Ankle injuries can happen to anyone at any age. Every day approximately 25,000 people injure their ankles in the United States. More than a million people visit emergency rooms each year because of ankle injuries. The most common ankle injuries are sprains and fractures, which involve ligaments and bones in the ankle, but you can also tear or strain a tendon. Ankle injuries are defined by the kind of tissue, bone, ligament, or tendon that is damaged. The ankle is where three bones meet, the tibia and fibula of your lower leg with the talus of your foot. These bones are held together at the ankle joint by ligaments, which are strong elastic bands of connective tissue that keep the bones in place while allowing normal motion. Tendons attach muscles to the bones to do the work of making the ankle and foot move and help keep the joints stable.
A fracture describes a break in one or more of the bones. A sprain is a term that describes damage to ligaments when they are stretched beyond their normal range of motion. A ligament sprain can range from many microscopic tears in the fibers that comprise a ligament to a complete tear or rupture. A strain refers to damage to muscles and tendons as a result of being pulled or stretched too far. Muscle and tendon strains are more common in legs and lower back. In the ankle, there are two tendons that are often strained. These are the peroneal tendons, and they stabilize and protect the ankle. They can become inflamed as a result of overuse or trauma. Acute tendon tears result from a sudden trauma or force. The inflammation of the tendon is then called tendinitis.
If you have an ankle injury, we recommend an evaluation at the Jersey Shore Foot and Leg Center. At our center, we have digital x-ray capability to determine whether any of these bones are broken. In addition to an x-ray of your ankle, we may order other imaging scans such as an MRI and CAT scan. Also, if you happen to go to an emergency room at either Community Memorial Center, Jersey Shore University Medical Center, Monmouth South, Southern Ocean Medical Center, or JFK University Medical Center, as a physician who is on staff at these hospitals we can easily be called to the emergency room to see you at that location. If you do go to an urgent care center they will call us with your diagnosis, and we can coordinate treatment at that point, after which time fractures can be treated either surgically or nonsurgically. Most ligament damage and ligament sprains are treated nonsurgically.
Treatment of Fractures
Again, after x-rays, MRI evaluation, CAT scan evaluation, and physical examination, treatment of ankle fractures can be surgical or nonsurgical. In surgical intervention the ankle is made stable by utilizing a metal plate and/or screws to hold the bones in place, after which time it usually takes 6-8 weeks for the bone to heal, and it could take up to two years to completely recover full pain-free range of motion and strength after an ankle fracture, although most people are able to resume their normal daily routine within 3-4 months.
Treatment of Sprains
Treatment of sprains depends on the severity of the injury. They are graded as mild, moderate, and severe, and surgery is usually not a treatment option unless the damage is extensive, involving severe instability. Mild sprains can be treated with rest, ice, and compression and elevation. For a more moderate sprain, we may use a device such as a boot or a splint or a walking cast and utilize physical therapy. A more severe sprain may be immobilized in a cast for a longer period of time, after which time physical therapy would be considered. The possibility of instability after a very severe sprain may necessitate surgical intervention to reconstruct the torn ligaments.
The treatment for tendon strains and injury is similar to the treatment options and protocols for ankle sprains.
In conclusion, at the Jersey Shore Foot and Leg Center, we have been treating ankle fractures and sprains and tendon injuries for over 25 years. At the current time, we are on call for foot and ankle trauma at Community Memorial Hospital. If you go to any emergency room in the area, I am on staff, and you have the right to ask for the staff to contact me for your care. If you go to an urgent care center you may ask them to refer or call my emergency service, and we can transfer care to my service. We have the ability to operate if you need to have surgery to repair the ankle fracture or foot fracture, at Community Hospital, Jersey Shore University Medical Center, Monmouth South, JFK University Medical Center, and Southern Ocean Medical Center.
In sum, at Jersey Shore Foot and Leg Center, we not only take care of ankle fractures, but all fractures of the lower extremity, any type of foot fracture, and we do treat pediatric lower extremity fractures. If you do have a fracture, we strongly recommend that you call us for a second opinion, especially with pediatric fractures, as due to the open growth plates, they have significant potential for long-term sequelae.
Heel pain Syndrome
Heel pain is pain that is localized to the bottom heel area. The condition is sometimes known as heel spur syndrome. Although heel spurs are oftentimes painless, they can cause heel pain. They are frequently associated with plantar fasciitis, a painful inflammation of the fibrous band of connective tissue that runs along the bottom of the foot and connects the heel bone to the ball of the foot. Treatment options for heel spurs include physical therapy, custom-made orthotics, anti-inflammatories, medications, cortisone injections. If conservative treatment fails, surgery may be necessary.
