest, wearing appropriate shoes, and over-the-counter pain medications, such as ibuprofen, can help reduce swelling and pain. Padding or shoe orthotics can help reduce pressure.

If conservative treatments do not provide relief, your doctor may inject your foot. Corticosteroid medication is used to reduce pain and inflammation. Alcohol sclerosing injections are used to harden the nerve area and relieve pain.

SURGERY

Surgery may be recommended when other treatments do not provide symptom relief. There are a couple surgical options for Morton’s Neuroma, release surgery and removal surgery. Release surgery involves making an incision on the top of the foot to access the deep transverse metatarsal ligament that covers the nerve. By making an incision in the ligament, the pressure is released from the nerve.

Removal surgery is performed through the bottom of the foot.  The neuroma is easier to access this way. The neuroma is surgically removed, and the incision is closed with stitches.

RECOVERY

Recovery from surgery depends on the procedure that you received. Because release surgery is performed from the top of the foot, there are no stitches on the bottom of the foot and walking may be resumed soon after the procedure. Because removal surgery uses stitches on the bottom of the foot, you may need to use crutches for a time after surgery. No matter what surgical or nonsurgical treatment you receive, healing is an individualized process, and your doctor will let you know what to expect.

PREVENTION

Contact your doctor if you suspect that you have Morton’s Neuroma. Early diagnosis and treatment can help avoid future surgery. You may help prevent Morton’s Neuroma by modifying your activities to reduce high-pressure repetitive forces to your feet. Wear low heel shoes with wide toe boxes, padding, and orthotics as recommended by your doctor.

Bunion

Bunions are a common foot deformity, especially in females. They most frequently result from wearing shoes that are too small and or have a high heel. Abnormal pressure from poor fitting shoes causes the bones in the big toe and foot to move out of position. This results in a large painful bump on the side of the foot at the big toe.

Simply changing to wide shoes with a low heel can treat some bunions. If non-surgical treatments fail, surgery may be necessary to restore normal alignment, pain-free movement and function. There are numerous surgical techniques for treating bunions, and the majority of people experience good results.

ANATOMY

The base of the bone in your big toe (proximal phalanx) meets with the head of the metatarsal bone in your foot to form the metatarsophalangeal joint. Ligaments connect the two bones together. Tendons attach muscles to the bones and allow movement. The metatarsophalangeal joint bends whenever you walk.

CAUSES

Bunions are a common foot condition. The vast majority of bunions occur in females, but they may develop in males, as well. Most bunions result from pressure caused by shoes that are too small, narrow, pointed, or have a high heel. Bunions can run in families. Arthritis, particularly osteoarthritis, and polio can contribute to bunion formation.

A bunion occurs when the bones at the base of the big toe move out of alignment. The big toe may lean toward or move underneath the second toe. The second toe may move out of alignment and overlap the third toe. Long term irritation causes the base of the big toe to enlarge and a fluid-filled sac may form. This creates a large bump on the side of the foot at the joint.

SYMPTOMS

A bunion causes the base of your big toe to stick out and form a bump on the side of your foot. A bunion can be large, red, swollen, and painful. The skin on the bottom of your foot may thicken and form a painful callus. It may hurt to bend your toe, walk, or wear shoes.

A bunion causes your foot to look different. Your big toe may lean towards your second toe. The first few toes on your foot may lean and overlap. 

DIAGNOSIS

Your doctor can diagnose a bunion after reviewing your medical history, examining your foot, and taking X-rays of your foot. X-rays will show the alignment and condition of your bones. You should tell your doctor about your symptoms and concerns.

TREATMENT

Simply changing shoes may treat some bunions. It is helpful to wear wide-toed shoes with low heels. Good foot care and felt or foam pads worn between the toes or on the foot may help protect the area and prevent further discomfort. Custom-made shoe inserts can help position the toe and relieve pain.

SURGERY

If non-surgical treatments fail, surgery may be necessary to restore normal alignment, pain-free movement and function. Bunion surgery is used to realign the bones, joints, tendons, ligaments, and nerves. The toes are placed in their correct positions and the bony bump is removed. There are numerous surgical techniques for treating bunions. Your doctor will discuss the most appropriate options for you.

Bunion surgery is an outpatient surgical procedure. An ankle-block anesthesia or general anesthesia may be used so that you do not feel pain during the procedure. Following the surgery, the bones are held in position with wires, screws plates, or cast while they heal.

RECOVERY

You should keep your foot elevated the first few days following your surgery, and apply ice packs as directed. A special cast or orthopedic shoe will protect your foot as it heals. You will temporarily need to use crutches, a walker, or cane as you gradually increase the amount of weight you can put on your foot. Physical therapy can help to restore strength and motion. It can take many weeks to recover from bunion surgery. The majority of people have good outcomes.

