Foot ligament injury is a common problem in the foot and ankle. A ligament is a strong fibrous tissue whose function is to stabilize joints. A ligament is the tissue that connects the bones that form the joints. Ligaments can be injured from overuse but are more commonly injured from trauma. Ligament injuries are referred to as foot and ankle sprains. And out of all the possible ligament injuries, ankle sprains are the most common.

How Do I Know If I Have A Foot Ligament Injury In My Foot?

• You may feel or hear something pop or snap
• You may have pain and swelling in the area of injury
• Don’t assume if you can walk on your foot or ankle that the ligament is not injured
• It hurts when you put weight on your foot.

How Do We Know If The Ligament Is Injured?

It starts by taking x-rays in most cases to rule out bone injuries. X-rays may also be used to see if a joint has more motion in it than normal. These are called stress views and your local podiatrist will advise you after reviewing the results. This can indicate that the ligament is no longer stabilizing the joint, and this is sometimes done to evaluate ankle sprains. An MRI may be ordered. This can help the doctor know if it is a ligament that is injured, and the severity. There are three different grades of tearing depending on the severity of the injury. Grade 1 is the mildest and means most of the ligament is not torn. Grade 2 indicates that 40-60 percent of the ligament is torn. A large tear is grade 3 and this indicates that the tear is completely through the ligament.

Treatment Of A Foot Ligament Injury

The options for treatment of a foot ligament injury vary depending on the severity. The most severe tears may need immobilization for weeks using a Cam walker. Some doctors may even suggest surgical repair to reconnect the torn ligament ends to allow them to better heal. With a more minor tear such as a grade 1, resting, icing, and elevation with gradual return to physical activities may be all that is needed.

Ankle Sprains

Of all the potential ligament injuries of the foot and ankle, injuries to the ligaments of the ankle are most common. It’s important to consider if it’s the first ankle sprain you’ve had, or if you have a history of repeated sprains. If it’s your first one and it’s associated with severe pain and swelling, a sense of something popping or giving out is important to note. In this situation, you should be evaluated by a foot and ankle specialist. With a severe sprain, a complete tear would mean that immobilization in a Cam Walker may be recommended. This will allow the ligament ends to be in closer approximation and provide a better chance of full repair. Without proper treatment, you may now be left with an ankle joint that is chronically unstable. Without proper treatment from the beginning, the instability of the ankle may become chronic. In some cases, this might require surgery to stabilize the ankle. Ankle sprains tend to be the most under evaluated and undertreated foot and ankle injury. Patients often go to an emergency room or urgent care facility. If x-rays rule out a fracture, little after care may be given.

What You Can Do To Prevent Ankle Sprains?

• Consider wearing high top athletic shoes if you’re playing basketball
• Use an over-the-counter ankle brace
• Consider custom made orthotics as these give your feet better feedback regarding foot placement
• Do ankle exercises and consider trail hiking or running to build up muscle strength. This may help support your ankle joint more

So, it is important to understand that no matter where the foot ligament injury (ankle or foot) is, a ligament tear is to be suspected. Just because you can walk on it, and just because it’s not fractured doesn’t mean aggressive treatment wouldn’t be a good idea. As it’s often been said, a sprain can be almost as bad as a fracture. Finally, it is always better to error on the side of caution and consult with you podiatrist if you have concerns about a possible ligament injury.

Dr. Anderson, the founder of Anderson Podiatry Clinic, DPM, ABPS, FACFS, FAENS

So, you’ve heard the words flat feet pronation, but what is it? Pronation is a commonly used word to describe motion in your foot that naturally occurs. It’s a term you may have heard from a shoe salesman or if you’ve read about a potential cause of injuries during your athletic endeavors. Knowing this, let me now contrast flatfeet and pronation.

Putting it All Together – Keep Reading to Better Understand How Well Our Feet Are Engineered!

By our definition, flatfeet refers to the appearance of a foot with minimal to no arch. The footprint of this foot would show very little arch. This type of foot could have a foot that is rigid, meaning even when not bearing weight the arch of the foot is absent. Very few have a flat foot that is this severe. Most are flexible, and when non weight bearing an arch is present. It is important to know that most flatfeet are thought to be acquired.

