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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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Hindfoot Conditions

The hindfoot, also known as the heel, is the area between the ankle and the foot's arch. This region is prone to injuries and tendon problems. Dr. Jan-Eric Esway treats a variety of hindfoot conditions, including plantar fasciitis, Achilles tendon rupture and Achilles tendonitis. (Each is described in detail below.)

Plantar Fasciitis

Plantar fasciitis is a condition in which the plantar fascia becomes inflamed, usually due to overuse. The plantar fascia is a thick ligament that runs along the bottom of the foot. Plantar fasciitis typically produces a sharp pain on the bottom of the heel. Discomfort is greatest in the morning and after getting up from rest.

Typical non-surgical treatments include activity modification, therapy that emphasizes stretching and supportive shoes. Today, many patients find that designers create shoes that offer comfort without compromising style. When symptoms persist, limited use of injections can be helpful. If non-surgical treatments fail, surgery is a reasonable treatment option. Dr. Esway performs a minimally invasive procedure known as endoscopic partial plantar fascia release.

Endoscopic partial plantar fascia release is a minimally invasive procedure used to treat plantar fasciitis, which is inflammation of a thick, fibrous band on the bottom of the foot causing heel pain. In this procedure, the inflamed and thickened plantar fascia is released. The surgeon works through two small incisions made on each side of the heel. By using a small camera, similar to those used in arthroscopy, the surgeon is able to visualize and then release the inflamed and thickened plantar fascia. In comparison to traditional plantar fascia surgery, endoscopic release requires less dissection and disruption of normal tissue. This procedure usually achieves an 80 to 100 percent reduction in symptoms with minimal recovery time.

Achilles Tendon Rupture

An Achilles tendon rupture occurs when the Achilles tendon is torn. This injury causes sharp, immediate pain and often happens when athletes play sports that cause them to jump, such as basketball. The Achilles tendon is the strongest in the body and connects the calf to the heel bone.

Surgery is the preferred treatment because it gives the strongest repair, reduces the possibility of recurrence and allows the quickest recovery. After the procedure, a cast typically is required for about four to six weeks. Physical therapy usually begins 10 weeks after surgery and is vital for achieving the best results.

Achilles Tendonitis

Achilles tendonitis is an inflammation of this tendon and usually results from overuse. Symptoms include pain and swelling in the back of the heel, which typically are made worse by activities that stretch the tendon, such as bending over or walking up hills or stairs.

When Achilles tendonitis persists, it can result in thickening of the tendon, a condition called tendonosis. Bone spurs also may occur. Non-surgical treatments include use of anti-inflammatory medicines, immobilization of the tendon with a boot and wearing shoes with heels.

Surgical treatment involves removing the diseased parts of the tendon as well as bone spurs. The tendon is repaired back down to bone with use of bio-absorbable implants. This surgery can lead to excellent outcomes.

Tendon Disorders

In addition to the foregoing conditions, Dr. Esway treats other tendon disorders in this area of the foot, including those of the posterior tibial tendon and the peroneal tendons. The former is located on the inner side of the ankle; the latter are located on the outside of the ankle.

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