SERVICES

Rear Foot and Ankle Reconstruction

Bunions / Hammertoes

What is a Bunion?

• A bunion is a condition where there is a gradual change in the anatomy of the great toe, leading to a painful and permanent deformity over the side of the digit.
• A top bunion develop from Hallux rigidus or hallux limitus. For more info, connect to arthritis page.  

What are conservative treatments for bunions?

• Splints- Straps or splints that can release pressure on the big toe and realign the joint.   
• Stretching/Physical therapy- These can relax tendons that are the deforming force on the joint.
• Injections- These can relieve inflammation and pain, but do not correct the problem. 

What conservative treatments work for bunions?

• Wear proper fitting and comfortable shoes that provide plenty of space for your toes and forefoot. 
• Protect the bunion with a moleskin or gel-filled pad
• Use toe spacers between the 1st and 2nd toes
• Use orthotics to help position the foot and redistribute weight correctly
• Night splint to hold the toe straight
• Anti-inflammatories
• Steroid injections into the joint
• Maintain a proper weight

​NOTE: None of the above will permanently correct the structural bunion, but may limit the progression of the deformity and decrease pain.

What are my surgical options for bunion correction?

• Soft tissue correction- Involves balancing the joint capsule and tendons to realign the joint.
• Head Procedures-  Involves making a bone cut and removing the bunion.  Some type of fixation (Screws, Wires, etc.) may be used to correct the orientation of the bones.
• Fusion of the midfoot joint (Lapidus Procedure)- Involves fusing the metatrasl cuneiform joint which is part fo the midfoot.  This will reduce the metatarsal drift and involves fixation to join the bones together.  
• Minimally invasive-  these procedures involve smaller incisions and reduced healing with or without fixation.  

What bunion procedure is right for me?  

GPFAS specialists will examine your foot and use your x-rays to determine the best course of surgical treatment to correct your bunion and decrease the chance of reoccurrence.  

How successful is bunion surgery?

Bunions surgery is successful at decreasing pain and correcting the bunion.  The hard part is that bunions do reoccur. Compliance and good surgical technique are important for lasting outcomes.  

What are hammertoes?

Hammertoe and mallet toe are foot deformities that occur due to an imbalance in the muscles, tendons or ligaments that normally hold the toe straight.

Are conservative treatments available for hammertoes?

• If your toe is still flexible, your doctor might recommend that you change tp more comfortable shoes.
• Orthotics relieve pressure and pain.
• Padding/Splinting can reduce pressure, deformity, and pain.  

What does hammertoe surgery involve?

• Tendon Release for flexible hammertoes.
• Removal of bone and placement of a wire to hold the toe straight for 4-8 weeks.  

What skin or nail conditions are commonly treated by GPFAS physicians?

• Warts- Viral growths on the skin that can cause pain.
• Corns- Protective thickening of the skin on a bony, knobby portion of a toe.
• Callouses- Thickening of skin that is exposed to prolonged rubbing.
• Athlete’s Foot (Tinea Pedis)- Superficial fungal infection that can infect nails and other body structures.  
• Fungal Nails – Fungus can cause thick and discolored nails.  These can cause pain and ingrown toenails. 
• Ingrown Toenails- Nails that grow into the skin causing pain and infection.

Total Ankle Joint Replacement

Custom Molded orthotics (CMO) & Custom Bracing

Orthotics or inserts are foot supports designed to be worn inside shoes. Strong medical evidence has shown that both over-the-counter (OTC)  and custom molded orthotics (CMO),  are effective in treating lower-extremity injuries and pain. CMO help correct biomechanical irregularities in your feet like flatfeet, high arches, and plantar fasciitis.

What are orthotics?

Over-the-counter inserts encompass a variety of different foot products including arch supports, insoles, heel liners, and foot cushions. Not all prefabricated insoles are made the same.  GPFAS uses the most cost effective OTC inserts to help support your feet, relieve stress, and decrease pain.