Another definition to keep in mind is pronation.This refers to the motion that occurs on your foot. We were all built to have this motion occur. The biomechanics of the foot is remarkable when it’s fully understood. The motion of pronation is complex as it means your foot is moving in all body planes. It would be like a universal joint on a car. As the entire foot rolls in, something remarkable occurs. The bones of the foot that support the arch become more flexible meaning they align is such a way to provide more motion which equals more shock absorption. This shock absorption helps when you walk or run to reduce the stress of impact on the feet, knees, and hips. Again, if your feet are the suspension of a car, pronation absorbs the shock of your body weight coming down on the foot. So some pronation is necessary, but too much is not a good thing as it causes stress on the foot, ankle, knees, and hips. It may also be a cause of back pain.

What Does Flat Feet Pronation Look Like?

Some feet will have a heel bone that rolls in too much. Normally, when you are standing, your heel should be close to perpendicular to the ground or slightly rotated inward (pronated). Too much rolling inward of the heel means you’re overpronated.

Other feet will overpronate with more of the motion occurring in the arch. In this foot type, the heel may remain close to perpendicular to the ground and the arch is flat. You may pronate more in the rearfoot or more in the arch, or a combination of both. So remember that pronation is not a bad thing as it is good to have some pronation but not too much.

What Problems Can be Related to Over Pronation?

• Knee Pain – This can occur from overpronation causing too much inward deviation at the knee joint.
• Back Pain – It is thought that overpronation will cause the pelvis to tilt forward causing symptoms in the lower back.
• Bunions – This painful foot deformity is thought to be related to excessive weight beneath the great toe joint.
• Plantar Fasciitis – This is the primary cause of pain beneath the heel bone.

Treatment of Flat Feet Pronation

• Orthotics – This has been the primary treatment for patients with flat feet pronation for most podiatrists. It’s often times not enough to shop for more supportive shoes. The process involves taking a non- weight bearing impression of your foot, placing it in a position it should be in, not the position it is in while standing. Moving the orthotic from shoe to shoe allows you to take the customized support you need with it. So, the impact of the shoes is neutralized.
• Motion Control Shoes – When shopping for shoes you should ask for a motion control shoe. As an example, running shoes can be constructed with a lot of motion control built into the shoe or very little.The heel counter that cups the heel should be rigid. This is something to look for in a shoe if you overpronate.
• Stretching – For some this may be helpful as a tight Achilles tendon may be associated with a flat foot.
• Foot Exercises – There may be exercises that can be performed to increase the strength of muscles. This may have limited effect on more severe flatfeet.
• Surgery – In certain situations surgeries to correct the flatfoot may be considered. The severity and age of the patient are all taken into consideration. There are some advancements in surgery techniques that have reduced the risk and lay up time if surgery is indicated.

Call us today at our Fort Collins location (970) 329-8158, Broomfield location (303) 997-2795, Surgery Center (970) 329-8158, or use our online scheduling system to book your appointment.

The subtalar joint is the most complicated joint of the foot. This can lead to subtalar joint arthritis and the pain can significantly reduce your mobility. We will explain how this amazing joint works and what can be done both conservatively and surgically. Ideally, we all share with you some new approaches that may delay or eliminate the need for surgery.

Introduction to the subtalar joint

The subtalar joint is in the rearfoot. The joint lies below the ankle joint. Biomechanically it complements the ankle joint because the ankle joint allows the foot to move up and down and the subtalar joint allows the foot to move side to side. It is similar to a universal joint on a car. You may have heard of the term’s supination and pronation. These motions include motions in three body plans. Supination includes inversion, adduction and plantarflexion. Pronation includes eversion, abduction and dorsiflexion. If you were to do circles with your foot the majority of this motion would take place in the subtalar joint.  The ability to move in all different body planes allows the foot to adjust to irregularities in the surfaces that we walk on.

How do I know if I have subtalar joint arthritis?

• Pain will be noted when you first get up to walk right below your ankle joint
• You will notice more pain when you walk on irregular terrain.
• The pain will be deep and dull
• Arthritis  X-ray will be seen as the space between the bones is reduced.

What can you do if you think you have subtalar joint arthritis?

