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Click on a Topic to Learn More:
- Posterior Tibial Tendon Dysfunction
- Tarsal Tunnel Syndrome
- Ankle Arthroscopy
- Heel Spur Syndrome/ Plantar Fasciitis
- Adult Flatfoot Reconstruction
- Pediatric Flatfoot Reconstruction
- Bunion Surgery
- Hammertoe Surgery
- Polydactyly (extra digits over toes)
- Brachymetatarsia (short digits or toes)
- Traumatic Injuries
- Diabetic Foot Care and
Limb Salvage
Reconstructive Foot Surgery
At Park Plaza Foot Specialists, Houston, we perform reconstructive foot surgery to provide you relief from foot and ankle ailments.
Many people in Houston are undergoing treatment for dysfunction and other foot problem. We ensure that best medical care is provided to them while using state-of-the-art techniques.
POSTERIOR TIBIAL TENDON DYSFUNCTION
The posterior tibial tendon plays a crucial role in supporting the arch and providing stability to the foot. Dysfunction of this important combination of muscle and tendon may result in a severe flatfoot deformity. There is a broad spectrum in the symptoms of a patient with posterior tibial tendon dysfunction, ranging from a painful, well-aligned foot to a severe flatfoot. Most typical is the patient who presents early in onset and complains of painful swelling behind the inner ankle that may radiate to the arch.
X-rays may be taken of your foot and ankle during an examination. Even though x-rays will not image the tendon itself, they are of great value in assessing positional bony relationships and arthritic or adaptive changes. MRI studies provide much more information about the extent of damage to the tendon.
Classification is necessary and essential for the treatment of the dysfunction:
.Stage I- asymptomatic phase, results from an underlying biomechanical fault that predisposes one to develop PTTD
.Stage II- symptomatic phase with the development of tendonitis, mild symptoms, and progressive flatfoot deformity
.Stage III- characterized by tendon rupture, either complete or partial, severe symptoms, and a disabling flatfoot condition. The tendon and deformity may be reconstructable during this stage
.Stage IV- demonstrates rapid progression of the severely disabling arthritic flatfoot deformity
Conservative treatments are recommended in stages I and II. In the acute or early stages, treatment is directed at reducing inflammation and removing stress to the tendon in the hope that the damaged tendon will heal. Nonsteroidal anti-inflammatory drugs (NSAIDS) may be beneficial in providing pain relief and in reducing inflammation. Oral steroids may be indicated for short-term treatment of the acute inflammation in some patients. Physical therapy may be utilized to resolve inflammation and to strengthen the tendon. Often immobilization may be required with a cast, cam-walker, or braces.
Ankle Surgery is usually recommended for stages III
and IV. Soft tissue procedures for the treatment of tibialis posterior
tendon dysfunction revolve around two primary components: repair
of the tibialis posterior tendon, and restoring stability to the
foot. Recent medical advances have developed new techniques in
flexible flatfoot caused by PTTD. The Subtalar MBA implant is
a small threaded titanium implant which is inserted into the subtalar
joint. It is designed to block excessive pronation of the subtalar
joint to realign the foot, thus allowing normal joint motion and
lessening stress on the tendon. Bone procedures may also be necessary
to correct the deformity. These procedures provide greater structural
correction and stability to the foot.
RETURN TO TOP
Tarsal tunnel syndrome is compression of the posterior tibial nerve at the level of the ankle. The postorier tibial nerve, 3 tendons, 2 veins and 1 artery occupy a tight space called the tarsal tunnel. As they course through this fibro-osseous tunnel bounded by a thick band of tissue called the flexor retinaculum into the bottom of the foot, pressure on the nerve by swelling and inflammation of tendons, veins or a space occupying lesion may cause symptoms ranging from numbness and tingling to severe pain to the entire foot. It is similar to Carpel Tunnel Syndrome in the hands and wrist. Diagnosis of this condition may require nerve studies and imaging such as EMG, NCV and MRI.
There are four conservative steps to relieve symptoms of this condition. The first line of conservative treatment is directed toward reducing inflammation. The use of anti-inflammatory medication and cortisone injections may be used to reduce inflammation around the nerve tissue. Other conservative measures may involve physical therapy providing deep massage to break up scar tissue within the tunnel and to assist in mobilization of the constricted nerve. An orthotic may also be utilized to support the foot to take tension away from the nerve. If conservative treatment fails to relieve the symptoms, surgical decompression of the nerve may be required.
Arthroscopy of the ankle and small joints of the foot is a relatively new tool in the armament of the foot and ankle surgery. The advantage in arthroscopy over traditional arthrotomy lies in its limited dissection and disruption of tissue in order to accomplish the goals of operation. This leads to reduced postoperative pain, swelling, and recovery time.
HEEL SPUR SYNDROME/PLANTAR FASCIITIS
Heel pain is generally the result of faulty biomechanics that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury; a bruise incurred while walking, running, or jumping on a hard surface; wearing poorly constructed footwear; or being overweight. Heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous connective tissue (plantar fascia) running along the bottom of the foot. The inflammation is called plantar fasciitis.
The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length. This leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.
Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.
Four non-surgical steps are taken to relieve symptoms. Anti-inflammatory medication and cortisone injections help to decrease inflammation around the fascia. Stretching exercises help to relax and increase flexibility to the fascia. Lastly, orthotics play an important role in supporting the foot and decreasing strain on the fascia. If all conservative treatments fail to relieve the pain, surgical treatment may be necessary.
Previously, heel spur surgery required a large incision along the entire length of the heel. Currently, a much less invasive method is done through a one-centimeter opening call endoscopic plantar fasciotomy (EPF). A fiber optic camera unit is used to release a small portion of the fascia thereby relieving strain on the fascia. After surgery, patients are nonweightbearing for 2 weeks and back to most activities by one month.
ADULT FLATFOOT RECONSTRUCTION
Flat feet are hereditary and are caused
by a muscle imbalance. Feet with low, relaxed arches may bring
on such problems as hammertoes and bunions; arch, foot and leg
fatigue; calf pain; and an overly tight heel cord. There are a
wide range of treatment options from orthotics to reconstructive
surgery depending on the severity of symptoms.
Reconstructive surgery of the foot consists of complex surgical repairs that may be necessary to regain function or stability, reduce pain, and prevent further deformity. Reconstructive surgery in many of these cases may require tendon repair or transfer, fusion of bone, joint implantation, bone grafting, skin or soft tissue repair, and incision into bones in a precise fashion to realign them in a better position for function.
As with anyone facing any surgical procedure, those undergoing foot surgery require specific tests or examinations before surgery to obtain a successful surgical outcome. Prior to surgery, we will review your medical history and medical conditions. Specific diseases, illnesses, allergies, and current medications need to be evaluated. Other tests that help evaluate your health status that may be ordered are x-rays, CT scans, MRI, and blood flow studies. A consultation with another medical specialist may be required before surgery.
PEDIATRIC FLATFOOT RECONSTRUCTION
Flat feet are hereditary and are caused by a muscle imbalance. Feet with low, relaxed arches may bring on such problems as hammertoes and bunions; arch, foot and leg fatigue; calf pain; and an overly tight heel cord. There are a wide range of treatment options from orthotics to reconstructive surgery depending on the severity of symptoms.
Because children's feet are flexible and tolerate bracing well, orthotic devices are usually recommended as a first line of treatment for flatfeet. However, if the pediatric patient still complains of symptoms, surgery may be an option.
Recent medical advances have developed new techniques in pediatric flatfoot surgery by implanting a small device that supports the arch and realign joints in children. The subtalar MBA implant is a small threaded titanium implant, which is inserted into the subtalar joint. It is designed to block excessive pronation of the subtalar joint to realign the foot, thus allowing normal joint motion and an improved arch.
After surgery, the foot will be bandaged. In most cases, patients are placed into a camwalker boot with crutches to assist in walking for the following 4 weeks and back to normal activity with sneakers and orthotics.
A bunion, also known as Hallux Abducto Valgus is an enlargement of bone in the joint at the base of the great toe. Bunions are often inherited and usually worsen over time. Tight shoes don't cause bunions, but they can aggravate them. Bunions are unsightly and often cause pain, swelling, skin irritation, and other foot problems. There are conservative and preventive steps that can minimize the discomfort of a bunion, but surgery is frequently recommended to correct the deformity. There are several types of bunions and surgical treatments for each.
Positional Bunion- As new bone grows, the joint enlarges. This stretches the joint's outer covering. Force created by the stretching pushes the big toe toward the smaller ones. Eventually, the inside tendons tighten, pulling the big toe farther out of alignment.
Structural Bunion- When the angle between the bones of the first and second toes is greater than normal, the great toe slants toward the smaller ones. In severe cases, this may also cause the second and third toes to buckle.
X-rays may be taken of your foot to show the position of the great toe joint. The most common bunion surgery reduces the angle between the first and second metatarsals. Ligaments and tendons on the outside of the toe may be tightened to hold the joint properly. If a structural bunion is severe, a piece of bone is removed from the metatarsal. Once repositioned, this bone may be held in place with a pin or a screw and the remaining bunion is shaved away.
Hammertoe deformity is caused by an inherited muscle imbalance or an abnormally long proximal phalanx, causing the toe joints to contract. This in turn causes the tendon to shorten. Corns and calluses often form on top of the contracted joints where shoes rub. When irritated corns may turn into open wounds and become infected. Although the condition usually stems from muscle imbalance, ill-fitting shoes or socks that cramp the toes often aggravate the deformity. Surgery may be necessary to realign or shorten the toes to their proper position.
X-rays are taken of the hammertoe to show the amount of deformity. An x-ray may also show whether or not the joint is affected by arthritis. Hammertoes may be flexible or rigid, depending on the joint's ability to move. A flexible joint may become more rigid as you age.
If your symptoms are mild, conservative treatments such as changing shoes may be all the treatment you need. Using a splint or pad to hold your toes straight may also help. If your symptoms are severe, surgery may be needed. The type of procedure often depends on whether your toe joints are flexible or rigid.
POLYDACTYLY (extra digits over toes)
Polydactyly is a common congenital anomaly consisting of an extra digit or digits. The origin of polydactyly appears to be genetic with no specific sex predilection. Involvement of both feet and hands is seen in 25% to 50% of patients, and the incidence of polydactyly appears higher in the African and Asian populations.
Conservative treatment is not routinely practiced in the symptomatic child with polydactyly. In many instances, duplication of the toes make shoe fitting and subsequent function difficult. Parents are often concerned about future potential functional impairment as well as cosmetic appearance. Because the deformity has both physical and emotional sequelea, treatment of polydactyly is usually surgical. Conservative measures may also be used. Generally speaking, these measures provide only temporary relief.
Surgical evaluation may include x-rays to assess the level and severity of the pathologic anatomy. CAT scans and MRI may also assist in the perioperative planning. These tests may help to identify the digit that has the most potential for normal growth and function.
BRACHYMETATARSIA (short digits or toes)
Brachymetatarsia is a hereditary anomaly caused by premature closure of the growth plate of one or more metatarsals. Conservative treatment includes padding, strapping and orthotics.
Surgical evaluation may include x-rays to assess the level and severity of the pathologic anatomy. CAT scans and MRI may also assist in the perioperative planning. These tests may help to identify the quality of the bone and length needed to achieve a normal functioning foot.
Surgical treatment at our medical center in Houston is traditionally performed by interposition of bone grafting. In cases in which fairly significant correction is required, neurovascular compromise is a great concern when a one-stage lengthening procedure is performed owing to the abrupt stretch that is placed on the vessels.
At Park Plaza Foot Specialists, we have adopted newer techniques to effectively and safely elongate soft tissue along with your own bone to achieve a more normal appearance and better functioning foot. This is performed by callus distraction. Once the desired length is obtained, distraction is ceased and immobilization of the foot continues until bone healing is complete. Once x-ray evidence of healing is seen along the entire distraction gap, careful weight bearing may be allowed.
Foot and ankle injuries happen every day. Broken bones, dislocations, sprains, contusions, infections and other serious injuries can occur at any time. Early attention is vitally important.
DIABETIC FOOT CARE and FOOT SALVAGE
When you have diabetes, daily wear and tear can take its toll on your feet especially in areas that absorb the most pressure. Because of poor blood circulation or loss of feeling in your feet, even a minor problem, such as a tiny crack in your skin or ingrown toenails, may develop into a serious infection.
Infections of the foot are usually caused by bacteria but are occasionally caused by a virus or fungus. They range from simple superficial infections to more complex deep infections involving tendons or bone. All potential infections are taken very seriously. Symptoms may include pain, tenderness, swelling, redness, warmth, drainage, odor, and even fever. Some infections form a pocket of "pus" or abscess.
Mild skin infections can be treated non-surgically with antibiotics and careful observation. Sometimes, these infections will not respond to this type of treatment alone. If the infection involves deeper structures of the foot such as tendons and bone or if an abscess is present, surgery is required. The purpose of surgery is to eliminate all infected tissue from the wound. Some infections such as those around the edge of a toenail may only require removal of the nail for drainage. Other more serious infections require complex debridements involving soft tissue and/or bone. It is critical to isolate the responsible bacteria so that the correct antibiotics can be given. In certain cases, the wounds are left open for daily dressing changes and to prevent recurrence of the infection.
Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach. We at Park Plaza Foot Specialists will perform a thorough podiatric evaluation of your overall health and condition of your feet. We are part of a healthcare team working closely with Internal Medicine, Vascular Surgery, and Infectious Disease to keep your feet healthy.