Common Foot & Ankle Problems

Common Foot & Ankle Problems

Hallux Valgus / Bunion Deformity
* A structural (bony) deformity where the metatarsal bones spread apart causing a prominent bone to protrude on the inside of the foot.
* A progressive deformity.
* May be treated conservatively, but usually requires surgical correction if pain persists.

Bunion prior to correction
Bunion after correction
Severe Hallux Valgus / Bunion Deformity
Cut in bone and fixation with screws

Tailor’s Bunion / Bunionette
* Bony deformity which is located on the outside part of the foot.
* The bump, bunionette or Tailor’s Bunion, can become very painful due to shoe irritation.
* Tailor’s bunions may be treated conservatively. Surgical correction may be necessary.

Note prominent 5th metatarsal head with swelling
Note Bowing of the Metatarsal
Note Straight Metatarsal
After Correction
Prior to Correction
Tailor’s Bunion / Bunionette
Hammertoe Deformity
* Contracted or abnormal position of the toes, which may be flexible or rigid in nature.
* Usually caused by weakened muscles of the foot.
* May cause pain due to irritation from other toes. The pain may be exasperated by tight fitting shoes.
* Hammertoes are often accompanied by a corn or callous.
Toe prior to surgery
Toe after surgery
Hammertoe Deformity
Hallux Rigidus
* Osteoarthritis of the big toe joint usually associated with pain and restricted motion.
* May be caused by injury or repetitive joint damage due to a biomechanical / structural problem of the foot.
* Chronic wear and tear causes a wearing out of the cartilage at the joint and bone spurs to form.
Hallux Rigidus of the Big Toe Joint
Note bone spur formation

Hallux Rigidus of the Big Toe Joint
Note joint space narrowing and bone spur formation at the joint margins
Rheumatoid Arthritis
* An inherited arthritis which affects joints in the feet and hands.
* The joint destruction and deformities are progressive in nature.
* May predispose patients to bunion and hammertoe formation.
Bunion Deformity
Hammertoe Deformities
Rheumatoid Arthritis
Rheumatoid nodule
Plantar Wart
* Human papaloma virus infection in the feet.
* Warts are obtained by barefoot exposure to the virus.
* Warts are often spread in showers, gyms, or other areas where barefoot walking is common.
* May be treated with any number of methods but recurrence ranges between 18-22%.
Plantar Wart
Callous / Corn
* Thickened area of skin caused by chronic rubbing or irritation of a bony prominence by the ground or shoe gear.
* Very high areas of pressure within a callous can develop a painful central core.
* Lesions reoccur because the cause of the lesion is often from bone.
Callous / Corn
Athletes Foot
* A fungal infection typically caused by fungus found in soil (Dermatophyte).
* Picked up by contact with the fungus usually walking barefoot (Gym, hotel, pool, etc.).
* May occur anywhere on the foot and may burn and/or itch.
* The affected areas of skin will often peel or may have small blisters.
Ingrown Nails
* Toenail which grows into the skin. Most often caused by a wide toenail and an external pressure.
* The nail may cause pain or infection due the pressure of the nail border.
* May be treated with removal and/or antibiotics. May be permanently corrected with retaining a normal nail appearance.
Fungal Toenail
* A thickened nail caused by a fungus.
* Initially caused by an injury to the nail which allows the organism to enter the nail.
* Progressive in nature and slow growing.
* May spread to other nails or other people in close contact. Organism may also spread from nail to the skin (athletes foot).
* May be treated if pain or concerns arise.
Fungal Toenail
Fungal Infection which caused ingrown nail
Thickened curled nails caused by fungus
Nail Injury
* Chronic injury (i.e. athletic activities) causes injury to the nail root and results in nail horizontal layers.
* Isolated injury may also cause bleeding under the nail, leaving a dark spot which persists until the nail grows out.
Lines of injury
Dried blood under the nail plate from injury.
Eczema
Gout
Redness and swelling of the big toe joint
High Arched Feet / Pes Cavus
Pes Cavus / High Arch Feet
Flat Feet
Note low medial arch height
Pes Planus / Flat Feet
Note collapse of entire foot inward
Note low medial arch height
Plantar Fascitis / Heel Spur Syndrome
* Inflammation and partial tearing of a ligament band which attaches from the heel to the ball of the foot.
* Usually a result of poor arch support and overuse.
* May be accompanied by a calcified spur on the heel.
* Usually resolves with conservative treatments.
Ankle Sprain
* Tear or stretching of the ligaments of the ankle. Usually the ligaments on the outside of the ankle are involved.
* Caused by and twisting injury of the foot / ankle .
* Instability of the ankle can develop due to the ligament injury.
* Most often treated conservatively. Surgical repair can be performed to treat chronic ankle sprains.
Bruising after ankle sprain
Morton’s Neuroma
* Injured or compressed nerve most often between the 3rd and 4th toes.
* Burning / pain on the ball of the foot or toes.
* Patients may feel fullness or a mass in the area when they walk.
* Treatments may be conservative or surgical.
Haglund’s Deformity / Retrocalcaneal Exostosis
* Prominent bone on the back of the heel.
* Back of the heel is irritated by shoes and activity, which places pressure on the area.
* Can also be aggravated by a tight Achilles tendon over prominent heel bone.
* Treatments may be conservative or surgical.
Ulcerations
* Erosions of the skin caused by loss of sensation or poor circulation.
* Skin break down occurs which, places patients at risk for local or systemic infection.
Ischemic Ulceration(Ulcer due to poor circulation)
Diabetic Ulceration
Ganglion Cyst
* Benign soft tissue mass which arises from a weak area in a tendon lining or joint.
* Cyst is often filled with a gelatinous fluid.
* Cyst may change size depending on irritation.
Subungual Exostosis
* Bone and cartilage growth under the great toe nail.
* Pain may arise if pressure is placed over the area.
* May be treated with shoe style changes, nail removal or surgical removal.
Venous Stasis
* Discoloration of skin due to longstanding swelling of legs.
* Persistent swelling can lead to skin breakdown.
* Compression and elevation of the legs are essential to the prevention of complications.
Heel Fissuring / Cracking
Heel Fissuring with Hyperkeratosis
Fractured Proximal Phalanx (Toe)
Fractures
Hyperhydrosis
Achilles Tendonitis
Inflammation of tendon

Common Foot & Ankle Problems.ppt