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Recovery Guide: Foot Fracture

What Is It?

Fractures of the foot can come in many different forms. More of the most common types of foot fractures are discussed in their own categories (see Lisfranc, Jones stress, and Calcaneal fractures for more details). Almost a quarter of our bones are in our feet and since we use our feet frequently to bear our weight and move, they are constantly exposed to a lot of forces. Sometimes during extreme activities your bones become overworked and are prone to fracture. That is why athletes and dancers, such as ballerinas, are prone to getting foot fractures. Foot fractures also occur due to sudden sharp movements or as a result of a post traumatic accident, such as a fall or a motor vehicle crash. Post-traumatic breaks tend to be more severe since they are the result of high-impact forces. Calcaneal and Lisfranc fractures are a good example of breaks that can occur due to a high-impact injury. Low-impact injuries result in stress fractures, fractures that occur due to exposure and overuse at the same spot over and over again. Stress fractures are the products of overuse and exceeding too rapidly in physical activity. Pain, bruising, and swelling can be an indication of a foot fracture, though clinical evaluation and x-rays will be needed to confirm the presence of a fracture.

Treatment

Most types of foot fractures can be treated without surgery. Surgical intervention will be required if the bones become displaced, meaning that are shifted out of their original anatomic position. If a break is stable, then it can be treated conservatively with casting to hold the bones in place while they heal. For forefoot and toe fractures, you may be placed in short-walking cast allowing you to walk in a boot or with minimal amount of weight bearing. Sometimes your doctor may brace the injury without a cast depending on the type of injury. For a break in the toes, your doctor might tape the broken toe to a neighboring good toe to stabilize it. This is known as “buddy-tapping”. If the break in the foot is displaced, then your surgeon will realign the bones and fix them in place using hardware such plates and screws. Recovery time for conservative and surgical treatment can range anywhere from 6 to 8 weeks depending on factors such as the type of injury, age, smoking, and other medical conditions. A patient may be instructed to be non-weight bearing during this period to not expose the break to any unnecessary forces and to allow the bones to heal. Your doctor will tailor make your recovery to fit your type of fracture.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

 

Recovery Guide: Calcaneal Fracture

What Is It?

The calcaneus is the bone that makes up your heel. Calcaneal fractures usually occur after a high-energy accident, such as in a motor vehicle crash or a fall from a great height. Because of this calcaneal fractures tend to come with other problems that vary with the extent of the injury. This is usually related to the amount of force that was used to cause the break. The worst case scenario is that the calcaneus shatters resulting in many fragments. This is known as a comminuted fracture (a break that results in three or more fragments). Because calcaneal fractures are usually the result of a high-force impact, there is a chance that the bones can damage soft tissue and puncture the skin as well.

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Breaks of the calcaneus can be very serious since they can affect the subtalar joint; the joint that is comprised of the calcaneus and the talus (the ankle bone). This joint is responsible for the side-to-side motion of your foot.  Therefore, a severe break in the calcaneus can also result in a stiff ankle, limiting movement. In addition, the calcaneus is also where the Achilles tendon joins from the calf muscle. Tendons are connective tissue that connects muscle to bone and allows us to perform our movements. The Achilles tendon allows us to point our foot down when walking and running. It also helps our heel to support our body weight. A fracture in the calcaneus can disrupt the union of the heel and the Achilles tendon, thus destabilizing our foot and ankle. Lastly, since it typically takes a lot of force to break the calcaneus, other bones in the foot and ankle can be broken as well. All of these features can attribute to instability, swelling, and pain. If a fracture is really severe, it might limit or prevent the patient from walking or even weight bearing all together.

Treatment Options

Calcaneal fractures that present with a displacement of bone can result in the formation of deformity if not properly realigned. The bone also risks not healing altogether if not taken care of. Therefore displacement fractures or fractures that result in many broken fragments (such as comminuted fractures) are treated operatively. Surgery will require internal fixation, such as the use of plates, nails, and screws to realign the bone and fix them in place. Any damaged tissues will be fixed, such as reattachment of ligaments or the Achilles tendon, if separated. The difference between conservative and surgical treatments all depend if there is any displacement of bone or not. If the bones look intact and the soft tissues are relatively undamaged, then casting and immobilization will be the primary means of treatment. Any fracture that results in puncturing of the skin will require immediate surgery to clean and sterilize the wound. Calcaneal fractures that result in an avulsion of the Achilles tendon (the bone that connects with the Achilles tendon breaks away and detaching it from the main body) would also require immediate surgery to reattach the tendon. A non-weight bearing scooter is almost always recommended.