• Wear more supportive shoes
• Take NSAIDs when you have pain
• Avoid irregular surfaces
• Consider an over-the-counter arch support or ankle brace
• Being overweight – Weight loss may also be important to consider

What is the cause of subtalar joint arthritis?

• Trauma – if you have had a fracture to the heel bone (calcaneus) or the ankle bone(talus). These fractures can result in trauma to the cartilage of the joint leading to eventual arthritis
• Overuse – just being very active and possibly experiencing occasional ankle sprains may also contribute.
• Secondary disease processes – If you have any arthritic conditions such as rheumatoid arthritis this also can cause secondary damage to the cartilage of the joint.

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Treatment of subtalar joint arthritis pain

Conventional treatments

Orthotics – these are custom made arch supports.  These help by reducing the amount of side-to-side motion that occurs in your foot.  It’s very important to understand that the orthotics you get from retail stores, ski shops and other non- specialized healthcare providers may not be adequate. Many healthcare dollars are wasted on the types of devices. As podiatrists we are trained to use a different approach when it comes to the steps to create an orthotic. We believe a non-weight bearing neutral position of your foot. Placing your foot in this position is critical to having a very precise orthotic made.  We place the foot where it should be not where it is when you’re putting weight on it. This makes for a much more precise fit. This is important if you’re going to get the maximum benefit from an orthotic.

Braces – ankle braces may also be used however they are not as practical in many situations as orthotics.

Cortisone – injections of cortisone can also be used to pain relief and to reduce  inflammation. It’s important to understand that the long-term effects of cortisone are not good for the joint and in fact will accelerate the deterioration of the joint. So, if the last step in your treatment plan is to fuse the joint then this approach can be appropriate.

Fusion of the joint – finally when conservative efforts fail fusion of the joint can be performed. This surgery involves removal of the remaining cartilage from the joint and using bone screw(s) to help fuse it. In some cases a bone graft may be used to assist in the fusion. This requires extensive lay-up, usually off weight bearing for 6 weeks (about 1 and a half months). Full recovery will take months after surgery and  you will no longer have the ability to move your rearfoot side to side. However, this limitation will usually be minimal compared to the pain you had before the surgery was performed.

At Anderson Podiatry center we offer two key alternatives that should be considered!

Yes, we also emphasize orthotics as part of our conservative approach, however the use of human cellular tissue products (stem cell) and a procedure called joint denervation surgery is also used.

• Human cellular tissue products – We were one of the earliest adopters of the idea 15 years ago. It started with the use of restorative medicine (stem cell) for getting rid of heel pain, plantar fasciitis. Soon we were noticing good results when used on arthritic joints of the foot. We currently use placenta cells or umbilical cord products. These are acquired from labs that are regulated by the FDA for safety. The process is done in our clinic with an injection into the joint and patients are able to ambulate immediately with minimal lay-up.

Our Patient Testimonials – Restorative Medicine

• Joint denervation surgery – The concept comes from a doctor Lee Dellon , a professor of plastic surgery and neurosurgery at John Hopkins. Very few doctors are trained to perform surgery on the peripheral nerves in the lower extremity. The idea is to block the pain you sense from an arthritic joint by removing one or nerve pathways that signal the pain to your brain. There are four primary nerves in the lower leg that do not supply muscles. We determine which of these branches can be removed. This is an outpatient surgery that allows you to walk in less than a week. This compares to 6 weeks (about 1 and a half months) off weight bearing for a subtalar joint fusion. The risk of this procedure is considered less. We remove the branch and bury the tip of the branch in muscle to eliminate potential regrowth. Your ability to feel the arthritic joint is significantly eliminated and your ability to ambulate is not affected and you do not lose strength or numbness to an area of the foot that allows you to balance. You may also return to most exercises.

Our Patient Testimonials – Joint denervation Surgery

Many of you may not be aware of the use of human cellular tissue products and joint denervation procedures. We’ve had great success with both as an alternative to joint fusion procedures and joint replacement surgeries in the foot and ankle. Anderson Podiatry Center has its own foot surgical center, which is beneficial for the paitent’s cost and final outcome because of the combined experience of the surgical team. So when searching for the ‘nearest podiatrist‘, please consider visiting our Anderson Podiatry Center clinics in Fort Collins and Broomfield.

Are you considering plantar fibroma surgery?

Fibromas are a benign growth of fibrous tissue that can develop in various parts of the body. Fibroma is classified as a hyperproliferation of fibrous tissue. They may occur in the uterus or in places like the hand as examples. When this occurs on the palm of the hand, they are called dupuytren’s contracture. Fibroma can also occur in the arch of the foot and is referred to as plantar fibromatosis. The growth itself is within the plantar fascia. Plantar fibroma surgery is not our recommended treatment method, we will discuss the pros and cons to help one decide.

Until recently, the treatment options were very minimal. For many, surgery was considered a way to get rid of the growth. Options such as cortisone injections and the use of ultrasound physical therapy may have some effect, but tend to not provide significant long-term benefits.

Plantar Fibroma Surgery

When plantar fibroma  surgery is performed There are two approaches:

• Removal of the growth through includes a small incision localized to the area around the growth. This may include removal of a small portion of the plantar fascia around the growth.
• Removal of the entire plantar fascia through an incision that extends the entire length of the foot.
• The more aggressive approach using a long incision and removal of the fascia is most successful, but still results in a 25 percent recurrence rate.

Recovery

The recovery from this surgery requires the patient to remain non weight bearing for 3 weeks. This is to avoid the creation of a painful scar on the bottom of the foot. Besides the potential for a painful scar, recurrence and potential for nerve damage may be other potential risks.

Our Preferred Non-Surgical Solution to Ledderhose Disease

We have had great success using a series of injections to reduce and eliminate plantar fibromas from your foot. This treatment option was pioneered by a colleague of mine, Dr.Ed Davis, who originated the concept ¹ . The process involves a series of three injections into the tumor.

Before the procedure is performed, the plantar fibromatosis is measured using diagnostic ultrasound. Ultrasound is also used to guide the needle into the tumor. A combination of local anesthetic, cortisone, and enzyme solution are used to break down the tissue.

Recovery

Patients are able to walk immediately with minimal layup. Most can return to full activity in 2 days. At first, the plantar fibromatosis becomes soft, followed by reduction in size with each subsequent treatment. Although three treatments at 2-to-three-week intervals may be enough for many, a fourth and fifth injection may be necessary. For many, this may complete the treatment with no recurrence; however, if an occurrence occurs, and is caught early before the tumor becomes too large, fewer injections are needed.

Risks of Plantar Fibroma Surgery vs Injections

These injections have little to no risk compared to surgery, and have a higher success rate. This treatment option has become the standard at Anderson Podiatry Center. For many it has been very gratifying to discover that finally they may have a non-surgical option for this difficult problem.

Consider this new option when it hurts to walk from your plantar fibromatosis. It’s a low-risk process with a high percentage of success. Don’t lose hope and throw in the towel if you have this aggravating problem. This is a new option that you should consider! We are conveniently located at Fort Collins and Broomfield should you wish to book an appointment with one of our podiatrist.

For patients outside colorado there is information on planning a visit on our patient resources section.

References
¹ Occtober 25, 2018. Dr. Ed Davis. Ledder Hose Disease. https://www.ledderhosedisease.com/about/

The Achilles tendon is the largest tendon in our body and can be prone to injury. A lot of stress is placed on the tendon as it is responsible to lift your heel off the ground and propel our body forward when we walk or run. It also plays a function in helping us to balance and jump which is why we should all stretch our Achilles tendon regularly.

The basics – There are two muscles that attach to the Achilles tendon.¹ One is the gastrocnemius muscle. This is the large muscle that forms the muscle bulk you see in your leg. The other muscle is the soleus muscle which lies deep beneath the gastrocnemius muscle. It’s a flat but very powerful muscle. There are some anatomical differences between the two muscles.

Anatomy -The gastrocnemius muscle attaches to the Achilles and its origin is above the knee. It attaches to the femur bone above the knee joint. The soleus muscle originates from an area called the soleal sling which is a fibrous band of tissue below the knee joint. These differences are important because when the knee is straight your notice that you’ll feel more pull than when your knee is flexed. This is because the large gastrocnemius muscle originates above the knee flexion of the knee, it will reduce the pull while the extension of the knee will cause more pull (tension) on the muscle. This is important to know because when you pull your foot up towards you when you stretch you won’t be effectively stretching the gastrocnemius muscle as much when your knee is bent as when it is extended. So it is preferred that the majority of stretching of the Achilles should be done with the knee straight.

Options for stretching to reduce stress on the Achilles tendon.

How to stretch while sitting?

While sitting on the floor you can use a towel or a stretching band. This is referred to as resistance band calf stretch. Place it against the ball of your foot. Then with your leg extended holding the towel or stretching band pull the foot up towards you. Do it slowly and make sure to hold the stretch for 30 seconds. Then switch to the other foot and repeat one to four times.

How to stretch while standing?

1. Standing wall stretch
   While facing a wall place one foot behind you and one foot closer to the wall. The foot furthest from the wall will be stretched. Think about moving your hips forward towards the wall to stretch the Achilles tendon. It’s also important to point your foot forward toward the wall. If your foot is facing out it’s likely to be in a pronated (flattened Position) and this will cause your foot to flex, and you’ll have less flexion at the ankle joint where it is needed. Lean forward keeping your knee straighten to get a maximum stretch. Do it slowly and hold for 30 seconds. Repeat 1-4 times and then switch legs.
2. Standing toe raises
   The exercise helps to stretch the Achilles but also has the advantage of strengthening your gastrocnemius and soleus muscles. To do this exercise make sure that you can hold onto something stable to help you balance. This could be a table, counter, or handrail on the stairs. You can stand on some steps with the ball of your foot supported on the steps and your heel off the steps so it is hovering. You should not be bearing weight on the opposite foot. Then allow the heel of the foot to drop down The same process can be accomplished standing on a board, curb, or large book. Now simply relax your calf muscles and allow your heel to drop below the surface you’re standing on to create stretches on the muscles and Achilles. Hold for 5 seconds. Then lift the heel so you rise onto the ball of the foot. Repeat this 8–10-time times. Then switch sides.

How to stretch the Achilles tendon properly?

Make sure you do your stretching slowly, no need to bounce. The muscles are more likely to relax using this technique.
Hold for 30 seconds. When you feel the stretch of your achilles tendon, it’s important to hold for the pose for 30 seconds. The muscles will be more likely to relax and stretch. Remember the natural response the muscle will have immediately when stretched is to contract so a longer time is better.

If you’re feeling any pain while you’re doing your stretch stop.

Important word of CAUTION!

Finally. Use caution if you have significant Achilles tendon pain or swelling. If you find yourself in this situation don’t assume stretching is a good thing to do. I’ve seen too many people who have been attempting to get rid of Achilles tendon pain by stretching and they’ve never been diagnosed. You may have a tear! Yes, I’ve even seen patients who were doing stretching exercises on a ruptured Achilles tendon.

I have heard stories too often of “my friend told me to stretch, or I read that I should stretch or worse, yet my physical therapist told me to stretch my achilles tendon“.

Contrary to what you may hear or read on the internet; you’re putting yourself at risk of causing more injury to the Achilles. If you see swelling and significant pain, consider getting it evaluated by your podiatrist. You could damage your tendon even more. It’s less likely that your Achilles tendon is not inflamed, or tendonitis, but rather is more likely to be injured, tendinosis, which means you may be getting small tears from overuse or trauma. An MRI, or ultrasound evaluation may be needed to evaluate. Stretching could make what was assumed to be tendonitis worse, as you were really dealing with an Achilles tendon tear. If this is the case regenerative medicine treatment could be considered instead of surgery. If you have questions about making a long term plan, please read about our regenerative health management process.

So don’t assume you’ll need surgery and the earlier the treatment the better. Our treatments with human cellular tissue products, and regenerative medicine, can assist in repairing the damage.

View Matt’s Story on how we used regenerative medicine to resolve his Achilles tendon pain!

1. Bryan Dixon J. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Curr Rev Musculoskelet Med. 2009 Jun;2(2):74-7. doi: 10.1007/s12178-009-9045-8. Epub 2009 May 23. PMID: 19468870; PMCID: PMC2697334.