Heel pain syndrome can be associated with intermittent or chronic pain. Many times the pain is worse in the morning with the first couple of steps, eases up somewhat, by the end of the day hurting again. Many times patients will state that they will be sitting in their car, driving for quite a distance, and the first couple of steps out of the car are quite painful. Many people describe the pain of heel spur and plantar fasciitis as a knife or pin sticking into the bottom of the feet when they first stand up in the morning, pain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.
If you have heel pain that persists more than a month, consult a health care provider. He or she may recommend conservative treatment such as shoe modification, offloading devices which are orthotic devices, physical therapy, stretching exercises, and cortisone injections into the area. At Jersey Shore Foot and Leg Center, more than 90% of the people get better with nonsurgical treatment. If conservative treatment fails to treat symptoms of heel pain after a period of 3-6 months, surgery may be necessary to relieve the pain of the area. Surgical techniques include the release of the plantar fascia and removal of the spur. There are many techniques that have been developed over the years for surgical intervention of the heel spur and plantar fasciitis. These techniques can be discussed with the doctor at Jersey Shore Foot and Leg Center with regard to the prognosis and outcomes.
In summary, heel pain is a very common complaint that is seen in the office. Most of the time it is related to inflammation of the plantar fascia and heel spur. Conservative therapy of physical therapy, injections, and offloading devices which are orthotics alleviate the symptoms, and this is in approximately 90% of the people. If the patient does not get better, surgical intervention is certainly a possibility. We have multiple techniques that we do, depending on the patient’s situation. Many patients are concerned about the injection. In our office, we use a very gentle technique, with most people describing it as not painful at all. Again, this can be discussed with the doctor during the appointment.
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A podiatrist, also called a doctor of podiatric medicine, is a specialist who provides medical diagnosis and treatment of foot, ankle and lower leg problems, such as bunions, heel pain, spurs, hammertoes, neuromas, ingrown toenails, warts, corns and calluses. A podiatrist also renders care of sprains, fractures, infections, and injuries of the foot, ankle and heel. In addition to undergraduate medical school training, podiatrists also attend graduate school for a doctorate degree in podiatry. Podiatrists are required to take state and national exams, as well as be licensed by the state in which they practice.
People call a doctor of podiatry for help diagnosing and treating a wide array of foot, ankle and lower leg problems. Please contact our office if you experience one of the following:
- Persistent pain in your feet or ankles.
- Changes in the nails or skin on your foot, ankle and lower leg.
- Severe cracking, scaling, or peeling on the heel, foot, ankle or lower leg.
- Blisters on your feet.
The foot is made up of 26 bones, 33 joints, 107 ligaments, 19 muscles, and numerous tendons. Complex biomechanics keep all these parts in the right position and moving together. Given these intricacies, it is not surprising that most people will experience some problem with their feet at some time in their lives.
Foot, ankle and lower leg problems usually fall into the following categories:
- Acquired from improper footwear, physical stress, or small mechanical changes within the foot.
- Arthritic foot problems, which typically involve one or more joints.
- Congenital foot problems, which occur at birth and are generally inherited.
- Infectious foot problems, which are caused by bacterial, viral, or fungal problems.
- Neoplastic disorders, also known as tumors, which are the result of abnormal growth of tissue anywhere on the foot and may be benign or malignant.
- Traumatic foot problems, which are associated with foot, ankle and lower leg injuries, such as fractures.
Don't ignore foot pain. It is not normal. If you experience any type of persistent pain in the foot or ankle, please contact our office.
Most individuals will experience foot pain at some point in time during their lives. Foot pain is caused by a wide variety of injuries, health problems or disorders, including (but not limited to):
The American Podiatric Medical Association (APMA) stresses the importance of foot care in exercising. People don't realize the tremendous pressure that is put on their feet while exercising. For example, a 150-pound jogger puts more than 150 tons of impact on his or her feet when running three miles. The APMA also reports that improper foot care during exercise is a contributing factor to some of the more than 300 foot ailments.
Inspect your feet regularly. Pay attention to changes in color and temperature. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet could indicate Athlete's Foot. Any growth on the foot is not considered normal.
Understanding the basic construction of shoes will help you make more informed decisions and select shoes that fit your foot and needs.