TRAUMA

We provide conservative and surgical treatment options for all fractures, lacerations, and tendon ruptures located in the ankle and foot. Most importantly, we’ll be your support team as you rehabilitate back to your activities.

Achilles Tendon Ruptures

The Achilles tendon is the most powerful tendon in the lower extremity and aids in propulsion. Achilles tendon ruptures typically occur in middle-aged individuals, while engaging in sports. However, they can also occur spontaneously with forced plantar flexion.

Undoctored Treatment

Most patients describe an Achilles tendon rupture as feeling like they were “hit in the back of the leg with a tennis racket”. A patient’s ability to propulse during gait will be significantly reduced. If you suspect an Achilles tendon rupture, stop your activity and become strict non weight bearing. Ice, elevate and apply compression to the affected leg until you seek medical attention.

Medical Treatment

All Achilles tendon ruptures need immediate medical attention. Surgery is necessary to provide an end-to-end repair of the tendon and restore propulsion power during gait. Non surgical options are also available in certain circumstances. Nevertheless, for active individuals I recommend surgical intervention to ensure a strong end-to-end repair of the tendon and reduce the risk of tendon re-rupture. Following surgery, patients should expect to be non-weightbearing for 6 weeks. Various types of cross training is permitted and encouraged during recovery. Physical therapy is an essential part of the post op recovery process. Patients should expect a gradual return to full weight bearing activities.

Ankle Fractures

Ankle fractures typically occur from a combination of impact and rotational stress. There are a number of different ankle fractures patterns depending on the severity, and injury mechanism of action. The two leg bones, the tibia and fibula can be involved. With more severe injuries, a fracture can also occur in the talus, or one of the foot bones. Typical presentation includes bruising, swelling, and moderate to severe pain.

Undoctored Treatment

If you suspect an ankle fracture, you should immediately be non weightbearing. Ice, elevation, and compression should be applied to your ankle until you receive medical care.

Medical Treatment

If you suspect an ankle fracture, always call immediately for an appointment or go to your closest emergency room. If you can see your bone protruding from your skin, go directly to the emergency room to be scheduled for emergent surgery. It is important to get both ankle and foot x-rays during your initial evaluation. More often than not, ankle fractures require surgical intervention. You should expect a 6-8 week period of non-weight bearing immobilization after surgery. Physical therapy is also highly recommended during your recovery course. Various types of cross training is permitted and encouraged during recovery. Patients can expect to gradually return to full weight bearing activities after surgery.

Contusions

A contusion, is another name for a bruise. These occur from blunt trauma, which results in skin discoloration and pain. The skin discoloration occurs from damaged capillaries and venules, resulting in blood seeping into surrounding tissues.

Undoctored Treatment

If you suspect a contusion, avoid direct pressure to the area and apply ice to help with pain and swelling. With a simple contusion, with no further bone or soft tissue involvement, you may resume your usual weight bearing activities as tolerated.

Medical Treatment

If you have moderate to severe pain while weight bearing, and your symptoms are not improving, please schedule an appointment. X-rays will be performed during your consult to evaluate for a possible underlying fracture. Ultrasound exam can be performed to evaluate for a hematoma, seroma, inflammation around ligaments or tendons, or tearing of these soft tissue structures.

Lacerations

A laceration is a cut in the skin that can vary in depth. Lacerations may occur from dropping a sharp object on your foot or from a shear force from an injury such as a fall or misstep.

Undoctored Treatment

Once you have sustained a laceration, stopping the bleeding is your first priority. If the injury is superficial (i.e only involving the epidermal layer) then compression and a band-aid might be all you need. It is important to wash the laceration well with antibacterial soap and water prior to applying the band-aid. Avoid peroxide application since it is caustic to the skin and can impede healing.

Medical Treatment

If the laceration extends into the dermal layer of skin, or deeper, you should seek medical attention immediately. Depending on the depth of the laceration, treatment may vary from a simple in office wash out and suture closer, to a more involved surgery. Surgery would consist of a wash out of the wound and possible repair of a tendon, nerve, or blood vessel — if these structures were also lacerated during the injury. Surgery rehabilitation depends on the depth of the laceration and structures repaired. Various types of cross training is permitted and encouraged during recovery. If no soft tissue structure was repaired during the surgery, patients can expect to return to full weight bearing immediately after surgery. However, if a tendon or ligament had to be repaired during surgery, patients should expect 4-6 weeks of non-weight bearing.

Lateral Ankle Sprains

Lateral ankle sprains can occur from a dorsiflexion inversion force or a plantarflexion inversion force. The anterior talofibular ligament is involved if the ankle is forced into plantar inversion. The calcaneal fibular ligament is involved if the ankle is forced into dorsiflexion and inversion. Both these ligaments are essential for ankle stability. The severity of an ankle sprain ranges from minimal stretching of the involved ligament, to complete rupture of the ligaments, or the ligament avulsing a piece of bone from one of it’s attachments.

Undoctored Treatment

If you have sustained an inversion ankle injury, determine the severity of your pain and your ability to bear weight on the ankle. With mild sprains, patients can bear weight on their ankle immediately. A more severe sprain may not permit any amount of weight bearing. If you have pain directly when you press on any boney prominence it is best to remain non-weight bearing until seeking medical advice.

Medical Treatment

Avoid long emergency room waits and the associated costs. We offer same day appointments for ankle sprains Your consult will include a comprehensive consult to evaluate the severity of the sprain. X-rays will also be necessary to evaluate for a fracture. The goal is to decrease the swelling and pain and get you rehabbing your sprain quickly. The faster we get you strengthening on your injured ankle, the better the long term outcome. Most patients get back to running within a day or two after a mild grade I sprain.

