Lisfranc Injuries

The Lisfranc Joint
The Lisfranc joint is the point at which the metatarsal bones (long bones that lead up to the toes) and the tarsal bones (bones in the arch) connect. The Lisfranc ligament is a tough band of tissue that joins two of these bones. This is important for maintaining proper alignment and strength of the joint.

How Do Lisfranc Injuries Occur?
Injuries to the Lisfranc joint most commonly occur in automobile accident victims, military personnel, runners, horseback riders, football players and participants of other contact sports, or something as simple as missing a step on a staircase.

Lisfranc injuries occur as a result of direct or indirect forces to the foot. A direct force often involves something heavy falling on the foot. Indirect force commonly involves twisting the foot.

Types of Lisfranc Injuries
There are three types of Lisfranc injuries, which sometimes occur together:

·     Sprains. The Lisfranc ligament and other ligaments on the bottom of the midfoot are stronger than those on the top of the midfoot. Therefore, when they are weakened through a sprain (a stretching of the ligament), patients experience instability of the joint in the middle of the foot.

·     Fractures. A break in a bone in the Lisfranc joint can be either an avulsion fracture (a small piece of bone is pulled off) or a break through the bone or bones of the midfoot.

·     Dislocations. The bones of the Lisfranc joint may be forced from their normal positions.

Symptoms
The symptoms of a Lisfranc injury may include:

·     Swelling of the foot

·     Pain throughout the midfoot when standing or when pressure is applied

·     Inability to bear weight (in severe injuries)

·     Bruising or blistering on the arch are important signs of a Lisfranc injury. Bruising may also occur on the top of the foot.

·     Abnormal widening of the foot.

Diagnosis
Lisfranc injuries are sometimes mistaken for ankle sprains, making the diagnostic process very important. To arrive at a diagnosis, the Doctors at Hosey Foot and Ankle Center will ask questions about how the injury occurred and will examine the foot to determine the severity of the injury.

X-rays and other imaging studies may be necessary to fully evaluate the extent of the injury. The surgeon may also perform an additional examination while the patient is under anesthesia to further evaluate a fracture or weakening of the joint and surrounding bones.

Non-surgical Treatment
Anyone who has symptoms of a Lisfranc injury should see a foot and ankle surgeon right away. If unable to do so immediately, it is important to stay off the injured foot, keep it elevated (at or slightly above hip level), and apply a bag of ice wrapped in a thin towel to the area every 20 minutes of each waking hour. These steps will help keep the swelling and pain under control. Treatment by the Doctors at Hosey Foot and Ankle Center may include one or more of the following, depending on the type and severity of the Lisfranc injury:

·     Immobilization. Sometimes the foot is placed in a cast to keep it immobile, and crutches are used to avoid putting weight on the injured foot.

·     Oral medications. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.

·     Ice and elevation. Swelling is reduced by icing the affected area and keeping the foot elevated, as described above.

·     Physical therapy. After the swelling and pain have subsided, physical therapy may be prescribed.

When is Surgery Needed?
Certain types of Lisfranc injuries require surgery. Our Doctors will determine the type of procedure that is best suited to the individual patient. Some injuries of this type may require emergency surgery.

 

Black Toenails

A black, purple, or brownish discoloration under or involving a toenail is frequently due to trauma to the toe nail, such as when something is dropped on the toe. The color results from a blood clot or bleeding under the nail, and may involve the entire nail or just a small portion of it. This can be very painful when the entire nail is involved, and may need medical attention to relieve the pressure caused by bleeding under the toenail.

Although it is very rare, a more serious cause of black toenails is malignant melanoma. Since early diagnosis and treatment of melanoma improves the chances for a good outcome, it is important that all black toenails be evaluated by our doctors to rule out this cause.

Other rare causes of black toenails include fungal infections, chronic ingrown nails, or health problems affecting the rest of the body.

Nail Fungus

A fungus is an organism that lives in warm moist areas. Fungus of the toenails is a common problem that can affect people of all ages, although it most commonly affects individuals who are older. 

Toenail fungus often begins as an infection in the skin called tinea pedis (also known as athlete’s foot). The fungus often starts under the nail fold at the end of the nail. Over time it grows underneath the nail and causes changes to its appearance, such as a yellow or brownish discoloration. It can also cause thickening and deformity of the toenail. 

Many people have difficulty with their toenails and need assistance in caring for them. Hosey Foot and Ankle Centers can diagnose the cause of toenail problems and recommend treatments.

