The foot and ankle are complex structures used in nearly every form of human movement. They provide support, shock absorption, and balance. There are three bones that make up the ankle joint: the tibia, fibula, and talus. The ankle joint allows the foot to flex and extend. There are a total of 28 bones in the foot, and more than 30 joints that allow for a wide range of movement. Tough bands of tissue called ligaments are located on either side of the ankle joint to provide stability. Muscles and tendons are also located throughout the foot to allow for motion and to support the joints.
Cartilage covers the ends of the bones, allowing the bones to glide smoothly during movement. Loss of the cartilage due to arthritis can produce pain, stiffness, and swelling. When the bones begin to grind on each other it can result in constant pain during standing or walking, and loss of mobility.
Ankle arthritis
There are three common forms of arthritis that affect the ankle joint. Osteoarthritis is common in older adults. It is also known as degenerative or “wear and tear” arthritis. The protective cartilage wears away over time, resulting in bone rubbing on bone and ankle pain. Rheumatoid arthritis is an autoimmune disease where the immune cells attack the joint lining. It can also attack the ligaments and tendons and cause serious joint disability. Posttraumatic arthritis often occurs after an injury to the foot or ankle, such as motor vehicle accident or sports injury.
Symptoms
Ankle arthritis symptoms can include one or more of the following:
Swelling and tenderness
Increased pain with movement, in the morning, or after sitting
Pain flares up with activity
Difficulty in walking
Diagnosis and treatment
Your orthopedic surgeon will examine your foot and ankle for swelling and tenderness, do a gait analysis, and ask about your medical history. Generally, x-rays are taken to provide a detailed picture of your foot and ankle structure. There is no cure for arthritis, but treatments are designed to relieve pain and restore motion.
Nonsurgical treatments include modifying your lifestyle, physical therapy, braces, orthotics, and non-steroidal anti-inflammatories (NSAIDS). If your pain is not relieved with conservative treatments, your doctor may recommend a total ankle replacement.
Total Ankle Replacement
Ankle replacements offer patients more mobility than fusion and relieves the pain of arthritis. The prostheses is modeled after human anatomy and helps to reproduce natural movement of the ankle. Your orthopedic surgeon will make an incision on the front of the ankle. The diseased cartilage and bone are then removed from the tibia and talus. Lastly, a metal and plastic implant is inserted. Sometimes additional procedures are performed depending on the extent of your arthritis and ankle injuries.
Full recovery can take from 6-12 months, but most people can resume daily activities within two weeks. Your movement will be restricted for 6-8 weeks, and then you will start physical therapy to restore strength and range of motion. Your doctor will advise you on other restrictions depending on your lifestyle and goals.
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What is spondylolisthesis?
Spondylolisthesis occurs when one vertebrae slips forward out of alignment, usually in the lumbar spine. It is one of the most common causes of persistent back pain in children and adolescents.
Causes and risk factors
Spondylolisthesis is most commonly caused in adults by osteoarthritis. In children, it is usually due to a genetic condition or overuse. Individuals that participate in sports such as gymnastics, weight lifting, and football are at higher risk due to the stress on the spine and repeated hyperextension required.
Symptoms
The symptoms of spondylolisthesis vary greatly and it may or may not cause back pain. If pain is present, it may only be during certain activities or positions. It may also include muscle tightness, stiffness, tenderness, and pain in the thighs and buttocks. If the disk slips too far forward, the bones may begin to press on nerves and cause pain that radiates, numbness, and weakness in the leg or arm.
Treatment
Treatment for spondylolisthesis usually begins with a back brace, anti-inflammatory medication, and physical therapy. If conservative options fail to provide relief of symptoms or the vertebrae slips further, your neurosurgeon may recommend spinal fusion surgery to stabilize the spine.
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What is spinal stenosis?
Spinal stenosis is a condition in which the spinal canal narrows. This puts pressure on the spinal cord and the spinal nerves, leading to low back pain that radiates down into the legs and buttocks. It can be caused by herniated discs, arthritis, spinal injury, tumors, or bone disease. It is most common in older adults, resulting from a combination of aging and degeneration of the spine.
Symptoms
The most common symptoms are lumbar pain, numbness, or tingling in the neck, shoulders, arms, buttocks, back, or thighs. Weakness in one part of the leg or arm is also common. When stenosis is located in the lower back, it can also affect posture, gait, and bladder and bowel function. While many patients note some relief when sitting and leaning forward, standing and walking may bring on severe pain and weakness.
Causes and risk factors
Arthritis is the most common cause of spinal stenosis due to degeneration. Anything that narrows the spinal canal makes the spinal cord and nerves vulnerable to pressure that causes irritation and inflammation. Other conditions that can narrow the spinal canal include herniated discs, arthritis, swollen ligaments, bone spurs, and spondylolisthesis. A small number of people who have a narrow spinal canal from birth are at risk for developing stenosis earlier in life.