Prognosis

Because they can be pretty severe, breaks of the calcaneus take quite a bit of time to heal. Recovery time is about the same for conservative and surgical patients.  It takes about 10 to 12 weeks for the bone to fully heal. During this time period patients will be expected to be non-weight bearing. This is followed by a period where the patient will transition from partial to full weight bearing. Physical therapy is key because the subtalar joint will be stiff and will need to be conditioned back into mobility. After about 4-6 months patients will start seeing some real progress, though it could take up to a year or a year and a half to achieve maximum recovery. However, there is no guarantee that patients will achieve the same status that they were in prior to injury.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

Recovery Guide: Jones Fracture

What Is It?

A Jones fracture is a special type of stress fracture (see “Stress Fractures” for detailed information on what defines a stress fracture) that appears at the base of the fifth metatarsal (the long bone on the outside aspect of the foot that connects to the big toe). Patients with Jones fractures will feel pain on the far right of their midfoot. Like with any other stress fracture, patients who are highly active or progress to increased physical activity too rapidly are more likely to obtain a Jones fracture. However, Jones fractures can also occur acutely, as in a sudden break due to injury. What makes Jones fractures stand out is the fact that the break is located in an area where blood supply is limited, making them difficult to heal. Adequate blood supply is essential for healing, since blood supply carries nutrients to the bone that are necessary for healing. Without sufficient blood supply, the fracture risks becoming a nonunion (the bone fails to join together and heal) or it might require an extended period of time to heal. Though a Jones fracture can potentially heal on it’s own, surgical intervention is often necessary.

Prognosis

Individuals who have high arches in their feet have an increased likelihood of developing a Jones fraction since there is more loading on that side of the foot (the side of the foot facing away from the body). Conservative treatments such as protective footwear and being non-weight bearing can allow a Jones fracture to heal, but patients run the risk of re-fracture, especially if they have high arches or repeat the activity that developed the fracture in the first place (such as dancing or running). Surgery allows an individual to recover faster (since it forces the two pieces of bone together) and helps to prevent the risk of re-fracture. Typically, the bone is brought together and fixed in place with a screw. Drilling at the site of injury also stimulates blood flow which brings the needed nutrients to the fracture site. Most times athletes choose to undergo surgery to get them active again sooner, rather than taking the time for the fracture to heal on it’s own. The screw can be removed later on if it becomes a discomfort to the patient. This is left up to the patient and the discretion of the surgeon. Realignment surgery is also an option to help correct their high arches and prevent re-fracture. Custom shoe orthotics, such as inserts, can help to balance out the high arches and alleviate the added stress to the medial side of the foot. Recovery is usually 6 to 8 weeks for a Jones fracture, but those who choose to recover more conservatively might take a while longer to heal. Patients will be expected to be non-weight bearing during the healing process and will progress to weight bearing only when advised by the surgeon.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

Recovery Guide: Lisfranc Fracture

What Is It?

A Lisfranc fracture describes a fracture of the midfoot that can range from mild to very serious. Sometimes an injury can occur at the midfoot that does not break any bones. This is known as a Lisfranc injury. The midfoot is comprised of many tiny bones that are held together by ligaments, a type of connective tissue. Ligaments connect the two ends of bones together to form a joint. The ligaments that cross the midfoot connect the midfoot bones to the metatarsals (the long bones that connect to the toe bones). These joints form what is known as the Lisfranc joint complex and spans across the entire midfoot. It is essential for maintaining the shape of the foot and providing it with stability.

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Unfortunately, with so many little pieces it makes the foot prone to injury. Lisfranc injuries can be caused by low-energy impacts, resulting from something as simple as a twist in the foot. The injury therefore, can result in fractures, tears in the ligaments, or both. This can cause the bones to displace and the joints to be dislocated. If left untreated, a flat foot deformity can develop as well as arthritis and other medical conditions.

Symptoms

The first symptoms that appear are usually bruising and swelling at the site of injury. Bruising along the bottom aspect of the midfoot is highly indicative of a Lisfranc injury. Pain might be so extreme that the patient may have difficulty weight bearing. The only real way to diagnosis a Lisfranc injury is through clinical evolution. Your doctor will most likely perform a series of test to identify a Lisfranc injury. One such test called the piano key test places stress along the midfoot by pulling the toes up and down. Sharp pain is a positive sign of injury. Radiographic assessment is the most surefire way to confirm an injury. An MRI might be required to confirm if there is any damage to the soft tissues. It’s important to identify the number of joints that are afflicted and the extent of their damage. Some injuries can be so severe that it causes displacement of the toes. Surgical intervention will be required to realign them in their normal anatomical position.

Treatment 

If there is no displacement and only minor damages to the soft tissues, then conservative treatment is the most likely course of outcome. Casting and/or splinting will be used to immobilize the bones. Patients will be non-weight bearing for about 6 weeks. During this period it is critical not place any weight on the foot. Since the midfoot is comprised of many small bones any type of pressure can cause them to shift around and prevent healing. Even worse, bone displacement can occur. When you progress to partial weight-bearing, some sort of orthotic or shoe/boot will be provided to ease you into activity. If there is any evidence that the bones have been shifted during recovery, surgery will be needed.

Recovery

If it is apparent right when you present with your injury that you have displaced bone and torn ligaments, then surgical intervention is a must. Your surgeon will set the bones in place using internal fixation such as a plate or screws. This will not only realign them, but also fix them in place to prevent movement. If the joints and cartilage are badly damaged, they might need to be fused to eliminate pain (known as an arthrodesis). Fusion might also be an option down the road if midfoot arthritis occurs as a result of the injury. Post-operative recovery is similar to conservative treatment. The patient will experience 4 to 6 weeks of non-weight bearing in a cast or splint followed by a transition into a boot/shoe or orthotic when the patient returns to weight bearing. Again, it cannot be greater emphasized how critical it is to remain non-weight bearing when instructed. Once weight bearing is established, you might be instructed to wear your protective footwear for a further 4 to 8 weeks. This is followed by transitioning into a stiff shoe for a further few weeks. The recovery time from a Lisfranc injury can be long and some individuals may not retain their pre-injury levels of activity.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

 photo credit

Recovery Guide: Stress Fracture

What Is It?

Stress fractures are typically non-displaced breaks in bone that occur through overuse of physical activity. Fractures are brought on by high energy and low energy injuries. High energy breaks are termed traumatic fractures and occur through a significant amount of force. Stress fractures are low energy breaks and occur through rapid exposure to low energy forces. Thus, a break can form when the same site is exposed over and over again to the same amounts of force. These types of fractures are common in athletes who increase the intensity, severity, and frequency of their activity (such as running). In a nut shell, stress fractures are an injury of overuse. Sometimes transitioning to higher level activities too soon or running on improper terrain can also lead to a stress fracture. This is one of the reasons why healthcare and exercise specialists recommend progressing steadily to more active workout routines and running on soft terrain like a treadmill. Though stress fractures are typically attributed to overuse, other underlying medical conditions can contribute. Conditions that weaken the bone such as osteoporosis or malnutrition can make individuals more prone to obtaining a stress fracture.

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Stress fractures in the foot and ankle are common since we are on our feet all the time. The metatarsals (second and third metatarsals most commonly), the calcaneus (heel bone), and navicular (one of the main bones of the midfoot that connect to the ankle bone) are the most common bones that obtain a stress fracture. Stress fractures in the tibia (long bone of the lower leg), fibula (smaller long bone of the leg that runs along the tibia), and talus (ankle bone) also run the risk of acquiring a stress fracture. It could be difficult to tell if you have a stress fracture since signs can be subtle. Pain can rise with activity, but dissipate with rest. Pain levels can also increase over time depending on how active and aggressive individuals are in their daily routines. Swelling, bruising and some tenderness may also appear. The only real way to rule out a stress fracture is to visit a doctor and have an x-ray or MRI taken. MRI’s are stronger then x-rays, but are often not needed to confirm a diagnosis.

Treatment Options

Fortunately, most stress fractures do not require surgery and can heal on their own. However, recovery times depend on the location of the breaks since some bones can take longer to heal then others. The goal is to reduce activity and to protect the break. Doctor’s will most likely prescribe protective footwear such as an orthotic boot, shoe or a brace, and occasionally require a knee scooter. The length of wearing such footwear can take anywhere from 4-6 weeks. Your level of activity will also be decreased. Runners for example will most likely need to reduce activity to biking or another workout that does require placing pressure on the foot. A stress fracture can take about 1 to 2 months to heal so you would most likely be advised not to return to your typical active routine until at least after two months. Again, this all depends on the bone broken. The navicular, talus, and fifth metatarsal bones take the longest to heal so patients with these types of stress fractures may have a longer recovery period.