Running Injuries

Whether an athlete is a recreational, competitive, or elite runner, foot and ankle health is essential for optimal performance.  Runners are susceptible to overuse injuries including heel pain (plantar fasciitis), Achilles tendonitis, sesamoiditis, neuromas, MPJ capsulitis, stress fractures, posterior tibial tendonitis (or PTTD), and calcaneal apophysitis in children/adolescents.  Evaluation by the podiatrists at Hosey Foot and Ankle Centers will help the athlete determine the underlying cause of pain and the best course of treatment. Custom orthotic devices are often used for treatment of these conditions.

Calcaneal Apophysitis (Sever's Disease)

What Is Calcaneal Apophysitis?


Calcaneal apophysitis is a painful inflammation of the heel’s growth plate. It typically affects children between the ages of 8 and 14 years old, because the heel bone (calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop.
Calcaneal apophysitis is also called Sever’s disease, although it is not a true “disease.” It is the most common cause of heel pain in children, and can occur in one or both feet.
Heel pain in children differs from the most common type of heel pain experienced by adults. While heel pain in adults usually subsides after a period of walking, pediatric heel pain generally doesn’t improve in this manner. In fact, walking typically makes the pain worse.


Causes


Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. The heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer, track, or basketball are especially vulnerable.


Diagnosis


To diagnose the cause of the child’s heel pain and rule out other more serious conditions, the Doctors at Hosey Foot and Ankle Centers obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child’s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.


Treatment


The surgeon may select one or more of the following options to treat calcaneal apophysitis:
Reduce activity. The child needs to reduce or stop any activity that causes pain.
Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel.
Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue.
Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile.

Fallen Arches

"Fallen arches" is a common term used to describe a flatfoot condition that develops during adulthood. This should not be confused with other causes of flatfoot that may develop during childhood or adolescence.

Most cases of “fallen arches” develop when the main arch-supporting tendon (the posterior tibial tendon) becomes weakened or injured, causing the arch to gradually become lower. With time, the shape of the foot changes and secondary symptoms start to appear.

Common problems associated with fallen arches include plantar fasciitis, tendonitis, increased fatigue, and arthritis of the foot and ankle.

Additional information is available by reading Posterior Tibial Tendon Dysfunction (PTTD), Flexible Flatfoot.  

Ankle Sprain

What Is an Ankle Sprain?

An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue – like rubber bands – that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.

Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.

Causes

Sprained ankles often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position. Ankle sprains commonly occur while participating in sports, wearing inappropriate shoes, or walking or running on an uneven surface.

Sometimes ankle sprains occur because of a person is born with weak ankles. Previous ankle or foot injuries can also weaken the ankle and lead to sprains.

Symptoms

The symptoms of ankle sprains may include:

·     Pain or soreness

·     Swelling

·     Bruising

·     Difficulty walking

·     Stiffness in the joint

These symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people with previous ankle sprains. Instead, they may simply feel the ankle is wobbly and unsteady when they walk. Even if there is no pain or swelling with a sprained ankle, treatment is crucial. Any ankle sprain – whether it’s your first or your fifth – requires prompt medical attention.

Why Prompt Medical Attention Is Needed

There are four key reasons why an ankle sprain should be promptly evaluated and treated by a foot and ankle surgeon:

·     An untreated ankle sprain may lead to chronic ankle instability, a condition marked by persistent discomfort and a “giving way” of the ankle. Weakness in the leg may also develop.

·     A more severe ankle injury may have occurred along with the sprain. This might include a serious bone fracture that, if left untreated, could lead to troubling complications.

·     An ankle sprain may be accompanied by a foot injury that causes discomfort but has gone unnoticed thus far.

·     Rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly. 

Diagnosis

In evaluating your injury, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. X-rays or other advanced imaging studies may be ordered to help determine the severity of the injury.

Non-surgical Treatment

When you have an ankle sprain, rehabilitation is crucial—and it starts the moment your treatment begins. Your foot and ankle surgeon may recommend one or more of the following treatment options:

·     Rest. Stay off the injured ankle. Walking may cause further injury.

·     Ice. Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.

·     Compression. An elastic wrap may be recommended to control swelling.

·     Elevation. The ankle should be raised slightly above the level of your heart to reduce swelling.

·     Early physical therapy. Your doctor will start you on a rehabilitation program as soon as possible to promote healing and increase your range of motion. This includes doing prescribed exercises.

·     Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.

When Is Surgery Needed?

In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments. Our Doctors will select the surgical procedure best suited for your case based on the type and severity of your injury as well as your activity level.

After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome.