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The average person walks more than 100,000 miles in a lifetime. To accomplish this, feet and ankles must be strong and stable. With the constant impact of walking and running, it's not surprising then that feet and ankles are some of the most frequently injured areas of the human body.

Every year, the Rothman Institute treats thousands of patients for foot and ankle problems related to bunions, hammertoes, arthritis, tendonitis, nerve damage, sport injuries and trauma. Our team of physicians and surgeons is composed of both Foot and Ankle Fellowship trained orthopaedic surgeons (medical doctors trained in care of the musculoskeletal system with additional specialty training in care of the foot and ankle) and Doctors of Podiatric Medicine (DPMs), who have specific training in the prevention, diagnosis and treatment of all conditions associated with the foot and ankle.  Together, our team leads the region in total ankle replacements and performs more than 900 surgeries annually. With a broad range of conservative, nonsurgical treatments offered as well, our specialists can often diminish or eliminate pain and restore maximum mobility.

When to Seek an Evaluation

Foot and ankle pain is a common disorder. Almost 80% of the population will experience foot pain in their lives. At the Rothman Institute, we believe that no one should have to live with painful feet. We are trained and equipped to diagnose and treat all problems involving the foot and ankle. We treat people of all ages, for problems such as calluses and bunions, as well as serious injuries and disorders. Many foot and ankle problems can be remedied with conservative care, including correctional orthotics devices. For patients with conditions that fail to respond to conservative care, surgical intervention may be necessary.

Foot and ankle surgery includes the treatment of fractures, repair of ligament and tendon injuries, correction of deformity, management of ankle arthritis, instability, bone/cartilage from sports-related injuries, and comprehensive management of heel pain.

The Rothman Foot & Ankle Team is dedicated to keeping our patients’ feet in the healthiest condition. Our goal is to relieve patients of chronic pain and to return function and enjoyment to everyday activities.

Symptoms

Pain

Is the most common symptom associated with plantar fasciitis (heel pain) and ankle sprains. The pain occurring with plantar fasciitis is usually sharp and occurs during the first few steps after sleeping or resting. This is because foot and heel tissue (fascia) contracts when at rest. When this contraction is stretched, pain develops. However, once the tissue (fascia) is stretched, the pain diminishes. Thus, the pain normally disappears after a few steps. The pain of an ankle sprain is usually very sharp and almost nauseating. Ankle sprain pain is associated with swelling and bruising. The most common location of ankle sprain pain is on the outside (lateral) part of the ankle over the fibula. Usually, the pain is decreased with time, rest, elevation, ice and compression. However, if the pain is extreme and continues for over 48 hours, see a physician.

Instability (Giving Away) 

A feeling of instability to a foot or ankle after a single or multiple injuries may mean that ligaments are torn. In some cases, arthritis of the ankle joint or the joints beneath the ankle many have developed. Feelings of instability may be worsened when walking on uneven surfaces such as yard or stairs. Some instability is normal after a minor sprain especially in the early phases of recovery. People with recurrent (chronic) ankle sprains complain of instability on a long-term basis. However, if instability continues, report this to a physician.

Stiffness 

Can occur with ankle sprains, arthritis, and plantar fasciitis. Usually, the stiffness occurs after resting the foot and ankle. The stiffness is usually temporary and will start to diminish with exercise, proper shoe wear, weight loss, cryotherapy, and time. However, if stiffness continues despite simple efforts to treat this symptom, please contact a physician.

Swelling 

Swelling is common after an injury, such as an acute ankle sprain. Sometimes this swelling can be severe and may last a long time. People with recurrent ankle sprains can experience swelling to a more mild degree. Sometimes swelling can be caused by problems not related to the ankles at all - such as heart problems or blood clots further up the legs. For this reason, if swelling occurs, you should have it evaluated by your doctor - especially if there was not an injury to the ankle or there is swelling in both ankles.

Popping/Snapping 

Popping of the ankle or feet without any associated pain or instability is usually normal. The cracking you hear when moving around quietly in the morning is just the snapping and stretching of the tissue lining the joints. However, if a tendon is snapping over one of your ankle bones when making quick, cutting motions or descend stairs, this may indicate a condition called subluxation or dislocation of the tendons. A subluxation is when tendons jump out of their normal position and then move back. A dislocation is when these tendons move out and may have to actually be pushed back into place. A patient may also experience pain, and instability of the ankle. Some people with chronic ankle sprains complain of popping in their ankles. If these symptoms are present, please contact a physician.

Numbness 

A feeling of pins and needles around the foot and ankle may indicate a compression of the nerves or a general problem with the nerves, such as that caused by diabetes or vascular problems. The compression of nerves may be located in different areas of the body, including the spine. Numbness on the outside or top of the foot may be due to the compression of a nerve in the lower back or around the knee. Numbness on the inside or bottom of the foot can be due to a compression of the nerve around the inside of the ankle. This is due to compression of the nerve traveling through a fibrous tissue tunnel called the tarsal tunnel. This is very similar to carpal tunnel syndrome in the wrist. If there is severe swelling in the leg, ankle or foot, this can cause serious damage to all of the surrounding tissue including the nerves. If there is painful, tightness, or swelling, see a physician immediately. Also, if a patient experiences numbness that does not seem to be improving, see a physician for a proper diagnosis and treatment.

· Don’t ignore foot pain, it isn’t normal. If pain persists, see a physician.
· Inspect your feet regularly. Note changes in color and temperature, thickness or discoloration of nails, and cracks or cuts in the skin. Peeling or scaling on the soles could indicate athlete’s foot. Any growth on the foot is not considered normal.
· Wash your feet regularly, especially between the toes, and be sure to dry them completely.
· Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; it can lead to ingrown toenails. People with diabetes, poor circulation or heart problems are more prone to infection and should not treat their own feet.
· Make sure that your shoes fit properly. Replace worn-out shoes as soon as possible, and try on new shoes later in the day when feet tend to be at their largest.
· Select and wear the right shoe for your activity, in other words, running shoes for running.
· Don’t wear the same pair of shoes every day, alternate them.
· Avoid walking barefoot. Your feet are more prone to injury and infection when walking barefoot. When at the beach or wearing sandals, remember to use sunscreen on your feet as well as the rest of your body.
· Use home remedies cautiously. Self-treatment often turns a minor injury into a major foot problem. If you have diabetes, it is essential that you see a podiatric physician at least once a year for a thorough check-up.

At some time in your life you should experience foot, heel, or ankle pain. This is natural since we ambulate over one million steps per year. Luckily, over 95% of all foot, heel and ankle pain will heal itself over time. This section provides information to help understand the basic anatomy of the foot and ankle and the fastest and most effective methods of reducing pain.

The center of the ring is the bone called the talus. The talus bone has a shiny joint surface covering which allows the ankle to glide effortlessly across the shiny undersurface of the large leg bone called the tibia. When these two bones meet they form the ankle joint. On the outside of the ankle is a smaller, thin bone called the fibula. This bone helps prevent the major ankle bone from shifting outward. On the other side of the ankle is a bump on the inside which is connected to the larger leg bone called the tibia. This part of the tibia is called the malleolus, which just means "hammer" in Latin.

The stability of the ankle joint is dependent upon the ability of these bones to keep the central bone in place while the ankle moves back and forth. The joint is more stable when the foot is flat on the floor. The ankle is more rigidly held in place by the bony stabilizers of the fibula and malleolus because they are closer to the talus. However, when the toes are pointed, the ankle becomes unstable because the distance between the bony stabilizers of the ankle becomes larger. Thus, the ankle relies more and more on the soft tissues including ligaments to continue to provide stability. Since soft tissues are "softer" than bones, the ankle becomes more vulnerable to a sprain when the toes are pointed.

When an ankle twists, it is usually when the toes are pointed. However, the ankle can be twisted while in any position. There are six major soft tissue structures that hold the ankle in place. Four of these are located on the outside part of the ankle and all attach to your smaller ankle bone called the fibula. Thus, all three of these ligaments have the word fibula in them. The most commonly injured ligament of the ankle is called the Anterior (meaning front) Talo-Fibular Ligament, or AFTL for short. This is the ligament that is most commonly torn in ankle sprains. The second most commonly torn ligament is the ligament connecting the heel bone to the fibula called the Calcaneal-Fibular Ligament. The third ligament again attaches the fibula to the back of talus called the Posterior (meaning back) Talo-Fibular Ligament. The fourth ligament connected to the fibula is the Syndesmotic Ligament, which connects the fibula to the large leg bone (tibia). The soft tissue just in front of the ankle is the capsule of the ankle joint and helps keep the ankle from sliding forward along with the other ligaments. The final stabilizing ligament is on the inside part of the ankle. The ligament forms a triangle shape like the Greek letter delta thus it is called the Deltoid Ligament. The deltoid ligament attaches the malleolus to the talus. This is sometimes referred to as the strongest ligament in the body, however it is commonly torn.

Sometimes the bones around the ankle can break. Most commonly it is the smaller outer bone called the fibula. However, with larger forces applied to the ankle, both bones can break and occasionally, a part of the back of the tibia can also break. When the bones around the ankle break, they can cause gross instability and this may even result in a dislocation of the ankle joint. In some cases, the ankle moves slightly out of joint called a subluxation. If a physician diagnoses a break or fracture, they may recommend surgery usually based upon the actual dislocation or potential dislocation of the ankle.