Ankle and foot problems might be treated by both orthopedic surgeons and podiatrists with some exceptions. Orthopedic specialists will treat Achilles tendinitis and tendinosis, broken bones, fractures, and sprains, osteoarthritis, ligament tears, Lisfranc injury or midfoot injury to the ligaments and bones, metatarsalgia foot pain (ball of the foot), plantar fasciitis, and plantar fibroma and fibromatosis, which are benign nodules on the bottom of the foot.
Foot and ankle problems can originate in the knee, hip, or lower back so they will be involved in those situations. Acute pain can shoot up the leg when ankle problems occur. Interventional pain management specialists in New Jersey can help in any type of pain in the muscles, ligaments, bones, tendons, and especially the spine.
The Achilles tendon is a strong, fibrous band that connects the calf muscles to the heel. When the muscles contract, they pull on the Achilles tendon causing your foot to point down and helping you raise up on your toes, sprint, jump, or climb. Several different problems can affect the Achilles tendon
Tendocalcaneal Bursitis: A bursa is a fluid-filled sac designed to limit friction between rubbing parts. Tendocalcaneal bursitis is an inflammation in the bursa behind the heel bone, limiting the Achilles tendon movement.
Achilles Tendinitis: A violent strain can cause injury to the calf muscles or the Achilles tendon. This can happen during a strong contraction of the muscle, as when running or sprinting.
Achilles Tendon Rupture: In severe cases, the force may rupture the tendon. The classic example is the middle-aged tennis player or “weekend warrior” who places too much stress on the tendon and experiences a rupture of the tendon.
Tendocalcaneal bursitis begins with pain, irritation, and swelling at the back of the heel. Achilles tendinitis usually occurs farther up the leg, just above the heel bone itself. Pain is present with walking or touching the area.
Achilles tendon rupture is usually an unmistakable event. Sometimes a snap can be heard, and the victim of a rupture usually describes a sensation like “someone kicked me in the calf.” Following rupture there can be swelling in the calf and usually the patient cannot rise up on the toes. This results in severe nociceptive pain and is the most common type of pain.
Commonly called a ‘heel spur,’ plantar fasciitis is where the plantar fascia (a structure that runs from the front of the heel bone (calcaneus) to the ball of the foot) becomes injured. This dense strip of tissue helps to support the longitudinal arch of the foot by acting similar to the string on a bow. Small tears of the tendon can result, and although the body often heals itself, repeated injury and repair causes a bone spur to form in the hopes of firmly attaching the fascia to the bone.
This condition causes pain on the bottom or center of the heel when putting weight on the foot. This is usually most pronounced in the morning when the foot is first placed on the floor. Other patients will complain of pain when standing after a brief rest of sitting.
Osteochondritis dissecans occurs at the top of the talus. Most of these lesions are thought to be caused by injury to the bone underneath the joint surface by a twisting injury. Some are actual chip type fractures, while others may result from injury to the bone’s blood supply causing an area of the bone to actually die.
Osteochondritis dissecans can cause swelling and a generalized ache in the ankle. There may also be a “catching” sensation with the ankle in certain positions.
Posterior Tibial Tendonitis
The posterior tibial tendon runs behind the inside bump on the ankle, across the instep, and into the bottom of the foot. The tendon is important in supporting the arch of the foot and helps turn the foot inward during walking. As we age, the tendon is subject to degeneration within the tendon. The normal arrangement of the fibers of the tendon becomes jumbled and the tendon loses strength. This condition is called tendinosis.
The symptoms of tendinitis of the posterior tibial tendon include pain in the instep area of the foot and swelling along the course of the tendon. In some cases the tendon may actually rupture due the weakening of the tendon by the inflammatory process.