Orthopedic Foot Surgery Brookings SD
Sioux Falls, SD
Hospital: Orthopedic Institute-331-5890
Accepting New Patients: Yes
4.4, out of 5 based on 5, reviews.
Rapid City, SD
Orthopedics, Aerospace Medicine
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduation Year: 1974
Hospital: Brookings Hosp, Brookings, Sd
Group Practice: Brookings Medical Clinic
Rapid City, SD
Medical School: Northwestern Univ Med Sch, Chicago Il 60611
Graduation Year: 1968
Rapid City, SD
Dakota Dunes, SD
Foot Pain: Causes and Treatment
In this review article, orthopedic surgeons specializing in foot care bring us up-to-date on a type of foot pain called metatarsalgia. Metatarsals refer to the long bones of the toe. The term -algia always indicates pain. So in metatarsalgia, the pain occurs at the base of the toes where the metatarsals join the phalanges (end of the toes). You might recognize this area as the "ball" of the foot.
If you look up the treatment for metatarsalgia, you won't find a "one-size-fits-all" recipe. Every patient who presents to the surgeon with this problem has a different reason why it developed. And in order to get the best results, treatment must be individualized for each person.
What are some of the most common causes of metatarsalgia? The first is congenitalfoot problems (deformities). Congenital means they are present at birth. This can include pes cavus (excessively high arch), equinovarus (clubfoot), or abnormal differences in the length of the toes.
Acquired problems such as neuromas, malignant tumors, infection, arthritis, or fractures (especially fractures that don't heal properly) can contribute to metatarsalgia. Basically, anything that alters the way the foot hits the ground or changes the contact points for pressure and load through the foot can lead to metatarsalgia.
There are still other potential causes such as trauma, failed foot surgery, or nerve entrapment. This is called iatrogenic metatarsalgia. In order to get to the bottom of the problem, the surgeon will conduct a careful exam, look at the wear pattern of the shoes, and probably order some X-rays or other imaging studies (e.g., MRIs).
Often calluses on the bottom of the foot point right to the area of abnormal weight bearing and overload. The problem can be severe enough for the bones to form spurs or shift out of alignment. The end-result can be even more deformities such as hallux valgus (bunions).
The examiner will check out the motion of each individual joint (ankle, forefoot, toes) and assess muscle strength and function. Pulses will be palpated (felt) to assess circulation to the foot and any skin changes (e.g., ulcers) or swelling will be noted.
Most cases of metatarsalgia are treated conservatively (nonoperative care) first. Physical therapy may be a good idea. The therapist will help find the right shoe modifications, work on correcting postures that might be contributing to the problem, and address any muscle imbalances.
Stretching and strengthening may be needed as well. The therapist's evaluation will guide the specifics of which muscles need additional training in either direction (flexibility or endurance training).
Other noninvasive approaches may include corticosteroid injections into the painful area. This treatment technique is used carefully as there are often more side effects than benefits. For patients who have painful calluses, the surgeon may decide to shave or trim off the excess tissue. Injections and callus sha...
Keys To Diagnosis of Foot and Ankle Injuries
Missed or delayed diagnoses of peritalar injuries can leave a patient limping for the rest of his or her life. To help orthopedic surgeons quickly and accurately diagnose these injuries, orthopedic specialists have written this article reviewing these rare and often subtle foot and ankle injuries.
Peritalar refers to the talus and the soft tissues and bones around that bone. The talus is one of the large bones in the back part of the foot that helps form the ankle joint. It sits just above the calcaneus, or heelbone. The two bones make up the back part of the foot (sometimes referred to as the hindfoot). The talus is connected to the calcaneus at the subtalar joint. The ankle joint allows the foot to bend up and down. The subtalar joint allows the foot to rock from side to side.
Diagnosis can be difficult because the hindfoot and ankle is a very complex structure. Flat, two-dimensional X-rays don't always show what's really going on. It isn't until the injury doesn't heal and the patient continues to report pain and difficulty walking that additional imaging studies are done to find the real problem. By that time, it could be too late to save the natural biomechanics of the subtalar joint. Surgery may be needed to fuse the joint together to reduce pain and stabilize the joint. But fusion means a loss of motion and possibly, function.
Specific injuries covered in this article include bone fractures, joint dislocations, and ligament tears/ruptures affecting any of the periarticular joints. The talus articulates (moves against) the calcaneus, tibia (shin bone), and navicular bones. The calcaneus articulates against the talus and the cuboid.
So, injury to any of the following joints can result in peritalar instability: the tibiotalar joint, subtalar, calcaneocuboid, and talonavicular. That covers a lot of territory in the foot/ankle structure. And it makes up quite a bit of foot and ankle motion as we walk. The calcaneus hits the ground first, then the leg rocks over the foot until we push off with the toes to swing the leg through and start the cycle over again. Any disruption of the bones, joints, and ligaments can impair motion and function creating significant disability.
Pictures drawn of the foot/ankle anatomy along with X-rays and CT scans help illustrate what happens when any of these areas are injured. Descriptions are given for each injury and the most common mechanisms for those injuries. This information can help physicians recognize the history and clinical presentation of peritalar disruptions, thus making the diagnosis sooner than later. Things to watch out for include:
Physicians are encouraged to look at both the foot and ankle, all the joints, and all of the soft tissue structures in between...