Metatarsal Stress Fracture

Stress fractures are prevalent amongst patients of all activity levels. Bone is in a constant state of remodeling. It can undergo stress, and then repair itself daily. Stress fractures occur when there is increased demand on the bone, and the bone cannot remodel itself at an adequate rate. As a result, a small crack in the cortex develops, and can be extremely painful.

Undoctored Treatment

Symptoms include localized pain and swelling. Pain will be localized to an area the size of a dime. You can elicit pain by pressing directly on the injured bone. If you have a gradual or sudden increase in pain, you should discontinue your activity immediately. Stress fractures may turn into complete fractures if you continue to stress the bone. Icing is permitted to help with pain and swelling. However, avoid NSAIDs, as these will delay healing. Low impact cross training is encouraged when recovering from a stress fractures. As always, let pain be your guide when choosing cross training activities.

Medical Treatment

Rather than just deeming this an “overuse injury” we look for an array of factors that may have contributed to developing a stress fracture. Labs are recommended to evaluate for nutritional deficiencies. X-rays are always performed to evaluate your foot pain. Often times stress fractures are not seen during your initial consult; however, during your follow up visits, we can track healing progress with subsequent x-rays. Not all stress fractures are treated equally. A short course of immobilization is recommended. Typically this involves a protected walking boot or stiff soled shoes. Your pain will guide the treatment protocol. Rarely is non weight bearing with crutches necessary.

Midfoot Fractures

Midfoot bones include: cuboid, navicular, intermediate cuneiform, medial cuneiform and lateral cuneiform. Crush injuries or indirect axial loading are the most likely mechanisms for midfoot fractures. These fractures can be subtle, and may be missed if not evaluated by a foot specialist. Fractures can range in complexity from a simple avulsion fracture (i.e. a ligament or tendon displacing a piece of bone) to a severely comminuted fracture.

Undoctored Treatment

A midfoot fracture will present as severe pain, bruising, and swelling. If you suspect a midfoot fracture, become strict non-weight bearing to that extremity. Ice, elevate and apply compression until you receive medical treatment.

Medical Treatment

X-rays are necessary to evaluate the severity of the fracture and determine if surgical intervention is necessary. If the fracture is non-displaced, or displaced less than 2mm on radiograph, conservative care can be implemented. This will involve a 6 week course of cast immobilization and non-weight bearing. If the fracture is displaced more than 2mm on radiograph, surgical intervention is necessary for correct anatomical reduction and to ensure appropriate healing. You should expect a 6-8 week period of non-weight bearing immobilization after surgery. Physical therapy is also highly recommended during your recovery course. Various types of cross training is permitted and encouraged during recovery. Patients can expect to gradually return to full weight bearing activities after surgery.

Peroneal Tendon Ruptures

The peroneus longus and peroneus brevis muscles run along the outside of your leg and turn into tendons at the level of the ankle joint. The peroneus brevis tendon inserts into the base of your 5th metatarsal bone and serves to evert and dorsiflex the foot. The peroneus longus tendon inserts into the base of the 1st metatarsal and helps to stabilize the midfoot during the stance phase of gait. It also serves to plantarflex and evert your foot.

Undoctored Treatment

If either peroneal tendon ruptures, you will notice an immediate weakness in everting your foot. If you suspect a peroneal tendon rupture, stop your activity and become strict non weight bearing. Ice, elevate and apply compression to the affected leg until you seek medical attention.

Medical Treatment

If you suspect a peroneal tendon rupture, you should seek medical attention immediately. Surgical intervention is necessary to repair both ends of the rupture to restore eversion strength and midfoot stability during gait. Following surgery, a 4-6 week course of non weight bearing is necessary, followed by several weeks of physical therapy. Various types of cross training is permitted and encouraged during recovery. Patients can expect to gradually return to full weight bearing activities.

Tibialis Anterior Tendon Ruptures

The tibialis anterior muscle is the strongest dorsiflexor of the ankle (i.e helps you point your toes to your nose). The tibialis anterior is essential during ambulation in helping your foot clear the ground. The tibialis anterior tendon runs down the front of your ankle and inserts into the medial cuneiform and base of the first metatarsal. If the tibialis anterior tendon is ruptured, you can develop a drop foot gait. Ruptures may occur from trauma, or just occur spontaneously due to a degenerative tendon.

Undoctored Treatment

If you sustain an anterior tibialis anterior tendon rupture, the symptoms will include difficultly clearing your foot during walking. You will also notice a significant weakness in your ability to dorsiflex your ankle when non weight bearing. Pain will likely accompany a tibialis anterior tendon rupture. But weakness should be your most obvious symptom.

Medical Treatment

If you suspect a tibialis anterior tendon rupture it is important to seek medical attention immediately. Surgical intervention is necessary to repair the two ends of the ruptured tendon in order to restore your ankle dorsiflexion strength. Following surgery, a 4-6 week course of non weight bearing is necessary, followed by several weeks of physical therapy. Various types of cross training is permitted and encouraged during recovery. Patients can expect to gradually return to full weight bearing activities.

Toe Fractures

Small fractures may result after stubbing a toe. The toe will become swollen, discolored, and painful.

Undoctored Treatment

If you suspect a toe fracture, it is best to immobilize it immediately with a technique called buddy tapping (pic). Wear accommodative shoe gear Expect pain and swelling to resolve in 2-4 weeks. If pain does not improve, seek medical attention.

Medical Treatment

It is best to get x-rays to evaluate the severity of injury. Most toe fractures are minimally displaced and only require buddy taping and a minimal decrease in activity. If an x-ray confirms a displaced fracture, closed reduction and immobilization can take place in the office. On very rare occasions, the fracture may have to be surgically fixed.