Custom molded orthotics (CMO) are insoles that have been prescribed by a doctor and constructed for your individual foot. A physician must conduct a thorough evaluation of your feet, ankles, and legs.  CMO are cast and ordered specific for each patients conditions and symptoms.  

While scientific research has proven that that insoles help treat and prevent lower-extremity injuries, studies have not found a significant difference between pre-fabricated versus custom orthotics.

Am I a good candidate for custom orthotics?

The following are groups of patients that typically benefit from CMO:

Diabetics – Diabetes and poor circulation increase the risk of foot ulcers and infections. GPFAS Podiatrists can determine the need for a CMO if you are at risk for any ulcers or other foot problems. 

High-performance athletes – Running or playing competive sports puts a lot of stress on the lower extremity. If you engage in sustained, high-level activities (particularly weightbearing ones like running), you could benefit from an CMO.

People with recurring injuries that don’t go away with OTC versions with conditions like plantar fasciitis, flatfeet, stress fractures, etc may benefit from a CMO.  

GPFAS team of podiatrists can help determine if you would benefit from prescription orthotics.

What are the types of CMO?

Functional orthotics – As William R. Olson, DPM, and former President of the American Academy of Podiatric Sports Medicine (AAPSM) writes, “The purpose of the functional orthotic is to accurately and precisely position the foot throughout the gait cycle so as to promote proper function.” These orthotics control abnormal motion. They also treat foot pain and injuries such as tendinitis and shin splints. 

Accommodative orthotics – Accommodative orthotics are designed to provide cushion and support. They are often custom-fitted for people suffering from diabetic foot ulcers or painful calluses on the bottom of their feet.

How am I fitted for CMO?

Gait /ROM Exam – GPFAS podiatrist will measure the motion of your lower-extremity joints to identify any irregularities in joint motion like excessive flexibility or extreme limitation.  

We will then cast your foot to provide a model for the orthotic laboratory. A specific order or prescription will be sent and the devices will be custom made.  Allow approximately 4 weeks for delivery of the devices.

Custom Bracing

GPFAS provides thorough evaluation and consultation for custom braces or other orthopedic equipment.  These conditions below and others may benefit from custom bracing or other orthopedic equipment include the following:

Diabetes with Neuropathy

Peripheral Vascular Disease

Foot/Ankle Deformities

Neurological Conditions

Charcot Deformities

Pediatric Deformities

Foot/Ankle Arthritis

Foot Drop

Custom braces and orthopedic medical equipment prescribed by GPFAS:

Diabetic shoes with inserts

Custom Molded Orthotics

Arizona Brace

AFO

Ritchie Brace

Charcot Walker or Crow Boot

Minimal Invasive Surgery

Arthritis of the Foot and Ankle

Arthritis is inflammation of one or more of your joints. It can cause pain and stiffness and is common in the joints of the foot and ankle. There are multiple causes of arthritis and they cause varying degrees of joint degeneration.  There is no cure for arthritis, but there are conservative and surgical options that slow the progress of the disease and relieve symptoms. With proper treatment, many people with arthritis are able to decrease pain, continue activity, and live as they desire.

Anatomy

There are 28 bones in the foot, and more than 30 joints that provide support, shock absorption, balance, and several other functions that are essential for motion. In many of these joints the ends of the bones are covered with articular cartilage.  Cartilage helps the bones glide and rotate smoothly over each other during motion. Ligaments, connect the bones to each other and keep the joints in place. Muscles and tendons provide the strength/support to make them move.

What are the types of arthritis commonly found in the Foot & Ankle?

The major types of arthritis that affect the foot and ankle are osteoarthritis, gouty arthritis, rheumatoid arthritis, and posttraumatic arthritis.

Osteoarthritis

Osteoarthritis or “wear-and-tear” arthritis, is a common degenerative condion that mainly affects people of middle age, but it can occur in young people as well.