Prognosis

It is important to listen to your doctor and only progress back to active duty once the stress fracture is fully healed. Even after a stress fracture is healed it’s important to make a gradual progression in activity to prevent the risk of re-fracture. Low impact exercises are key as well as comfortable and supportive footwear. If surgery is needed, it’s typically because the break has not healed after conservative methods. A surgeon will most likely have to fasten the bones together using internal fixation such as screws, plate or nails.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

photo credit

Recovery Guide: Ankle Fracture

What Is It?

A fracture is the term used to describe a break in the bone. Breaks usually result due to high energy or low energy injuries. A fracture that occurs due to a high energy injury is termed a traumatic fracture and is a result from a significant amount force. Low energy fractures are termed stress fractures and are a result from repeated exposure to low amounts of force. Fractures of the ankle can be a serious problem depending on the level of severity. The ankle joint is a very complex system and disruption of the joint from severe fractures can lead to joint instability. A joint, simply put, is a surface that is comprised of the ends of at least two bones (where the bone come together and meet), cartilage (which cushions our joints), tendons (which connects muscle to bone), and ligaments (which connects bone to bone). All work together to give our joints the ability to move. Any injury that disrupts this unity eliminates the joints ability to function properly.

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The two main bones of the ankle are the tibia (long bone of the lower leg) and the talus (the ankle bone). The fibula also comprises the ankle joint, though the tibia and fibula make up it’s own joint as well, known as the syndesmosis joint. Both joints are held together by ligaments. In the gap between the tibia and talus is cartilage to cushion the joint during movement. The malleolus is the term used to describe the prominence on each side of the ankle (the bony bumps that you feel). This is comprised of the bones that make up the ankles and are classified into three regions. The lateral malleolus is comprised of the fibula and is located on the side of the foot away from the body. The medial malleolus is the inner side of the foot and is comprised of the tibia. The posterior malleolus is the back part of the tibia, so the side behind the body. Doctor’s classify fractures based on these regions and their level of severity.

Types of Fractures

Fractures of the ankle can come in many shapes and forms and can affect one or more of the bones that make up the ankle. A Bi or Trimalleolar fracture for example implies that two or three sections of the malleolus are fractured respectively. In addition, patients can have a non-displaced fracture or a displaced fracture. Non-displaced fractures imply that the fragments of bone that make up the fracture are intact, while displaced fractures mean that the fracture fragments are separated. Typically, breaks result in non-displaced fractures and can be treated conservatively by casting and wearing a boot. Healing time for conservative treatment is about a month. Displaced fractures can be more serious and run the risk of disrupting the anatomy of the ankle. Some serious high energy accidents can result in severe displacement fractures. In pediatric patients, displaced fractures also run the risk of disrupting the growth plate, causing growth arrest. For these types of injuries, surgical intervention is most likely necessary.

One of the more severe types of ankle fracture is the pilon fracture. Pilon is the French word for pestle, a tool used for grinding in labs and apothecaries. Here it is used to describe the damage done to the ankle during a high-energy accident (you might hear a pilon fracture called a high-energy ankle fracture). The talus acts like a jack hammer and grinds into the tibia. Shattering or splintering of all three ankle bones can result. Patients typically present with a pilon fracture after a motor vehicle accident or fall from a large height. Though a pilon fracture can be a serious injury, in some instances it could be treated conservatively.

Treatment Options

For most displacement injuries, surgical correction will be needed. Surgery will require internal fixation (such as nails, screws, and plates) to reset the bones and to hold them in place while they heal. This is to realign the bones back to their normal anatomic position. Sometimes displaced bone fragments can heal improperly resulting in a deformity. Surgical correction and fixation will also be needed to correct any deformity that is present. It may possible to remove the hardware down the road, though this depends on the individual. Sometimes an individual can live comfortably with the hardware remaining in place.