PREVENTION

You may prevent bunions by wearing shoes that fit correctly. It is beneficial to wear wide, low heel shoes. Following bunion surgery, you can prevent future bunions by wearing the same type of shoes. Wearing improper shoes can cause bunions to recur.

Claw Toe

Claw toe most frequently develops in older women. It causes the joint at the base of the toe to bend upward and the other joints on the toe to bend downward in the shape of a claw. Claw toe may be related to underlying medical conditions or caused from wearing poor fitting shoes. It is important to diagnose and treat claw toe early because the condition tends to become worse over time. Significant cases of claw toe may require surgery to correct the toe joints.

ANATOMY

Your toes are part of your forefoot. They help you balance, walk, and move. Your big toe (hallux) contains two bones (phalanges). Your second through fifth toes contain three bones. Claw toe results when the joint at the base of the toe is bent (contracted) upward and the remaining joints in the toe bend downward, creating the appearance of a curved claw.

CAUSES

People may be born with claw toe or develop the condition later in life for a variety of reasons that are associated with structural changes in the nerves, muscles, or tendons that bend the toes. Alcoholism, diabetes, multiple sclerosis, stroke, Charcot-Marie-Tooth disease, rheumatoid arthritis, spinal cord disorders, and cerebral palsy increase the risk of developing claw toe. It can be an inherited condition for some people. Wearing shoes that are too small or have high heels and pointed toes can contribute to claw toe. In some cases, the cause of claw toe is unknown.

Claw toe is four to five times more common in women than in men. The likelihood of claw toe increases with age. It most frequently develops in adults that are in their 70s or 80s.

SYMPTOMS

Claw toe causes the joint at the base of the toe to bend upward and the remaining joints on the toe to bend downward, even to the point of curling under the foot. The affected toe may be painful or irritated, especially at the base or tip of the toe. Your toenail may be malformed. Areas of thickened skin (corns) may develop on top of the toe and thickened skin (calluses) may appear on the ball of your foot. It may be difficult to find a pair of shoes that is comfortable to wear. Without treatment, claw toe tends to get worse over time, leads to a permanently deformed toe, and interferes with walking.

DIAGNOSIS

Your doctor can diagnose claw toe by reviewing your medical history and examining your foot. X-rays will be taken. In some cases, nerve studies may be conducted.

TREATMENT

Treatments for claw toe depends on its cause and if the toe joints are flexible or rigid. Although treating the underlying medical conditions is important to overall health, it usually does not reverse claw toe. If your toe joints are still flexible, your doctor may recommend specific shoes, cushions, linings, and pads to help absorb force and place your toes in the proper position. You should avoid wearing high heel narrow toed shoes.

Your doctor can safely remove corns and calluses. You should not try to remove them at home.

SURGERY

Surgery may be necessary to correct the angle of rigid or fixed toe joints. Surgery for claw toe is usually an outpatient procedure. Surgery can entail lengthening or transferring tendons, removing cartilage at the end of bones, and using surgical hardware to hold the bones in position. You may need to use crutches or a walker for a short time following surgery.

RECOVERY

Recovery from claw toe surgery can take several weeks. Fresh dressings are applied daily. After about 2 weeks stitches are removed. Surgical pins are removed after about two to four weeks.

PREVENTION

You may help prevent claw toe by taking care of underlying medical conditions that can be treated. Wearing low healed shoes with a roomy toe box can help. Be sure to follow your doctor’s recommendations for using pads or special insoles.

Hammer Toe

Hammertoe most commonly affects the second toe on the foot. It causes the middle joint to bend. Hammertoe is most frequently caused by structural problems in the toe or from wearing poor fitting shoes. It is important to diagnose and treat hammertoe early because the condition tends to become worse over time. If left untreated, hammertoe can require surgery.

ANATOMY

Your toes are part of your forefoot. They help you balance, walk, and move. Your big toe (hallux) contains two bones (phalanges). Your second through fifth toes contain three bones. On these toes, hammertoe results when the middle joint is bent (contracted).

CAUSES

Hammertoe commonly develops because of structural changes that take place over time in the muscles and tendons that bend the toes. People with certain medical conditions, such as diabetes, are at risk for developing hammertoe. It can be an inherited condition for some people. Other causes include trauma and wearing shoes that are too tight, narrow, or have high heels. The toe next to the big toe (second toe) is most frequently affected by hammertoe.

SYMPTOMS

The symptoms of hammertoe are progressive, meaning that they get worse over time. Hammertoe causes the middle joint on the second, third, fourth, or fifth toes to bend. The affected toe may be painful or irritated, especially when you wear shoes. Areas of thickened skin (corns) may develop between, on top of, or at the end of your toes. Thickened skin (calluses) may also appear on the bottom of your toe or the ball of your foot. It may be difficult to find a pair of shoes that is comfortable to wear.

DIAGNOSIS

Your doctor can diagnose hammertoe by reviewing your medical history and examining your foot. In most cases, X-rays are taken.