The cartilage in the joint gradually wears away and exposes the bone. This can result in bone rubbing on bone, and produce painful bone spurs.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that can affect multiple joints throughout the body. It usually affects the same joint on both sides of the body. Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks the synovial tissue that overlies the cartilage.  This may cause serious joint deformity and disability.

Posttraumatic Arthritis

Posttraumatic arthritis can develop after an injury to the foot or ankle. Dislocations and fractures are the most common injuries that lead to posttraumatic arthritis.  Post traumatic arthritis wears the cartilage away similar to osteoarthritis. An injured joint is about seven times more likely than an uninjured joint to become arthritic. 

Gouty Arthritis

Gout is a type of arthritis that typically causes inflammation in one joint. Gout is the collection of crystals of uric acid in a joint. Gout can cause nodules under the skin called tophi, joint redness, swollen joints, pain and heat in the joint.

What is the Treatment for Gout?

Chronic Gout is treated using medications that lower the uric acid level in the body. Untreated gout can lead to joint damage, kidney problems, and tophi.

Acute Gout treatment consists of inflammation control with steroids, NSAIDS, or other treatments.  

What triggers Gout Attacks?

dehydration

 beverages sweetened with sugar or high fructose corn syrup

 beer/liquor

red meat

seafood

Cheese

Foods high in protein

What preventative measures can I take for Gout?

Cherries may help prevent gout attacks.

Diet modifications

Proper Hydration

What are the major symptoms of arthritis?

Pain with joint motion

Pain that flares with heavy activity

Tenderness with pressure on the joints

Joint swelling, warmth, and redness

Increased pain and swelling in the morning, or after sitting or resting

Difficulty in walking due to any of the above symptoms

How is arthritis diagnosed?

Physician exam will help identify affected joints and symptoms.  X-rays will provide detailed pictures joints and bones. An x-ray of an arthritic foot may show narrowing of the joint space, changes in the bone, or the formation of bone spurs. Other imaging may show further joint or bone damage including bone scan, MRI, and/or CT.

Laboratory tests. Your doctor may also recommend blood tests to determine which type of arthritis you have. With some types of arthritis, including rheumatoid arthritis, blood tests are important for an accurate diagnosis.

What is the Treatment for Arthritis?

There is no cure for arthritis but there are a number of treatments that may help relieve the pain and disability it can cause.

Nonsurgical Treatment

Lifestyle modification- Minimizing activities that aggravate the condition.

Switching from high-impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) to lessen the stress on your foot and ankle.  Losing weight to reduce stress on the joints, resulting in less pain and increased function.

Physical therapy- Specific exercises can help increase range of motion and flexibility, as well as help strengthen the muscles in your foot and ankle. Your doctor or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.

Assistive devices- Using a cane or wearing a brace may help improve mobility. Wearing shoe inserts (orthotics) or custom-made shoes with stiff soles and rocker bottoms can help minimize pressure on the foot and decrease pain. Custom Bracing can also stabilize the foot and ankle joints providing support and stability decreasing ROM/pain. 

Medications- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help reduce swelling and relieve pain. Steroids also are effective anti-inflammatory agents that can be taken orally or injected into an arthritic joint.  Steroid injections are typically temporary treatments. 

Surgical Treatment

Your doctor may recommend surgery if your pain is not relieved with nonsurgical treatment or severe disability is present.   

Arthroscopic debridement- This surgery may be helpful in the early stages of arthritis. Debridement or shaving/cleaning removes loose cartilage, inflamed synovial tissue, and bone spurs from around the joint. This surgery is minimally invasive and uses a small camera to look in the foot or ankle joint.

Arthrodesis (fusion)- Arthrodesis fuses the bones of the joint completely, making one continuous bone out of two or more bones. The goal of the procedure is to reduce pain by eliminating motion in the arthritic joint.

During arthrodesis, the damaged cartilage is removed and the surgeon uses pins, plates, screws, and/or rods to fix the joint in a permanent position.  The bones will grow together reducing motion and pain with recovery.  

