Surgical Services - Integrated Foot and Ankle

Chronic exertional compartment syndrome (CECS) is a musculoskeletal condition that occurs when exercise causes increased pressure within specific muscle compartments, most commonly in the lower legs. Symptoms include pain, tightness, numbness, weakness, and occasionally swelling during exercise. Pain typically subsides within 15 minutes of stopping activity but returns upon resuming exercise. CECS can be mistaken for shin splints. Risk factors include age, type of exercise (repetitive impact activities), and overtraining. While not life-threatening, CECS can limit physical activity and performance if left untreated. Prompt medical attention is advised if you experience symptoms while exercising.

Arthroscopy of the foot and ankle is used to examine and treat joint conditions. The procedure uses an arthroscope, a thin fiber-optic camera, which enables the surgeon to view close-up images of the inside of the ankle and/or foot while working. This usually allows for a less invasive procedure than traditional open surgery, as only a small incision is necessary for the arthroscope, which is about as wide as a drinking straw.

Among many other conditions, ankle and foot arthroscopy can be used to assess and treat fractures, arthritis, infection, impingement (bony and soft-tissue), joint instability, bone chips, and ligament damage.

Ankle ligament reconstruction is a surgery that tightens the outer ligaments of the ankle, specifically the anterior talofibular ligament and the calcaneofibular ligament. It’s typically for active individuals who suffer from frequent ankle sprains, leading to chronic instability and pain. Non-surgical treatments like physical therapy and ankle braces are tried first, but if symptoms persist, surgery may be recommended. During the surgery, the surgeon assesses the condition of the ligaments and may use your own tissue or a donor tendon to reinforce them. Depending on the severity of instability, one or both ligaments may be reconstructed. This procedure is highly effective, allowing patients to regain stability and resume previous activities.

Toe joint replacement, also known as toe arthroplasty, is a surgical procedure aimed at removing a damaged toe joint and replacing it with an artificial joint. Typically performed on the big toe, and to a lesser degree the smaller toes, this surgery can alleviate pain and restore function to toes affected by injury, arthritis, or other conditions.

In ankle replacement surgery, damaged cartilage and bone are replaced with metal or plastic components, while ankle fusion involves fusing ankle joints to the leg bones to limit motion and reduce pain.

Treatment options range from pain management with medications, steroid injections, ankle braces, custom orthotics, physical therapy and surgical intervention if conservative care is not successful.

Ultimately, personalized care and shared decision-making between patients and their healthcare providers are crucial in determining the most suitable approach for managing ankle osteoarthritis and improving overall quality of life.

Reconstructive surgery of the foot and ankle consists of complex surgical repair(s) that may be necessary to regain function or stability, reduce pain, and/or prevent further deformity or disease. Reconstructive foot and ankle surgery should also restore function and mobility.

Unfortunately, there are many conditions or diseases that range from trauma to congenital defects that necessitate surgery of the foot and/or ankle. Reconstructive surgery in many of these cases may require any of the following: tendon repair/transfer, fusion of bone, joint implantation, bone grafting, skin or soft tissue repair, tumor excision, amputation, and/or the osteotomy of bone (cutting of bones in a precise fashion).

Bone screws, pins, wires, staples, and other fixation devices (both internal and external), and casts may be utilized to stabilize and repair bone in reconstructive procedures.

Minimally invasive surgery (MIS) is a technique used by foot and ankle surgeons to correct specific foot and ankle conditions with very small incisions. This technique has gained attention among surgeons and patients alike due to its reported faster recovery time, smaller scars, and reduced postoperative opioid use.

Common foot and ankle conditions that can be treated using minimally invasive surgical techniques include bunions, hammertoes, big toe arthritis, and metatarsalgia.

It is important to note that not all patients are good candidates for minimally invasive surgery. If you have a foot or ankle condition, first consult with one of our foot and ankle surgeons to determine the best treatment option for you.

Laser surgery is a significant advancement in dermatological treatment, particularly for addressing warts and onychomycosis (nail fungus). Laser treatments precisely target and eliminate warts by focusing on the affected tissue. Moreover, they offer potential improvement in the appearance of nails affected by onychomycosis. Laser surgery’s targeted approach and minimally invasive nature make it an effective option for providing relief to persistent skin and nail conditions.

A hammer toe is a contracture, or bending, of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammer toes are more common in females than males.

There are two different types of hammer toes:

Flexible Hammer Toes: These hammer toes are less serious because they can be diagnosed and treated while still in the developmental stage. They are called flexible hammer toes because they are still moveable at the joint.
Rigid Hammer Toes: This variety is more developed and more serious than the flexible condition. Rigid hammer toes can be seen in patients with severe arthritis, for example, or in patients who wait too long to seek professional treatment. The tendons in a rigid hammer toe have become tight, and the joint misaligned and immobile, making surgery the usual course of treatment.
A hammer toe develops because of an abnormal balance of the muscles in the toes. This abnormal balance causes increased pressures on the tendons and joints of the toe, leading to its contracture. Heredity and trauma can also lead to the formation of a hammer toe. Arthritis is another factor, because the balance around the toe in people with arthritis is disrupted. Wearing shoes that are too tight and cause the toes to squeeze can also cause a hammer toe to form.

If you are worried that you may have hammer toes that are causing significant pain our doctors are here to help.

Typically, conservative treatment is initially attempted and is often successful; however, sometimes surgery is necessary to treat hammer toes.

Conservative treatment approaches for hammer toes can include alteration of footgear, over the counter or prescription pads and cushions to offer relief, orthotic shoe inserts to prevent the hammer toe from worsening, or regular trimming of corns and calluses associated with hammer toes.

Hammer toe surgery may involve removing a portion of one of the bones in the toe to realign the toe or could involve fusing the joints in the toe (see Fusions, above). In some cases, it may involve placing a temporary wire to hold the toes straight or a permanent implant in the toe to maintain realignment.

The doctors and staff will be happy to help you find the best solution for your feet, to relieve your toes of their pain and to get you back on your feet, pain free.

Flat foot, or fallen arches, is a condition characterized by a lack of arch at the bottom of the foot. Flat foot occurs when tendons that hold the joints of the foot together are loose, flattening the area where you would normally have an arch. People with flat feet experience the soles of their feet completely touching the floor when they stand and walk.

Being flat footed is common in infants and toddlers. As a baby grows over time, the tendons in the feet strengthen, helping to form a normal arch in the foot. But in some children, an arch never develops properly, which causes various problems.

In adults, flat feet may develop later as a result of an injury or wear and tear due to aging.

Flat foot pain can worsen with prolonged standing or activity. Symptoms include:

Foot pain (most prevalent in the heel and arch area)
Leg pain
Back pain
Swelling of the feet and ankles
Flat foot surgery typically involves the repair of loose tendons or realigning the bones in the foot.

Depending on the severity of your condition, we may perform a combination of the following surgeries to treat flat feet:

Arthrodesis: Arthrodesis is another name for joint fusion surgery. By eliminating the space between the bones that would allow painful movement, fusing the bones in the foot together relieves the pain. To ensure the bones heal properly together, we also may do bone grafting, a surgical procedure that uses transplanted bone to repair damaged bones.
Foot bone reconstruction surgery: Involves bone grafting and tendon transfer to create a new arch.
Dorsal opening wedge osteotomy: A bone wedge or bone graft is placed at the top of the medial cuneiform bone located in the middle of the foot.