Recovery

Because of the wide range of injuries that could be present, recovery times can vary. Other factors like age, smoking, and medical conditions such as diabetes can also have an impact on healing. Patients will be expected to be non-weight bearing for several months after surgery. Casting and splinting may likely follow surgery to help further immobilize the joint and minimize movement while the bone heals. A non-weight bearing scooter is recommended. It could take as soon as six weeks for the bones to fuse together, but may take longer depending on the individual. Soft tissue structures such as ligaments will take longer to heal. Your doctor will instruct when to progress to partial and full weight bearing. It is essential to not put weight on your ankle until told to do so. Placing pressure on the joint too soon might shift the bones if they have not set yet. Two to three months is the typical time frame for progression to full weight bearing. Most individuals can expect to be back to regular activities such as work and driving after three months.

Prognosis

Physical therapy will be essential during the recovery period and beyond. It is important to train your foot and ankle in the months after healing is completed. Studies have shown that patients can still be in the recovery process for up to two years after surgery. This all depends on the extent of the injury. Some severe injuries like a pilon fracture could also limit the function of an individual even after healing is completed. Athletes for example may not be able to reach the full range of activity that they had before surgery. Again, this all depends on the individual and the extent of the injury. Your doctor and other healthcare professionals will help to assess and reach the level of activity that you will be able to obtain. Lastly, depending on the severity of the injury your ankle joint might see damage to the cartilage. This could lead to the onset of arthritis in the future. However, there are conservative and operative techniques that could be employed to take care of arthritis should symptoms arise.

 

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

photo credit

Recovery Guide: Achilles Tendon Rupture

What Is It?

Tendons are the structures that connect muscle to bone. They are key in giving us the ability to move. The Achilles tendon is the largest tendon in our body and connects to the two muscles that make up our calf. The Achilles tendon extends from this complex, crosses the talus (the ankle bone) and attaches itself to the calcaneus (the heel bone). Together they form a unit that allows the calf muscle to pull the foot down and is essential for our mobility.  Like muscle, tendons are made up of tiny fibers that come together and form a bigger structure (you can imagine it like the weaves of thread that make up a rope). An Achilles tendon rupture occurs when these fibers tear and can result in partial or complete separation of the tendon from the muscle.

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Most of the time a tear occurs as a result of sports injury, such as over extension or exertion during a quick and sudden movement. The typical tell-tale sign is a sudden sharp pain, snap, and/or a distinct popping sound at the site of the injury. However, pre-existing conditions can also lead to the gradual wear of the tendon resulting in a tear. The typical Achilles tendon rupture usually happens 4 to 6 centimeters above the point where the tendon joins the heel bone. Another type of Achilles rupture is a heel rupture. In this scenario, the tendon is either torn away from the heel bone or is detached along with a fragment of the bone itself. This is known as an avulsion fracture and results when a bone fragment breaks away from the main body.

Indications

Other indications for a rupture include bruising and swelling, as well as weakness in the effected foot. Your doctor will perform tests to confirm if your Achilles tendon is ruptured or not. One test known as the Thompson test is used to confirm separation of the tendon from it’s muscle. By having the patient laying down flat on their stomach with their feet bent toward the ceiling, a doctor can squeeze the calf in such a manor to illicit a response from the foot. A positive test for an Achilles tendon rupture will result in no such reflex response. An MRI or an ultrasound can also be ordered to confirm the presence of a rupture and the extent of the damage. Clinical and radiographic assessment is always necessary in confirming a diagnosis.

Treatment Options

An Achilles tendon rupture can be treated conservatively by flexing the foot downward and casting it in that position, allowing the two ends to be rejoined and healed over time. This process usually takes at least three months, but could take more. Afterwards the patient would have to undergo a period of physical therapy to regain motion and strength. Although it is possible in some occasions for an Achilles tendon to heal without the need for surgery, many healthcare professionals advise surgical intervention for a more optimal recovery. Patients treated conservatively typically don’t regain full strength in their tendon. They also run the risk of re-rupture. Surgeons can reattach the tendon by suturing the torn pieces together. This usually results in a quicker recovery time and a stronger tendon and is advised for younger or more active individuals. The goal surgically is to restore both length and tension to the tendon. It is important to note that though outcomes may be more optimal for surgical intervention, the repaired tendon will always be weaker than the opposite side. Surgery also runs its own risks, which could make some patients favor a more conservative treatment. Thus it is up to the patient and their own expectations in deciding a treatment course.

