Advanced Orthopedics & Sport Medicine

Specialized Orthopedics Services Since 2005

Foot & Ankle

The foot and ankle are two of the most versatile and complex areas of your body. One foot alone contains 26 bones supported by a network of muscles, tendons, and ligaments. When everything is working well, you hardly give them a thought. But when a problem arises, it’s often impossible to ignore.

More than 11 million visits were made to physicians’ offices in 2003 because of foot and ankle problems, including more than 2 million visits for ankle sprains and strains and more than 800,000 visits for ankle fractures.* Some conditions that may affect your foot and/or ankle could be:

  • A fracture and/or sprain
  • Tendonitis
  • Tarsal tunnel syndrome
  • Plantar fasciitis (heel pain)
  • Bone spurs
  • Morton’s neuroma
  • Bunions
  • Hammertoes
  • Ingrown toenails
  • Diabetic foot ulcers

Your Treatment Options for Foot and Ankle Pain

Fortunately, most cases of foot and ankle pain respond well to treatments like rest, ice, orthotics (shoe inserts), prescribed exercises, and anti-inflammatory medications. Local cortisone injections can also provide pain relief.

However, when these medical treatments fail to provide adequate pain relief, surgery may be an option. Often foot and ankle surgery is performed on an outpatient basis using minimally invasive techniques. These techniques may mean less pain and less risk, as well as a faster recovery time.

Understanding Foot and Ankle Arthritis

What Is Arthritis and Who Develops It?

Simply put, arthritis is inflammation of a joint. But there’s nothing simple about the pain or loss of mobility that can be associated with it. In fact, arthritis is the leading cause of disability in the United States. Although it can affect anyone, arthritis is mainly found in adults.


The most common form of arthritis, osteoarthritis (OA) typically affects older people. The cartilage that normally cushions and protects the bones of the joint breaks down over time. Eventually, bone rubs against bone, opening the door to inflammation and other mechanical problems like bone spurs.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory disease process that may affect the entire body. The body’s immune response attacks the soft tissue in the joints causing inflammation and pain. Over time, the inflammation leads to compromises in the joint’s cartilage and bone.

Arthritis Caused by Injury

When cartilage in the joints is damaged by a trauma like a fracture or dislocation, arthritis may develop. Even properly treated injured joints are much more likely to develop arthritis than joints that have not been injured.

What Are the Symptoms of Arthritis?

Depending on which of the joints is affected, symptoms of arthritis vary. Typically, symptoms include pain, tenderness, swelling and difficulty moving the joint. Arthritis in the foot or ankle may make walking difficult and painful, reducing your activity level.

In order to diagnose you properly, your doctor will consider your symptoms, examine your feet, and take X-rays, a CT scan or MRI to get a clear view of the alignment of your toes and the condition of the joints in your feet.

How is Arthritis Treated

Your doctor may recommend different treatment options depending on the type and severity of arthritis in your feet or ankles

Manage the pain

Your doctor may prescribe or recommend the use of anti-inflammatory medications (like aspirin or ibuprofen) and cold packs may help to reduce inflammation as well as the pain associated with arthritis. Sometimes a local injection of cortisone helps to further reduce inflammation.

Look at the big picture

Your doctor may recommend that you lose weight, take certain nutritional supplements and exercise. In some cases, a physical therapist may help provide pain relief and the return of some lost mobility through guided exercise and other techniques.

Get the right support

Orthotic devices sometimes help. Custom-made shoes and shoe inserts provide support. Your doctor may recommend a brace or a cane to help take some of the pressure off your affected joint while you walk.

Understand your surgical options

If you are still experiencing arthritis pain after all other conservative measures have been taken, your doctor may suggest surgery to help relieve your pain and restore your mobility. Your doctor will determine the proper surgical treatment based on the type of arthritis you have, its severity and its location. Today, a full range of surgical solutions are available that enable your doctor to customize surgical procedures to your particular needs and anatomy, whether you need arthroscopic debridement (removing inflamed and/or irritating debris from the joint), arthrodesis (fusing the joint for greater support) or arthroplasty (replacing the arthritic joint).

Be sure to talk with your doctor about the best treatment option for you.

Pin Tract Care With External Fixation

What is External Fixation?

We’re all acquainted with the non-surgical approaches that help a broken bone heal: the doctor applies a cast, brace or splint around a fracture or a corrected bone deformity to provide support during the healing process. In some cases, however, particularly more severe injuries, today’s best orthopaedic treatment includes securing the fracture externally with a device called a fixator that is connected to the affected bone with special bone screws, often referred to as pins. The device remains outside the body (external) and the pins pass through the skin and muscle to secure the bone in proper alignment.

External fixation helps to maintain alignment of the fractured bone when a cast may be inadvisable. However, these devices do require that you take care of them and the pin sites to help prevent infection. Among other complications, an infection may create the need to remove the device and may compromise the proper healing of your fracture or repair.

How Should You Care for the Pin Sites?

Your doctor may recommend different cleaning techniques or solutions depending on the type of external device and the extent of your injury or fracture. In any case, use common sense with your external fixation device. Wash your hands well and often before cleaning your pin sites or the device. Be gentle and thorough, and dry everything carefully. The cleaning process should be followed routinely even if your doctor has prescribed antibiotics as a preventative measure.

Get It Together

Since you’ll be cleansing your pin sites and the device twice a day, it may make the most sense to gather everything you’ll need and keep it handy and dry in a central location. You’ll need cleansing solution (sterile water), disposable cups, sterile cotton swabs, sterile gauze pads (in two-inch and four-inch squares) and a small trash bag to dispose of soiled gauze pads and swabs.

Cleanse the Pin Sites

After washing and drying your hands thoroughly – doctors recommend drying with a fresh paper towel and discarding it after use – use your fingertips to lightly touch and press the skin around the pins. This will encourage any drainage to come to the surface. Use a cotton swab saturated with cleansing solution to remove any crust or drainage from the pin sites. Always work in a gentle, circular motion, moving away from the site. Use a fresh swab for each pin site.

Clean the Pins

Use a fresh two-inch sterile gauze pad to clean each pin. For the first few days, your doctor may advise you to wrap sterile gauze around each pin site. Once no further drainage is present, the pin sites may be left uncovered.

Clean the Device

Use cotton swabs and the larger gauze pads to clean the entire fixator device carefully. Dispose of all the soiled swabs and pads. Wash and dry your hands thoroughly.

Take a shower

After 10 days or so (your doctor will advise you), you may be allowed to shower with your external fixator. Dry the fixator thoroughly with a clean towel and follow all other cleaning instructions for the pin sites.

Be sure to talk with your doctor if you have any questions on how best to care for your fixator and the pin sites.

What Are the Symptoms of Infection?

No matter how carefully you’ve looked after your pin sites, an infection is still possible. Contact your doctor immediately if you observe redness or swelling at the pin site, thick or colored discharge, tenderness or pain, or any wiggling, play or movement in the pins.