Foot & Ankle Center 1 - Kayal

Calcaneus (Heel Bone) Fractures

Arthritis of the Foot and Ankle

Achilles Tendon Tear & Rupture

The Achilles tendon is the largest tendon in your body. It connects the muscles in the back of your lower leg to your heel bone (e.g., the calcaneus) and must withstand large forces during sporting exercises and pivoting. There are two main types of injuries that affect the Achilles tendon: overuse and inflammation, called Achilles tendonosis, and, a tear of the tendon.Your Achilles tendon may tear if it is overstretched, usually while playing sports. The tear may be partial or complete, and it most commonly occurs just above your heel bone. A snap or crack sound may be heard at the time of injury.

The Best Achilles Treatment in the Tri-State Area

Ankle Sprains & Strains

Treatment

Symptoms

Diagnosis

Prevention

Achilles Tendon Tear & Rupture

Bunions

Adult-Acquired Flatfoot Deformity

Clubfoot

Achilles Tendonosis

Calcaneus (Heel Bone) Fractures

Arthritis of the Foot and Ankle

Bunions

A bunion is a common foot deformity that’s characterized by a bump on the side of the big toe. In that characteristic “bump,” you are actually seeing the effect of additional bone formation in the joint and a mechanical misalignment of the big toe. A bunion causes the big toe to angle toward the smaller toes. As the bump grows in prominence so does the pain, making it increasingly difficult for affected individuals to walk or wear shoes in later stages of the condition.

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Ankle Sprains & Strains

Treatment

Symptoms

Diagnosis

Causes

Bunions

Achilles Tendon Tear & Rupture

Adult-Acquired Flatfoot Deformity

Clubfoot

Achilles Tendonosis

Calcaneus (Heel Bone) Fractures

Arthritis of the Foot and Ankle

Achilles Tendonosis

The largest tendon in the human body, the Achilles tendon is connected to the calf muscles and allows feet to flex during walking, running, and jumping. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendonosis, a condition associated with overuse and degeneration.

Say ‘Goodbye’ to Pain & Stiffness

Ankle Sprains & Strains

Treatment

Symptoms

Diagnosis

Causes

Achilles Tendonosis

Achilles Tendon Tear & Rupture

Bunions

Adult-Acquired Flatfoot Deformity

Clubfoot

Calcaneus (Heel Bone) Fractures

Arthritis of the Foot and Ankle

Adult-Acquired Flatfoot Deformity

Adult-acquired flatfoot deformity (AAFD) is a painful, progressive condition that occurs when the soft tissues of the foot are overstretched and torn, causing the arch of the foot to collapse.The posterior tibial tendon attaches to the bones on the inside of the foot, maintains the foot’s arch, and provides the strength needed for feet to effectively push off while walking. When this tendon loses its function, the bones will spread out of their aligned position and the foot will become “flat”—causing individuals to develop adult-acquired flatfoot deformity. Without an AAFD repair, the condition may progress until the affected foot becomes entirely rigid and quite painful.

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Ankle Sprains & Strains

Treatment

Symptoms

Diagnosis

Who’s At Risk?

Adult-Acquired Flatfoot Deformity

Achilles Tendon Tear & Rupture

Bunions

Clubfoot

Achilles Tendonosis

Calcaneus (Heel Bone) Fractures

Arthritis of the Foot and Ankle

Ankle Sprains & Strains

Ankle injuries are often thought of as sports injuries—but you don’t have to be an athlete or even a “weekend warrior” to turn your ankle and hurt it. The truth is that a sprained ankle is a very common injury. A strained or sprained ankle can happen to athletes and non-athletes, children, and adults. It can happen when you take part in sports and physical fitness activities. It can also happen when you simply step on an uneven surface or step down at an angle. Ankle sprains are caused by an injury that stresses a joint and overstretches or even ruptures the supporting ligaments, which connect bone to bone. Ankle strains, on the other hand, are typically caused when too much force is placed on muscles or tendons, which connect muscle to bone.

Stop the Pain & Get Back On Your Feet

Treatment

Symptoms

Diagnosis

Prevention

Ankle Sprains & Strains

Achilles Tendon Tear & Rupture

Bunions

Adult-Acquired Flatfoot Deformity

Clubfoot

Achilles Tendonosis

Calcaneus (Heel Bone) Fractures

Ankle Sprains & Strains

Arthritis of the Foot and Ankle

One common type of foot and ankle condition is arthritis. As people age, the cartilage that once served as a shock absorber for the body’s joints begins to wear away. This deterioration causes the ankle and foot bones to rub against each other, resulting in inflammation, pain, and stiffness within one or more joints and its surrounding soft tissue. There are over 100 forms of arthritis that exist, with the small joints of the feet and ankles enduring the condition often. The three forms of arthritis that most commonly affect the foot and ankle are:

• Osteoarthritis. An age-related degenerative disease where consistent wear-and-tear causes stiffness to slowly occur.
• Rheumatoid Arthritis. A system-wide autoimmune disease that attacks multiple joints and destroys the body’s cartilage.
• Post-traumatic Arthritis. Initiated by a foot and ankle injury, sprain or fracture, post-traumatic arthritis develops slowly in the affected joint.

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Achilles Tendonosis

Treatment

Symptoms

Diagnosis

Prevention

Arthritis of the Foot and Ankle

Achilles Tendon Tear & Rupture

Bunions

Adult-Acquired Flatfoot Deformity

Clubfoot

Arthritis of the Foot and Ankle

Ankle Sprains & Strains

Calcaneus (Heel Bone) Fractures

A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. This type of fracture commonly occurs during a high-energy event—such as a car crash or a fall from a ladder—when the heel is crushed under the weight of the body. When this occurs, the heel can widen, shorten and become deformed.

Get Back on Your Feet

Treatment

Symptoms

Diagnosis

Prevention

Calcaneus (Heel Bone) Fractures

Achilles Tendon Tear & Rupture

Bunions

Adult-Acquired Flatfoot Deformity

Clubfoot

Achilles Tendonosis

Arthritis of the Foot and Ankle

Ankle Sprains & Strains

Clubfoot

Clubfoot is a congenital birth disorder that occurs in one out of every 1,000 newborns. When a baby is born with tendons and calf muscles that are shorter than normal, it causes the baby’s foot to twist out of position or shape producing clubfoot. Ranging from mild to severe with the ability to affect one or both feet, clubfoot could potentially hinder a child’s ability to walk normally later in life, emphasizing the importance of providing treatment as quickly after birth as possible.

Improving Appearance, Restoring Function

Achilles Tendonosis

Treatment

Symptoms

Diagnosis

Causes and Risk Factors

Clubfoot

Achilles Tendon Tear & Rupture

Bunions

Adult-Acquired Flatfoot Deformity

Calcaneus (Heel Bone) Fractures

Prevention

The best way to prevent ankle sprains and strains is to maintain good strength, muscle balance and flexibility. Plus, be sure to do the following:

• Warm up before doing exercises and vigorous activities.
• Pay attention to walking, running or working surfaces.
• Wear good shoes.
• Recognize your body’s warning signs and slow down when you feel pain or fatigue.

Prevention

The best way to prevent arthritis is by consistently taking care of your feet and ankles, which involves:

• Wear shoes that are properly fitted and shaped to your foot.
• Wear shoes with rubber soles for elite foot and ankle cushioning.
• Regularly exercise and stretch your feet and ankles.

Diagnosis

To diagnose Achilles tendonosis, a thorough medical history is taken and an examination is performed. Patients will usually have pain right on the tendon or at the back of the heel. They may also have swelling and thickening of the tendon. X-rays may be taken to see if there are any bone spurs. A MRI or ultrasound may also be performed to further evaluate how much of the tendon is affected and to look for any tears.

Diagnosis

Our physicians provide expert treatment for arthritis. Our specialists diagnose the condition through a thorough examination of a patient’s medical history and an evaluation of the patient’s symptoms. Gait analysis, which observes the way that the patient walks, will allow our physicians to better determine the severity and location of the condition, while diagnostic testing, including X-rays, CT scans, MRIs, and blood tests, will further confirm the presence of the condition.

Treatment

Minor ankle sprains and strains may heal on their own with rest, ice, compression and elevation (RICE). Over-the-counter or prescribed anti-inflammatory medications and bracing may also be used to alleviate discomfort and swelling. Moderate sprains may need to be immobilized with air splits or cast-boots for 1 or more weeks. If symptoms persist or your sprain is severe, surgery may be required to repair the fully torn ligament. Surgery involves reconnecting the ligament to the bone. Your doctor will discuss the surgical options that best meet the needs of your injury.

Treatment

Non-surgical techniques can slow the progression of the disease and lessen symptoms. Non-surgical treatment may include anti-inflammatory medication, wearing an ankle-foot orthosis (AFO), or undergoing viscosupplementation. During this procedure, lubrication fluid is injected into the joint, enabling it to move more smoothly. When debilitating arthritis pain still exists after conservative measures, our foot and ankle surgeons may recommend minimally invasive ankle arthroscopy, ankle arthrodesis or total ankle replacement. These surgical treatments can return patient’s to their normal daily activities and allow patients to remain active.

Symptoms

Sprains are usually noticeable when they occur. But sometimes, a minor sprain will happen without your noticing. The primary symptoms of sprains include limited mobility, inflammation, pain, swelling and bruising. Strains are often accompanied by pain, cramping, swelling, muscle spasms, and stiffness or soreness in the muscle. As with sprains, you may be aware of the exact movement or activity that created the strain, or you may notice symptoms only later.

Diagnosis

In order to diagnose you properly, your doctor will consider your symptoms, examine your feet, and take X-rays to get a clearer view of the alignment of your toes and the condition of the joints in your feet.

Symptoms

Clubfoot symptoms appear in newborns at birth:

• The top of the foot is twisted downward and inward, increasing the arch and turning the heel inward.
• The foot is turned severely to the point where it looks as if the foot is upside down.
• Calf muscles in the affected leg are noticeably underdeveloped.
• The affected foot is anywhere from 1 centimeter to roughly ½ of an inch shorter than the unaffected foot.

If treated immediately and effectively, clubfoot typically doesn’t cause any tremendously noticeable or lasting problems with regards to difficulties later in life. That being said, mobility may be slightly limited on that side, shoe sizes may vary, and the calf on the affected side may appear smaller from its initial underdevelopment. Of course, it is extremely important that clubfoot is treated properly to prevent more serious problems from occurring later in life.

Causes

Achilles tendonosis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendonosis, too. These factors include:

• Sudden increase in the amount or intensity of exercise activity—for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance.
• Tight calf muscles—Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon.
• Bone spur—Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain.

Symptoms

Though a visible bump on the side of the big toe is the most apparent symptom, there are several other indications that signal a bunion’s presence. These symptoms include:

• Intermittent or chronic pain at the base of the big toe.
• Redness and inflammation.
• Hardened skin on the bottom of the foot.
• Possible numbness.
• A callus or corn on the bunion bump.
• A burning sensation.
• Stiffness and restricted motion in the big toe, leading to walking difficulties.

Symptoms

A person with a ruptured Achilles tendon may experience one or more of the following:

• Sudden pain, which feels like they have been kicked or a stabbed, in the back of the ankle or calf—often subsiding into a dull ache.
• A popping or snapping sensation.
• Swelling or bruising on the back of the leg between the heel and the calf.
• Difficulty walking, especially upstairs or uphill, and difficulty rising up on the toes.
• Inability to bend your foot downward or to walk normally.

Diagnosis

After discussing your symptoms and medical history, your doctor will perform a careful examination. He or she will examine your foot and ankle to see if your skin was damaged or punctured from the injury, and then check your pulse at key points of the foot to be sure that there is a good blood supply to the foot and toes. Your doctor will also check to see if you can move your toes, and can feel things on the bottom of your foot. Our foot and ankle experts use advanced diagnostic testing during examinations to determine the extent of the injury.

Symptoms

Patients with calcaneus fractures usually experience:

• Pain.
• Bruising.
• Swelling.
• Heel deformity.
• Inability to put weight on heel or walk.

With some minor calcaneus fractures, the pain may not be enough to prevent you from walking—but you may limp. This is because your Achilles tendon acts through the calcaneus to support your body weight. If, however, your calcaneus is deformed by the injury, your muscle and tendon cannot generate enough power to support your weight. Your foot and ankle will feel unstable, and you will walk differently.

Prevention

Since these fractures mostly result from falling or motor vehicle injuries, prevention is limited. Stress fractures—injuries that could be caused from twisting motion—can be prevented by strength training and stretching. Certain types of footwear, such as high heels or even running barefoot, can attribute to these fractures, too.

Symptoms

Many changes can be seen when the Achilles tendon becomes inflamed. Most of the time, there is no trauma or injury, but rather a slow progression of pain. Common symptoms of Achilles tendonosis include:

• Pain and stiffness along the Achilles tendon.
• Pain along the tendon or back of the heel that worsens with activity.
• Severe pain the day after exercising.
• Swelling that is present all the time and gets worse throughout the day with activity.

If you have experienced a sudden “pop” in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.

Symptoms

Symptoms of arthritis may develop gradually over time or onset suddenly. Common symptoms include:

• Flare-ups of pain in the affected joint when engaging in vigorous activity.
• Tenderness in the joint when pressure is applied.
• Swelling, warmth, or redness in the affected joint.
• Increased pain and swelling when first trying to walk either in the morning or after extended periods of sitting or resting.
• Experience difficulty in walking due to the aforementioned symptoms.

Treatment

Our foot and ankle doctors treat Achilles tendon injuries using cutting-edge techniques, such as radiofrequency coblation, platelet rich plasma injections and minimal incision surgery. These types of procedures expedite the healing process and allow patients to resume regular activities faster than conventional surgery options. In severe cases, the surgeon may recommend surgery to reattach a torn Achilles tendon or to remove the bone spur. Our foot and ankle surgeons will evaluate each patient’s medical history and customize a treatment plan to suit their individual needs.

Treatment

Our podiatric specialists use a number of cutting-edge surgical and non-surgical techniques to treat patients dealing with clubfoot. A proactive approach will be taken to prevent long-term disabilities from clubfoot while improving the appearance and function of your foot and ankle. Non-surgical methods involve manipulating the foot into the correct position. This may include repeated stretching, casting, splinting, and bracing for several weeks or months. Once the foot is correctly aligned, the infant may continue to wear a brace. The foot muscles can return to their original position, so the foot will have to be monitored by a foot specialist.When clubfoot is severe or doesn’t respond to non-operative methods, surgery may help lengthen the tendons or adjust the ligaments in the foot and ankle.

Diagnosis

To diagnose ankle sprains and strains, your doctor will look at the impacted area and ask questions about the injury or accident. He or she may also order X-rays to ensure that you don’t have a broken bone in the ankle or foot. A broken bone can have similar symptoms of pain and swelling. If there is no broken bone, the doctor may be able to tell you the grade of your ankle sprain based upon the amount of swelling, pain and bruising. The doctor may order a MRI, after the period of swelling and bruising resolves, if he or she suspects a severe injury to the ligaments, injury to the joint surface, a small bone chip or other problem. The MRI can make sure that the diagnosis is correct.

Treatment

Surgery is typically needed for a complete rupture. After surgery, your ankle will be kept stable in a cast or walking boot for up to 12 weeks. A torn ligament may also be managed non-surgically with a below-knee cast or boot, which would allow the ends of the torn tendon to heal on their own. This nonsurgical approach may take longer to heal, and there is a higher chance that the tendon could re-rupture. Surgery offers a better chance of full recovery and is often the treatment of choice for active people who wish to resume sports.

Treatment

Often, bunions are treated through nonsurgical treatment methods, which focus on reducing the pain and halting the bunion’s progression. Depending on your particular injury and symptoms, your doctor may recommend the following:

• Proper Footwear. Make sure the shoes that you wear have a roomy toe box and a low heel so that the toes are not crowded.
• Manage the Pain. Your doctor may prescribe or recommend the use of anti-inflammatory medications that will help to reduce inflammation, as well as the pain associated with your bunion. Sometimes a corticosteroid injection at the base of the big toe helps to further reduce inflammation.
• Get the Right Support. Custom-molded orthotic devices provide support, and may have the added benefit of helping to reposition the misaligned joint.

For a more permanent solution that’s intended to eradicate the presence of the condition and restore your mobility, our physicians will perform bunion surgery to remove the unwanted bony growth and re-align the big toe. Your surgeon will customize the procedure based on your needs and anatomy.

Prevention

To reduce your chance of developing Achilles tendon problems, follow these tips:

• Stretch and strengthen calf muscles. Stretch your calves to the point at which you feel a noticeable pull, but not pain. Don’t bounce during a stretch. Calf-strengthening exercises can also help the muscle and tendon to absorb more force and prevent injury.
• Vary your exercises. Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming. Avoid activties that place excessive stress on your Achilles tendons, such as hill running and jumping activities.
• Choose running surfaces carefully. Avoid or limit running on hard or slippery surfaces. Dress properly for cold-weather training and wear well-fitting athletic shoes with proper cushioning in the heels.
• Increase training intensity slowly. Achilles tendon injuries commonly occur after abruptly increasing training intensity. Increase the distance, duration, and frequency of your training by no more than 10 percent each week.

Diagnosis

Diagnosis for adult-acquired flatfoot deformity is accomplished through a combination of physical evaluations and imaging tools, such as X-rays and MRIs.

Treatment

Your doctor will consider several factors in planning your treatment, including the cause of your injury, your overall health, the severity of your injury and the extent of soft tissue damage. To restore function and the heel’s original dimensions, Dr. Rappaport may recommend:

• Nonsurgical treatment. If the bones have not shifted out of place, temporary immobilization devices, such as a cast, may be used.
• Surgical treatment. When the bones are displaced, patients may require:
• Ankle Fusion. In traumatic fractures where the cartilage is severely damaged, the calcaneus bone will be fused to the joint to stabilize the foot for walking.
• Reduction. Use small incisions to correct bone displacement, then insert screws and metal plates to keep the heel bone in place.

Symptoms

Common symptoms of adult-acquired flatfoot deformity include:

• Pain and/or swelling. As a result of inflammation of the nerve inside the tarsal tunnel, tenderness where the posterior tendon resides may occur and be accompanied by a burning, shooting, tingling or stabbing pain.
• Difficulty walking. Individuals may experience a constant ache while walking long distances or an inability to walk altogether.
• Change in foot shape. As an individual’s tendon stretches, the arch in their foot flattens, causing a change in the shape of the foot.
• Inability to tiptoe. If an individual’s posterior tendon is damaged, he or she may find it difficult, painful or impossible to raise their heels or stand solely on their foot’s toes.

Diagnosis

Physicians can quickly diagnose clubfoot by detecting shape or position abnormalities in newborns’ feet. After diagnosis, X-rays may be administered to determine the condition’s severity. Fetal ultrasounds allow doctors to diagnose clubfoot while a baby is still in the mother’s womb, allotting parents more time to research and absorb the knowledge that’s necessary to find qualified health experts with the most efficient treatment for their child’s condition.

Diagnosis

In diagnosing an Achilles tendon rupture, a foot and ankle surgeon will ask questions about how and when the injury occurred, and whether the patient has previously injured the tendon or experienced similar symptoms. Your surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle, as well. If the Achilles tendon is ruptured, the patient will have less strength in pushing down, as on a gas pedal, and will have difficulty rising on the toes. The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, your surgeon may order a MRI or other advanced imaging tests.

Causes

Individuals that wear ill-fitting shoes, particularly tight-fitting and high-heeled shoes, are more susceptible to developing bunions. Some inherited factors may predispose certain people to the formation of bunions, as well, including congenital abnormalities in bone formation, rheumatoid arthritis, nerve conditions and injury.

Causes and Risk Factors

Clubfoot is congenital, meaning it is a condition that’s present at birth. Though there are no known ways to prevent this condition from occurring, there are key risk factors that may indicate when a baby has an increased risk of being affected by the condition:

• Family history. If parents or siblings were born with clubfoot, there is a higher chance that the unborn baby will have the condition too.
• Congenital conditions. Abnormalities of a baby’s skeletal structure, along with other serious birth defects, such as spina bifida, can lead to the concurring combination of clubfoot.
• Environmental factors. If a pregnant woman has a history of clubfoot and smokes cigarettes during her pregnancy, the risk of the unborn baby developing the condition significantly increases. The use of recreational drugs or the development of certain infections during pregnancy increases the risk of developing clubfoot, too.
• Lack of amniotic fluid surrounding the baby. If a pregnant woman produces or retains too little amniotic fluid, which surrounds a baby in the womb, the risk of clubfoot escalates.

Who’s At Risk?

Common risk factors associated with adult-acquired flatfoot deformity include:

• Age. The risk of developing the condition increases with age, with middle-aged women between 40 and 60 being three times more likely to be affected by the condition than men.
• Weight. Obese individuals consistently carry more weight, meaning that their bodies steadily experience more stress placed on their feet and ankles. Gradually, bearing extra weight will begin to flatten the arch of the foot, until the foot becomes completely “flat” from the bones spreading out of position.
• Previous injury. Individuals who have experienced previous ankle trauma or surgery are at a higher risk to develop AAFD due to a previous form of joint deformity.
• Diabetes. Due to disease-related nerve damage, diabetics are more prone to stressing their posterior tibial tendon and acquiring AAFD.
• Inflammatory Arthritis. Arthritis degrades the cartilage in the ankle and foot joints and the ligaments that support the foot, causing the foot to change shape over time, eventually flattening it to cause adult-acquired flatfoot deformity.

Treatment

If caught early, adult-acquired flatfoot can be effectively managed through non-surgical treatments, such as bracing, custom-molded orthotics, or cast immobilization. When conservative care fails, our physicians will select a surgical treatment that will restore mobility, reduce pain and stop the progression of this serious foot condition. Surgical treatment will be selected that best suits your needs. Procedure options include tendon transfer, tendon debridement, and joint fusion. Our foot and ankle surgeons may also perform an osteotomy, which involves surgically cutting and reshaping a bone to realign the foot.