TREATMENT

There are many non-surgical treatments to help relieve symptoms of hammertoe. The first step for many people is wearing the right size and type of shoe. Low-heeled shoes with a boxy or roomy toe area are helpful. Cushioned insoles, customized orthopedic inserts, and pads can provided relief as well. Splints or straps may be used to help correct toe position. Your doctor may show you toe stretches and exercises to perform. Your doctor can safely remove corns and calluses. You should not try to remove them at home.

SURGERY

Surgery is used when other types of treatment fail to relieve symptoms or for advanced cases of hammertoe. There are several types of surgeries to treat hammertoe. A small piece of bone may be removed from the joint (arthroplasty). The toe joint may be fused to straighten it (arthrodesis). Surgical hardware, such as a pin, may be used to hold the bones in place while they heal. Other types of surgery involve removing skin (wedging) or correcting muscles and tendons to balance the joint.

RECOVERY

Recovery from non-surgical and surgical treatment for hammertoe is individualized. Recovery can depend on several factors, including the cause and extent of your condition and the type of treatment you received. Your doctor will let you know what to expect.

PREVENTION

It is important to visit a foot specialist if you develop hammertoe. Early treatment can help prevent future deformities. Hammertoe that is not treated can become worse over time, requiring surgery.

Shin Splints

Shin splints is a term to describe pain at the front or lower inside edge of the leg. The pain is most frequently caused by muscle overuse, improper form when exercising, or wearing the wrong type of athletic shoes. Most cases of shin splints resolve with rest. In rare cases, surgery may be necessary to treat complications from shin splints.

ANATOMY

Your leg contains two bones. The larger bone is the tibia, and the thinner bone is the fibula. The tibialis anterior muscle connects at the front of the tibia. You use your tibialis anterior muscle to move your foot upward and control the lowering of your forefoot when you walk. The tibialis posterior muscle attaches at the back inside edge of the tibia and fibula. You use your tibialis posterior muscle to turn your foot inward and down and lift your heal when walking.

CAUSES

Shin splints is the term for pain that occurs on the front or inside edge of the tibia or "shinbone".

The pain occurs when the edge of the tibialis muscles pull away from the bone from repeated stress or overuse. This causes the muscles and the covering of the bone (periosteum) to become inflamed.

Overused muscles from running or jumping most commonly cause shin splints. They can occur in athletes that play sports that require quick starts and stops, such as basketball or tennis. Shin splints commonly occur in people that participate in more athletic activity than their bodies are prepared for. Shin splints can also result from wearing shoes with poor shock absorption or running on hard surfaces.

Shin splints are described as anterior or posterior, depending on the muscle groups involved. Anterior shin splints usually result from using improper form while taking strides or running downhill. Posterior shin splints are typically related to an imbalance in leg muscles or flat feet.

SYMPTOMS

Shin splints cause a dull aching pain on the front or inside lower part of the leg. The pain may increase when you move your legs, climb stairs, or walk. The pain typically goes away with rest and may be worse when you first wake up in the morning. The sore area occasionally appears red and swollen.

DIAGNOSIS

Your doctor can diagnose shin splints after reviewing your medical history and completing a physical examination. You should tell your doctor about your symptoms, exercise activities, and the types of shoes that you wear. X-rays will be ordered to rule out stress fractures. In select cases, a magnetic resonance imaging (MRI) scan may be ordered to show a more detailed view of your tendons and bones.

TREATMENT

The majority of shin splints resolve with rest. It is helpful to stop the activity that caused the condition until your symptoms go away. Anti-inflammatory medication and cold packs may ease your pain. In rare cases, cortisone injections are used to treat pain.

Your doctor may recommend shoes that are appropriate for your sport or activity. If you have flat feet, it may be beneficial to use an arch support. Specialists can fabricate custom made orthotic insoles for your shoes.

Your doctor may refer you to physical therapy for pain control, rehabilitation, and training tips. Physical therapists can provide treatments to reduce your pain. They can teach you how to stretch and strengthen your muscles. You will also learn correct postures and form to improve your running style and suggestions for avoiding muscle overuse.

SURGERY

In rare cases, surgery may be necessary for complications related to shin splints, such as bone avulsion or compartment syndrome. Surgery can be required if part of the bone has torn away and needs repair. A fasciotomy is a surgical procedure used to reduce the pressure in the leg. Most surgeries are followed by a period of physical therapy.

RECOVERY

The recovery process is different for everyone. The length of your recovery period depends on many factors including the extent, type, and location of your injury and the type of treatment that you receive. Your doctor will let you know what to expect.

PREVENTION

You can prevent shin splints by preparing your body before intense exercise with strengthening and conditioning exercises. Rest when you need to and do not overdo it. Instead, increase your exercise program gradually. Use proper form when you walk, jog, or run. It is helpful to exercise on level surfaces that help to absorb impact. Make sure that you are wearing the correct athletic shoes, arch supports, or insoles for your activity.