Treatment
Diagnosing spinal stenosis requires several tests. In addition to a detailed medical history, your doctor will complete a physical exam and diagnostic tests such as x-ray or magnetic resonance imaging (MRI). These tests can help the physician rule out other conditions and provide you with an accurate diagnosis.
Back pain from spinal stenosis may be alleviated with conservative care, such as anti-inflammatory pain medications, physical therapy, steroid injections, acupuncture, or chiropractic manipulation. These nonsurgical treatments do not improve the narrowing of the spinal canal, but they can relieve pain, especially in early stages.
When surgery is necessary, the main goal is to remove the pressure on the nerve roots in the lumbar spinal canal. There are two main surgical options to consider: laminectomy or spinal fusion. Your neurosurgeon will discuss the advantages and disadvantages of both with you. In a laminectomy, your surgeon will enlarge the tube of the spinal canal and remove any bone spurs that are pushing into the nerve roots to decompress the lumbar spine. If arthritis has progressed to cause instability in the spine, spinal fusion may be performed to eliminate motion between painful vertebrae and fuse them together into one solid bone.
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What's a sacroiliac (SI) joint?
The sacroiliac joint (SI joint) is located in the pelvis; it links the iliac bones (pelvis) to the sacrum (lowest part of the spine above the tailbone). It is an essential component for energy transfer between the legs and the torso.
Symptoms
Lower back pain (below L5)
Sensation in lower extremity; pain, numbness, tingling, weakness
Pelvis/buttock pain
Hip/groin pain
Feeling of leg instability (buckling, giving way)
Disturbed sleep patterns due to pain
Disturbed sitting patterns (unable to sit for long periods, sitting on one side)
Pain when going from sitting to standing
Causes and risk factors
Trauma and degeneration are two leading causes of SI joint dysfunction. Sacroiliac joint trauma can occur during motor vehicle accidents, falls on the buttocks, lifting and/or twisting, pregnancy and childbirth. Sacroiliac joint degeneration can occur as a result of previous lumbar spine surgery, stresses to the SI Joint due to leg length differences, osteoarthritis, and prior infection of the SI joint.
Treatment
Once the SI joint is confirmed as the cause of your symptoms, treatment can begin. Some patients respond well to physical therapy, use of oral medications, or injection therapy. These treatments are often performed repetitively, and frequently symptom improvement using these therapies is temporary. If non-surgical treatment options have been tried and do not provide long-term relief, your surgeon may consider other options, including the minimally invasive iFuse procedure.
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What is sciatica?
A herniated disc in your spinal column that is pressing on the nerve roots in the lumbar spine may cause a condition called sciatica. Sciatica causes sudden low back pain or hip pain, and radiates to your buttock, thigh and leg.
Symptoms
Sciatica can cause sharp, burning or “pins and needles” sensations that radiates down your legs. This feeling can last for weeks before it goes away. Sometimes the pain worsens when you move, sneeze, or cough. This condition can be acute or recurring.
Causes and risk factors
Sciatica is most commonly caused by a herniated disc. Generally affecting people between 30 and 50 years of age, sciatica may occur as a result of osteoarthritis or the general wear and tear of aging.
Treatment
Symptoms range from mild to severe and can sometimes go away on their own. Treatment may include rest, applying hot or cold packs, stretching, walking, anti-inflammatory medication, epidural injection and/or physical therapy. Surgery may be recommended for extreme cases in which the compressed nerve results in disabling leg pain that is not resolved with nonsurgical treatments.
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What is a herniated disc?
A herniated or “slipped” disc is a common injury that can affect any part of the spine. It can cause severe back pain and other problems in the arms or legs. According to the American Academy of Orthopedic Surgeons, approximately one in every fifty people will experience a slipped disc at some point in their life. Of these, 10% to 25% have symptoms that last more than six weeks.
Vertebral discs are flexible, rubbery cushions that support the vertebral bones. Each disc has a jelly-like center (nucleus) that is surrounded by a tough outer ring (annulus). A disc herniates when its nucleus pushes against the outer ring and puts pressure on the sensitive spinal nerves, causing back pain. Because a herniated disc in the low back often puts pressure on the nerve root leading to the leg and foot, pain often occurs in the buttock and down the leg. This is called sciatica.
Symptoms
Some herniated discs cause no symptoms, and a person may not realize the disc is damaged. But a herniated disc can also cause severe back pain, numbness or tingling, and weakness. Most herniated discs occur in the lower back, where they can cause symptoms in the buttocks, legs, and feet. Herniated discs also occur in the neck, where they can cause symptoms in the shoulders, arms, and hands.
Causes and risk factors
A herniated disc often occurs with lifting, pulling, bending, or twisting movements. They can also result from age-related weakening of the spinal discs. This is called disc degeneration, and it can occur gradually over many years as a result of normal wear and tear on the spine.
Treatment
This condition may first be treated with pain-relieving medications, muscle relaxers, corticosteroid injections, or physical therapy. Your neurosurgeon may recommend lumbar microdiscectomy, one of the most common surgeries to alleviate back pain from ruptured, slipped, or bulging disks, if other treatment methods have been tried and failed.
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What is a compression fracture?
Fractures caused by osteoporosis most often occur in the spine and are called vertebral compression fractures. These fractures commonly occur in the lower thoracic and upper lumbar regions. According to the American Academy of Orthopedic Surgeons, they occur in nearly 700,000 patients each year. They are almost twice as common as other fractures typically linked to osteoporosis, such as broken hips and wrists.
Symptoms
A vertebral compression fracture causes back pain, typically near where the break occurs. They most commonly occur near the waistline. The back pain often gets worse with standing or sitting for a period of time. As osteoporosis progresses, another symptom can be a forward curving of the spine (“dowagers hump”) that results in a hunched appearance and the loss of height. Symptoms may also include a loss of range of motion and reduction of sensation in the extremities.
Causes and risk factors
Most compression fractures develop because of osteoporosis, which is a loss of bone density that causes your bones to become weak and brittle. If you have osteoporosis, routine daily activities such as bending down or coughing can gradually damage your vertebrae. Compression fractures can also caused by traumatic injury or by cancer of the spine.
Treatment
Treatment options may include rest, pain medication, and physical therapy. If your doctor has also diagnosed osteoporosis, you are at an increased risk for additional vertebral compression fractures and other fractures, such as to the hip and wrist. Your doctor will address treatments for bone density loss during this time. If you have severe back pain and these options are not successful, procedures such as vertebroplasty or kyphoplasty may be used to stabilize the fracture and prevent further collapse of the bone.
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What is a cervical radiculopathy?
Cervical radiculopathy, also known as a pinched nerve, is a condition caused by an irritation or compression of nerve roots in the cervical spine. Because these nerves travel to the shoulders, arms, and hands, it can cause numbness, tingling, or weakness in these areas.
Causes and risk factors
Degenerative disc disease
Osteoarthritis
Herniated disc
Spinal stenosis
Symptoms
Numbness, tingling, or weakness in the hand or fingers
Weakness in the arm, shoulder, or hand muscles
Loss of sensation
Pain decreases when hands placed on top of head
Diagnosis and treatment
Cervical radiculopathy typically responds well to nonsurgical treatment. After a physical exam, your physician may use imaging such as x-ray or MRI to help diagnose the condition. An EMG or Nerve Conduction Study will help confirm if your symptoms are caused by too much pressure on the nerve. Physical therapy and nonsteroidal anti-inflammatories are often the initial treatment for cervical radiculopathy. Steroid injections can help alleviate swelling and relieve your neck pain to allow the nerve to recover. If this does not relieve the symptoms, your doctor may recommend surgery.
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Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen.
Causes and risk factors
Repetitive high stress forces on the joint can result in a series of minor injuries on the elbow that can eventually lead to bony fragmentation and ultimately detachment of the bony fragment from the bone. Commonly seen in the adolescent sporting population; who partake in repetitive throwing or overhead activities such as baseball and gymnastics. More frequently seen in males (ages 10-14) than females and often affecting the dominant arm.
Symptoms
Lateral Pain over the joint
Stiffness
Feeling of instability
Stiffness after resting
Locking
Giving way
Popping/clicking
Treatment
In most cases, OCD lesions in children and young teens will heal on their own, especially when the body still has a great deal of growing to do. Resting and avoiding vigorous sports until symptoms resolve will often relieve pain and swelling. There are different surgical techniques for treating OCD, depending upon the individual case.
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Mallet finger is an injury to the thin tendon that straightens the end joint of a finger or thumb.
Causes and risk factors
Although it is also known as “baseball finger,” this injury can happen to anyone when an unyielding object (like a ball) strikes the tip of a finger or thumb and forces it to bend further than it is intended to go. As a result, you are not able to straighten the tip of your finger or thumb on your own.
Symptoms
The finger is usually painful, swollen, and bruised. The fingertip will droop noticeably and will straighten only if you push it up with your other hand.
Diagnosis and treatment
A mallet finger injury requires medical treatment to ensure the finger regains as much function as possible. Most doctors recommend seeking treatment within a week of injury. However, there have been cases in which treatment was delayed for as long as a month after injury and full healing was still achieved.