Prognosis

If a patient chooses surgery, they will be placed either into a cast, boot or splint until the tendon has enough time to heal. All procedures tend to be ambulatory, meaning that patients will be discharged to go home on the same day. They will require a non-weight bearing device such as a knee walker for mobility. No matter the course of treatment, physical therapy is essential to optimize recovery. Depending on the procedure and type of immobilization used, recovery times can vary. Patients will begin with motion training exercises a few weeks after surgery and work their way up to strength training. Recovery times can typically take anywhere from 4 to 6 months.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

photo credit

Recovery Guide: Bunionectomy

What Is It?

Bunions are most commonly known as the bony protrusion that occurs at the base of the joint of the big foot. This protuberance is also affiliated with a fluid filled sac resulting from friction and inflammation known as a “bursa”.  Therefore a bunion could imply both. However, a bunion is also associated with a “hallux valgus” deformity, a condition in which the big toe is deviated from it’s normal anatomical position and leans towards the second toe of the foot. As a result the anatomy of the big toe is disrupted and causes great discomfort and pain for the patient, though sometimes bunions can be painless and present the patient with a more cosmetic discomfort. Since the joint flexes with every step that we take, more severe deformity can result in more severe pain. If left untreated the bunion can affect the patient’s ability to walk. Dorsal bunions (bunions on the top aspect of the toe) are also possible and don’t result in valgus of the big toe. These are typically the result of arthritic changes in the joint and are not as frequent. When bunions do occur, they are usually appear on the big toes of both feet.

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Bunions and hallux valgus has been associated with improper footwear. Wearing tight and uncomfortable shoes for prolonged periods of time can result in the formation of a bunion and deformity. However, though tight footwear is associated with occurrence and level of severity of hallux valgus, it is not the only cause. Heredity can play a role resulting in bunions occurring in very young individuals, typically adolescents (you might hear it referred to as an adolescent bunion). In most cases bunions first surface in middle aged men and women. Some doctors believe that tight shoes might not be the source of bunions, but rather they enhance their onset and level of severity. Bunions are predominant in women with about half of all American women suffering from the condition.

Treatment

Fortunately, bunions can be treated conservatively by wearing wider footwear. There are times though when surgical intervention is needed. If patients allow their hallux valgus to progress by consistently wearing tight shoes, the deformity can induce instability of the toe joints and pain in the second toe as well. If left untreated, the second toe can begin to be deformed as well. The bunion would have to be removed surgically and the joints and ligaments realigned to correct the deformity and restore stability. Procedures vary depending on the surgeons preferences and on the patients etiology. For a simple bunion removal the protrusion is removed and/or shaved down. Though if a deformity is present it is advised that this is corrected as well otherwise the patient runs the risk of recurrence. Internal fixation is typically used to realign the bone and hold it in place while it heals. Sometimes the joints need to be fused depending on the level of arthritic pain that is present. Ligaments and other soft tissue might need to be cut and rearranged in order to restore proper anatomic alignment to the bones.

Healing Time

Because treatments can vary, the course of healing can vary as well. Patients with minimal deformity or having a simple excision can possibly be partial weight bearing the day of surgery, while other times it might take up to 2 weeks until they are able to weight bear. These individuals will most likely be back in shoes in less than two months. For more severe corrections, patients will have to wear a cast for up to eight weeks post-op. These Patients might not be back into shoes for three months. Most bunion surgeries are same day surgeries meaning that you could be discharged and home later that day. They almost always require a non-weight bearing mobility device such as a knee scooter.

 

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

 

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

photo credit

Recovery Guide: Ankle Arthrodesis (Fusion)

What Is It?

An arthrodesis in the truest sense of the word means a joint fusion, hence why in lay terms an ankle arthrodesis is known as an “ankle fusion.” A joint is comprised up of the ends of two pieces of bone, ligaments (which hold the bones together), tendons (which attaches muscle to the bone), and cartilage (which cushions our joints). In a nutshell, it’s a surface where two bones connect. Joint classification and composition can vary, but this is the simplest description. The two main bones that comprise the ankle joint are the tibia (long bone of the lower leg) and the talus (the ankle bone). Together they form the surface which allows you to pull your foot up or down. The ankle joint however is actually quite complex and other structures help to provide stability while standing and with movement (such as the fibula and ligaments).

