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THE ANKLE is a complex body part that plays a critical role in mobility and stability. Ankle pain may be due to sprains, arthritis, breaks and tendon problems.
THE FOREFOOT extends from the ball of the foot to the toes. Forefoot pain may be due to bunions, toe deformities and neuromas.
THE MIDFOOT runs from the ball of the foot to the heel and includes the arch. Midfoot pain may be due to arthritis or stress fractures.
THE HINDFOOT, also known as the heel, is the area between the ankle and the foot's arch. Heel pain may be due to plantar fasciitis or Achilles tendon problems.

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Ankle Conditions

The ankle is a complex body part that plays a critical role in the body's mobility and stability. Injuries to this area are common and can cause great difficulties in performing even the simplest of daily tasks. Dr. Esway treats a wide variety of ankle conditions, including ankle sprains, arthritis and ankle breaks. (Each is covered in detail below.)

Ankle Sprains & Instability

Ankle sprains happen when ligaments are stretched or torn. Ligaments are tough fibers that hold bones together. Ankle sprains can range from mild to severe. Ankle sprains are common and occur when the ankle is twisted, rolled or turned.

Surgical treatments are reserved for the most severe sprains. Newer surgical techniques can allow for excellent outcomes. With these procedures, doctors use a donor tendon to replace injured ligaments. This technique has several advantages. It can be performed through small incisions so recovery is faster, and the risk of re-injury is reduced, because the repair is much stronger.

Scar tissue can cause persistent pain after ankle sprains. This tissue forms when the body tries to heal the injured ligaments. When non-operative treatments fail, ankle arthroscopy should be considered. Ankle arthroscopy is a minimally-invasive technique that allows for treatment of several ankle problems through only two small incisions on the front of the ankle. A small camera is inserted through one of the incisions and another device, called a shaver, is inserted through the other incision. After an ankle injury, persistent pain can be caused by scar tissue or cartilage damage. If non-surgical treatments fail, ankle arthroscopy can alleviate symptoms by removing inflammation and scar tissue. Cartilage damage can also be addressed during this procedure. Therapy can begin as early as 10 days after surgery.

Ankle ligament reconstruction is used for people who suffer from chronic ankle sprains and instability. In severe cases, Dr. Esway uses a cadaver tendon to replace the injured ligaments, which is a similar concept to current ACL surgeries in the knee. This has several advantages over older techniques, because it can be performed through small incisions; therefore, recovery is faster, and the risk of re-injury is reduced because the repair is much stronger.

To learn more about advances in ankle sprain treatment, read this article by Dr. Esway and Rachael Ashworth, PA-C.

Fractures

Ankle breaks, also known as fractures, are common. They usually are caused by falls, accidents and twisting injuries. The ankle is composed of three bones - the fibula on the outside, the talus in the middle and the tibia on the inside. Each may fracture individually. More often, however, multiple breaks occur.

Breaks lead to pain, swelling, bruising and an inability to walk or to put weight on the affected foot. The ankle also may have a deformity due to the broken bones shifting from their normal alignment. Non-surgical treatments may be appropriate for minor breaks. Patients may wear a brace, boot or cast while the bone heals.

Severe breaks usually require surgical treatments. Specific options depend on the type and location of the break, and whether or not one or several ankle bones are injured. Generally speaking, the surgeon must realign the bones and then hold them in place using plates and screws while they heal. Recovery time depends on the seriousness of the break. Some breaks heal in about six weeks while others may take months. Most injuries that need surgery also will require physical therapy and exercise to maximize the results of the procedure.

Arthritis

Arthritis is caused by the erosion of cartilage between joints. Cartilage is the smooth, fibrous tissue that covers the ends of bones allowing them to glide over each other. No cure for arthritis exists, but treatment can increase a patient's comfort and mobility.

Generally, arthritis is characterized by pain, stiffness and swelling of the joint. These symptoms usually are worse in the morning and when getting up from rest. Patients with ankle arthritis often have trouble walking on uneven surfaces and playing sports, like soccer and tennis, which require side-to-side movement.

Non-surgical treatment options include physical therapy, anti-inflammatory drugs and use of small braces. Sometimes, injections can be helpful in relieving symptoms.

Surgical treatments vary depending on the condition's severity. These include:

  • Arthroscopic debridement: "Arthroscopic" refers to the surgeon's use of a miniature camera and tiny instruments inserted through two small incisions. This allows the doctor to work in a small space with minimal disruption of tissue and muscle. "Debridement" refers to the removal of inflamed tissue, scar tissue and bone spurs.
  • Fusion, also called arthrodesis: Doctors remove the abnormal cartilage and then use screws to hold the two bones together while they heal. Fusion provides excellent pain relief. Although joint movement is diminished, patients are typically still functional and able to enjoy more activities than they did previously.
  • Joint replacement: A surgeon replaces the diseased ankle joint with an artificial one. Unfortunately, this procedure has not shared the same success as hip and knee replacements. For this reason, insurance plans do not currently cover this procedure. The U.S Food Drug Administration is evaluating new implant designs that may produce better outcomes.
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