Arthroplasty or Joint Preserving Implants- these procedure the surgeon removes the damaged cartilage and bone, and then positions new metal or plastic joint surfaces to restore the function of the joint. See Total Joint Implant.

Ankle distraction and stem cell injection– this involves the cleaning of the joints and distraction with external fixation or other means.  Stem cells are injected to help rejuvenate cartilage. This is a newer treatment plan for arthritis.  

GPFAS physicians have successfully treated hundreds of patients conservatively and surgically with all types or arthritis.  If you are having joint pain, do not delay a consultation with the extensively trained doctors at GPFAS. 

Minimal Invasive Surgery

Foot & Ankle Deformity Correction surgery

Complex foot and ankle deformity can be difficult to treat conservatively and often require surgical approaches. Conservative options include: Bracing, physical therapy, injections, activity modifications and custom molded orthotics.  Delayed medical treatment can lead to chronic pain and inability to perform daily activities.  

Prompt evaluation by a foot and ankle surgereon will ensure early intervention, pain relief and improved healing/outcomes.  

What common Foot and Ankle Deformities treated by GPFAS?

Brachymetatarsia- Shortened metatarsal in the foot that can cause pain and other concerns.

Metadductus-  deformity of the foot where there is increased curvature of the forefoot. This gives the foot the appearance of a “C” shape and effect of in-toeing.

Adult Clubfoot- Residual or untreated clubfoot from birth.

Charcot Arthropathy- Deformity of the foot and/or ankle the causes joint/bone destruction with rocker bottom or other deformities.  Main cause is diabetes, but can happen with other neuropathies.  

Cavus foot or High Arches- Deformity that can cause abnormal pressures on the bottom of the feet or arthritis.

Pes Planus or Flatfoot- More common than Cavus foot and can cause severe stressing of foot/ankle joints.  This can also lead to other problems in the knee, hip, and/or back. This deformity can also be called Posterior Tibial Tendon Dysfunction.

Equinus-  A deformity of the Achilles tendon that is causes tightness and increased pressure/stressing of the foot.  

Midfoot Instability- Deformity that can lead to increased development of pain and bunions.  

Ankle/Rearfoot arthritis- See complete page on arthritis and joint replacement.  

What Conservative treatments can work for these Adult Deformities? 

Always first line of treatment, especially if no other interventions have been prescribed.  This can include:

• Ankle bracing, either over the counter or custom
• Custom orthotics
• Boot immobilization
• Physical therapy
• Activity modifications, ice and anti-inflammatory medications

When is surgical treatment indicated for the above deformities?

If all appropriate conservative measures have failed, then surgery may be the next reasonable step.  The type of surgery indicated depends on many factors to include severity of deformity, flexibility of deformity, presence of underlying arthritis and patient’s age and other medical co-morbidities.

 What current and modern surgical treatments are offered by GPFAS for foot and ankle Deformities?

External fixation with acute or gradual correction of deformities can be used to safely treat complex ankle deformity.

Callous Distraction-Process of Gradual bone lengthening with External Fixation

Acute and gradual bone lengthening– Using bone grafts to correct angular and shortened deformities of the bones of foot and ankle. 

Foot Fusions including triple arthrodesis, midfoot arthrodesis, and ankle arthrodesis.  Arthrodesis is the medical term for fusion.  This is where joints are removed and fused with hardware to decrease motion, decrease pain, correct deformity and improved stability.   

Joint Implants- Implants for the ankle and foot joints that can improve realignment and joint function.  See total joint implant page.  

Tendon Transfer or Lengthening- Flexible deformities and others can be treated with the transferring of tendons to better position the foot and improve function.

The foot and ankle surgeons at GPFAS have performed 100’s of these surgeries.  The will formulate a patient specific surgical plan to assist patients to decrease pain, improve function and fully enjoy life.