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Most importantly, wedged in this gap between the talus and tibia is cartilage. Cartilage provides the cushioning in the joint and allows for ease of movement. Cartilage cannot be grown back so overtime it wears down. The more active an individual is the quicker and more aggressive becomes the degeneration of cartilage.  Degeneration of cartilage leads to arthritis, a condition of pain within the joints. Since there is no cartilage to cushion the bones, they grind together which causes pain, swelling and inflammation. Sometimes range of motion becomes limited as a result. Increasingly severe levels of pain are typically symptomatic of advanced levels of arthritis.

Different Types of Arthritis

However it is important to point out there are many different types of arthritis. The arthritis that is described above is known as osteoarthritis, but you might see it abbreviated as OA for short. There are other factors that contribute to OA, such as heredity and obesity, but OA is most significantly a mechanistic condition that results in the wearing down of cartilage overtime. Sometimes a patient develops OA due to a severe injury to the joint that damages the cartilage or destroys it entirely (also known as post-traumatic arthritis). In comparison, Rheumatoid arthritis (RA for short) is an autoimmune disease that results in the destruction of cartilage by the body’s own immune system. RA and OA are the two most common types of arthritis. If patients are signed up for an ankle fusion, it’s usually because they are faced with late stages of arthritis; typically OA. Therefore, patients presenting for an ankle fusion are usually in their mid forties and older.

By fusing the ends of the talus and tibia together, the joint is effectively eliminated. You lose the ability to move your foot up or down, but with no joint present the bones no longer grind into each other resulting in the absence of pain. In addition, some patients presenting for ankle fusion lack sufficient stability in their joints, which is remedied by fusing the bones together. The procedure varies with the surgeon’s technique, but typically the ends of the bone are first shaved off to create a flat surface. Then, the ends are fused together with internal fixation (such as screws, rod or plate) or external fixation, or sometimes a combination of both. Healing time for a healthy individual should be about three months, though age and other existing medical conditions can also factor into healing time. Smoking and diabetes for example are known to have an impact on healing. Therefore, depending on the forces at play, healing could take anywhere from 3-6 months. Sometimes factors like smoking and diabetes can result in complications such as failure to heal or misaligned healing. This could lead to the need for a revision of the fusion or more aggressive treatments, such as the injection of bone marrow to help stimulate healing.

Recovery

Recovery is usually straight forward. Patients are expected to be non-weight bearing for the first few months of their treatment. Their surgeon will check on their healing progress periodically and will guide the patient to progress to partially weight bearing when appropriate. For the typical patient, this could be between one and a half to two months post-op, though again this varies per individual. For patients who have been fused with internal fixation, it might be possible to remove the hardware down the road. This all depends if the hardware becomes painful, or based solely on the patients preference. A lot of times the hardware can stay in without impacting the surgical outcome.

Another possible outcome of having an ankle fusion is arthritis of the neighboring joint. Fusing the tibia and talus together can have an impact on the other joints that make up the foot and ankle and could lead to arthritic changes. This varies with the patient’s level of activity. More aggressive patients run the risk of wearing the neighboring joint out. It is possible to fuse these joints as well, though again at the expense of motion. There are many types of joint fusions that are possible in the foot and ankle and all depend on the symptoms that the patient presents with. A patient may even need to have several joints fused at the time of their ankle fusion.

Tibo-Talor Fusion

A fusion of the tibia and talus is also known as a tibo-talor fusion or TT-fusion for short. However, depending on the status of the talus (whether it’s healthy or damaged or not) it might have to be removed. This leads to an alternative type of ankle fusion known as a tibo-calcaneal fusion, or TC-fusion. This is a fusion of the tibia and heel bone, otherwise known as the calcaneus. This type of fusion typically results in a significant shortening of bone which leaves the patient with a leg length discrepancy. However, this could be remedied with a shoe lift. In addition, by fusing the heel, the patient’s range of motion is further decreased by eliminating the joint that is responsible for side-to-side swinging motion of the foot. If the patient’s talus is healthy, but they also have arthritic heel pain, they may receive a TTC-fusion which stands for tiob-talor-calcaneal fusion. Here all three joints are fused and eliminates all motion in the foot at the expense of being pain free.

Healing Time

Healing time for a TCC and TC-fusion are about the same for a TT-fusion; somewhere between 3-6 months depending on the patient. Full recovery can take anywhere from 4-9 months. 

Almost always these operations require a non-weight bearing mobility device such as crutches or a knee walker.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm