Flexor tendons are the tendons on the palm side of the wrist and hand that enable you to bend or flex your fingers and wrist. Flexor tendon injuries are uncommon injuries that usually occur from a traumatic laceration to the palm side of the hand or finger, but can occasionally occur from a trauma without a cut or laceration. In most cases, flexor tendon injuries require surgical treatment to regain motion of the injured finger and maximize long term function.

Causes and risk factors

• A deep cut or laceration in the wrist, palm, or finger
• Closed, hyperextension injury to the finger
• Certain medical conditions, such as rheumatoid arthritis, may place patients at a higher risk of developing a flexor tendon injury

Symptoms

• Pain and swelling in the wrist/palm/hand
• Inability to flex (bend) a digit or one of the joints of a digit

Diagnosis and treatment

In most cases, the diagnosis is made clinically based off your physical examination findings. In rare cases, additional imaging such as MRI or ultrasound is used to confirm the diagnosis. If a flexor tendon is completely lacerated or ruptured, then surgery is generally advised to regain motion and maximize long term function. While overall outcomes with surgery are good, rehabilitation can be lengthy and requires dedicated hand therapy. Most patients will regain the ability to use the affected digit, but the motion may not return to normal. Occasionally patients develop significant scar tissue that can affect their function and may require additional surgery to release.

Distal radius fractures are one of the most common forms of fractures. The break occurs most commonly approximately one inch from the end of the distal radius.

Causes and risk factors

• Falling on an outstretched arm
• Osteoporosis may increase the risk of fracture
• Car accident or bike fall may generate enough force to cause a break

Symptoms

• Immediate pain
• Tenderness in the wrist
• Bruising
• Swelling
• Deformity the wrist

Diagnosis and treatment

Treatment will depend on the severity of the break, and most distal radius fractures are treated non-operatively. If the fracture is significantly displaced and/or unstable, your doctor may discuss surgical treatment with you. In many cases, treatment is patient dependent and varies based on age, activity level and functional goals. Regardless of treatment selected, distal radius fractures generally take 10 – 12 weeks to heal and require a period of immobilization followed by progressive increase in range of motion and activity.

What is posterior tibial tendonitis?

The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot. It holds up the arch and helps support the foot when walking. When the tendon becomes inflamed or torn, it may not be able to provide stability for the arch of the foot and result in flatfoot.

Causes and risk factors

• Overuse from high-impact sports such as soccer or running
• Acute injury from a fall or motor vehicle accident
• More common in women
• More common in middle-age adults and older

Symptoms

• Pain and/or swelling in the inside of the foot and ankle
• Pain worsens with activity
• Sometimes pain is felt on the outside of the ankle if the foot has collapsed due to the heel bone shifting to a new position

Diagnosis and treatment

When diagnosed early most patients with posterior tibial tendonitis can be treated conservatively with rest, ice, anti-inflammatory medications (NSAIDS), orthotics, and/or physical therapy. Your orthopedic surgeon will examine your foot and ankle and look for swelling, a change of shape in the foot, flexibility, and range of motion. Sometimes x-ray is used to confirm the diagnosis. If conservative treatment does not work, surgery may be necessary. The type of surgery depends on where the tendonitis is located and how much tendon is damaged.

What is posterior tibial tendon dysfunction?

Posterior tibial tendon dysfunction is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be able to provide stability and support for the arch of the foot, resulting in flatfoot.

Causes and risk factors

An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed. The tendon can also tear due to overuse. For example, people who do high-impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time.

Posterior tibial tendon dysfunction is more common in women and in people older than 40 years of age. Additional risk factors include obesity, diabetes, and hypertension.

Symptoms

• Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area.
• Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time.
• Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot.

Diagnosis and treatment

Most patients can be treated without surgery, using orthotics and braces. If orthotics and braces do not provide relief, surgery can be an effective way to help with the pain. Surgery might be as simple as removing the inflamed tissue or repairing a simple tear. However, more often than not, surgery is very involved, and many patients will notice some limitation in activity after surgery.

What is peroneal tendonitis?

The peroneal tendons run on the outside of the ankle and connect the lower leg muscles to the foot. These tendons allow the foot to turn outwards and provide stability to the ankle during weight bearing activities. Inflammation of these tendons causes pain and swelling on the back and outside of the ankle. Please refer to the graphic below for a visual of the ankle tendon anatomy.

Causes

• Overuse or rapid increase in training from activities such as running
• Improper footwear
• Recurrent ankle sprains can cause peroneal tendonitis

Risk factors

• Patients with a hindfoot varus posture (heel is slightly turned inwards)
• Patients with high arched feet are more likely to develop peroneal tendonitis
• Patients with tight calves are more likely to develop peroneal tendonitis

Peroneal tendon tear symptoms

• Back and outside ankle pain
• Pain with inversion (turning inward) of the foot
• Feeling of weakness with eversion (turning foot outwards)

Treatment

Most cases of peroneal tendinosis heal without surgery. Your orthopedic surgeon may recommend rest, ice, non-steroidal anti-inflammatory medication (NSAIDS), a walker boot, or physical therapy. New shoes or orthotics may be recommended when the patient resumes activities. If the peroneal tendon has torn and requires surgery, it may need to be cleaned out and repaired. In severe cases, the two tendons may need to be connected surgically to heal.

Neuroma

(Mortons) Neuroma is a benign tumor of the nerve, most commonly occurring between the third and fourth toes. It is the thickening of the nerve tissue as it passes under the ligament connecting the toe bones in the forefoot.

Causes and risk factors

• Irritation
• Trauma
• Excessive pressure on the area
• More likely to occur in women than men

Symptoms

• Usually no visible signs
• Burning in the ball of the foot
• Intensified pain with activity and wearing shoes
• Numbness in the toes

Diagnosis and treatment

Studies have shown that switching to a wider shoe can reduce pressure on the nerve and give it time to heal. Custom shoe inserts may also relieve irritation and reduce pain. If symptoms persist, your orthopedic surgeon may suggest an injection to reduce swelling and inflammation.

What are mallet, hammer or claw toes?

Mallet, hammer, and claw toes are toes that are bent into a deformed position. Most often these seemingly strange and painful looking changes affect the four smaller toes.

• A hammer toe is any of the second, third, or fourth toes that is bent at the middle joint, causing a deformity that looks like a hammer. Initially the toes can be corrected, but if left untreated, surgery is most often needed.
• Claw toe affects the four smaller toes all at once. Here, the bend occurs closer towards the foot at the joint where the toes actually connect to the foot itself. They continue to bend at each joint until the toes actually curl down towards the floor.
• In a mallet toe, the bend occurs at the last joint, on the end of the toe. It most often occurs in the second toe, but can happen in any of the other toes.

Causes and risk factors

• Shoes that do not fit properly (most often too small)
• Muscle imbalance
• Increased pressure on the toes
• Diabetes, rheumatoid arthritis, and stroke

Symptoms

• Pain in the toes and feet
• Corns or calluses on top of the deformed joint
• Difficulty finding comfortable shoes

Diagnosis and treatment

Conventional treatment can be as simple as a new pair of shoes, allowing more room for the toes. An orthopedic surgeon may also prescribe some toe exercises and stretches throughout the day to counteract the tightening joint, and an over-the-counter pain medicine. Your doctor may also recommend using straps, cushions, or corn pads to relieve pain and symptoms.

Osteoarthritis can occur in any joint, when it occurs at the base of the big toe, or metatarsophalangeal joint, it is called hallux rigidus, or stiff big toe. Osteoarthritis is a degenerative joint disease that develops after years of use. When the smooth cartilage that covers the ends of the bones wears down, it leads to joint 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.

Symptoms

Hallux rigidus symptoms can include one or more of the following:

• Pain in the joint
• Increased pain with movement, especially when pushing off the big toe
• Swelling
• Difficulty walking
• Bump develops on top of the foot
• Inability to bend the big toe up or down

Diagnosis

Your orthopedic surgeon will examine your foot for swelling, evidence of bone spurs, and test your range of motion. X-rays are taken to provide a detailed picture of your foot to show the level of cartilage degeneration and the size and location of any bone spurs.

Non-surgical treatment

There is no cure for arthritis, but treatments are designed to relieve pain and restore motion. Non-steroidal anti-inflammatories (NSAIDS) and ice can help relieve swelling and help reduce inflammation in the early stages of hallux rigidus. Lifestyle modifications such as wearing a shoe with a larger toe box and getting a stiff soled shoe with a rocker bottom design to reduce motion in the toe joint can also help relieve pain. Corticosteroid injections can also be effective in reducing inflammation and pain.

Surgical treatment options

Fusing the bones together (arthrodesis) is a very reliable treatment to relieve toe pain when the cartilage loss is severe and walking becomes difficult. In this surgical procedure, the bones of the big toe are attached with a plate and screws. In most people the operation is very successful and pain relief is achieved. However, your toes are designed for movement and the range of motion becomes limited. The recovery from this procedure requires a cast for six weeks, followed by using crutches for another six weeks.

When the damage is not as severe, chielectomy (kI-lek’-toe-me) may be recommended. This surgical procedure involves removing the bone spurs and a portion of the foot bone to make more room for the toe to flex. After surgery, the patient will wear a hard-soled sandal for at least two weeks. The toe and incision may remain swollen for several months after the operation.

A newer treatment option is using an implant called Cartiva. In this procedure, the orthopedic surgeon makes a small incision on the top of the toe and removes damaged bone in the toe joint. The gel-like implant is placed into a small hole in the bone and secured with cement or glue. The implant is made of a smooth organic polymer (plastic) that functions similar to cartilage. It provides a smooth, slippery, weight-bearing surface for the joint. Immediately following surgery, your foot will begin bearing weight in order to regain range of motion. The recovery from the implant procedure requires the patient to wear a soft boot for 2-3 weeks. Patients can begin to resume normal activities 5-6 weeks after surgery in normal footwear.

Each treatment option has risks and benefits that you should discuss with your doctor if you have this condition.

What's a bunion?

A bunion is a painful, bony bump that develops on the inside of the foot at the big toe joint. Bunions may also be referred to as hallux valgus. Bunions begin to form when the big toe joint is forced out of alignment.

Causes and risk factors

• Wearing narrow shoes, forcing toes into an unnatural position
• Heredity
• Inflammatory condition such as rheumatoid arthritis
• Neuromuscular condition such as polio

Symptoms

• Visible bump on the inside of the foot
• Callus or corn on the bump
• Pain and tenderness in the joint area
• Redness and inflammation
• Stiffness and restricted motion in the big toe
• Difficulty walking

Diagnosis and treatment

In most cases bunions are treated without surgery. Nonsurgical treatment of bunions cannot remove the bump but can reduce pain and keep symptoms from worsening. Changes in footwear and added padding to current shoes can help alleviate symptoms and take pressure off the bunion. Ice and nonsteroidal anti-inflammatory medications may also help. If pain continues over time despite changes in footwear, your orthopedic surgeon may discuss surgery to realign the bone, ligaments, tendons, and nerves and put the toe back in correct position.

An ankle sprain happens when the ligaments that support the ankle are forced to stretch beyond their limit. This is a fairly common injury that occurs among people of all ages. They range from mild to severe, depending upon how much damage occurs.

Causes and risk factors

• Running, walking, or cross training on an uneven surface
• Falling and twisting the ankle
• Sports that require cutting actions, creating the ability to roll the foot

Symptoms

• Swelling in the ankle and foot area
• Bruising in the area surrounding affected ankle
• Tenderness to the touch
• Weakness and instability of the ankle joint

Diagnosis and treatment

The majority of all ankle sprains will heal without the need for surgery. Even a complete ligament tear will heal naturally if given the appropriate rest. Rest and protection of the ankle are the initial recommendations for a sprained ankle. Once swelling is reduced, range of motion, strength, and flexibility will be reintroduced through various exercises dictated by your orthopedic specialist.