and Ankle Division at
Iowa Orthopaedic Center offers a team of foot and
ankle specialists, providing comprehensive orthopaedic
and podiatric care.
Our Center of Excellence provides board certified,
fellowship trained foot and ankle surgeons, providing
all inclusive foot and ankle care ranging from the
most complex foot and ankle fractures and injuries
to the most basic care.
Our Foot and Ankle division brings the latest
in surgical technology to our patients with the highest
level of care.
foot and ankle are uniquely important to the musculoskeletal
system and are the main anatomical structures responsible
for ambulation. The entire weight of the human body is supported by the joints,
muscles, tendons, and ligaments found in the foot
and ankle. These
components work together to provide the body with
support, balance, and mobility.
An injury to any one part of the foot or ankle
can cause the development of problems in other areas
of the body.
Conversely, problems in other areas of the
body can lead to foot and ankle problems.
ankle is a rotational hinge type joint capable of
The ankle consists of a capsule containing
fluid which both nourishes and lubricates the joint
making motion possible between the foot and the leg.
foot and ankle contain:
- 26 bones (One-quarter of the bones in the human body are in the feet.);
- 33 joints;
- over 100 muscles, tendons (fibrous tissues that connect muscles to
bones), and ligaments (fibrous tissues that connect
bones to other bones); and
- blood vessels, nerves, skin, and soft tissue.
ankle joint consists of the connection of the talus
and the lower ends of the two leg bones (tibia and fibula).
Multiple ligaments provide stability to the ankle
joint. The primary movements of the ankle are flexion
Due to many factors, the foot and ankle are
subject to many diseases and injuries.
alone places extra force on the foot and ankle. Due to the force of gravity, your body weight, multiplied by
7, is equilivent to the amount of weight placed upon
your feet and ankles with each step you take.
No other part of the human body takes the kind
of punishment that we give our feet and ankles.
Diagnosing the cause
of foot and ankle pain can be straightforward or require
diagnostic evaluation for an accurate diagnosis.
Once an appropriate diagnosis has been established,
treatment can be started to return individuals back
to their activities.
However, it’s important to remember that an
injury to the foot and ankle need adequate time to
heal before supporting body weight and participating
in high impact activities.
is a brief description of frequent foot and ankle
injuries and conditions.
of the ankle can range from minor twisting injuries
to severe trauma that causes complete disruption of
the foot and ankle.
Twisting injuries are more common than foot
and ankle fractures that are caused by trauma.
When a fracture occurs, the bones comprising
the foot and ankle are intricately aligned and therefore
must be carefully anatomically realigned regardless
of the severity or type of trauma sustained.
inner aspect of the tibia (the medial malleolus),
the outer aspect of the ankle (the fibula), and the
bone underneath the ankle (the talus), are most susceptible
to fractures. There are many different types and grades
of severity of ankle fractures.
Some fractures may involve only the medial
malleolus, only the fibula, or both bones (commonly
referred to as a bi-malleolar fracture). Sometimes
the talus may pop completely out of the ankle joint
during a fracture, this is referred to as a fracture
dislocation; indicating both a fracture and a dislocation
If the correct anatomical alignment of the ankle is not accurately
restored, the disruption of the cartilage lining in
the ankle will result in the almost certain development
of arthritis, difficulty walking, and chronic pain.
It’s important that treatment of ankle fractures
restores the bones so that they are re-aligned to
prevent the possible onset of these conditions.
Relatively minor ankle fractures can be treated conservatively with
placement in a boot or a cast.
Unfortunately, the majority of ankle fractures
will require operative treatment.
The most common procedure, an ORIF (Open Reduction
Internal Fixation), is performed for the placement
of screws and/or metal plates to appropriately align
the fracture and more accurately reduce or restore
the fracture alignment.
If you feel
you have sustained a foot or ankle fracture, you should
see your medical provider immediately.
Ankle sprains (sprains affect supporting ligaments) are not to be
confused with ankle strains (strains affect muscles). Ankle sprains are usually the result of a trip, fall, twist,
or any action that suddenly forces the ankle out of
its normal position.
Like fractures, ankle sprains range in severity
and can be quite serious, especially if they are not
treated quickly and correctly.
The ligaments in the ankle provide stability
for the ankle.
During an ankle sprain the ligaments surrounding
the ankle are either stretched too far or torn. These
ligaments are connecting ligaments, like rubber bands
that attach one bone to another and secure them to
Ambulating on a severely sprained ankle too
soon can cause the band of supporting ligaments to
be permanently elongate causing chronic ankle pain
Symptoms of an ankle sprain can include pain and soreness, swelling,
bruising, difficulty and pain when walking, and stiffness
in the ankle.
These symptoms differ for each individual and
depend upon the severity of the ankle sprain sustained.
If you suspect an ankle sprain, you should contact your physician
as soon as possible and begin the R.I.C.E. treatment
immediately: Rest, Ice, Compression,
This will help you reduce pain, swelling, and
further injury until you can be evaluated by a physician.
An evaluation by a physician is important for several reasons. This
would include to rule out additional ankle injury
Most ankle sprains are treated nonoperatively.
The severe cases may require surgery.
Recovery time is based upon the type of injury
and the treatment protocol that is right for you.
Achilles Tendon Rupture
Achilles tendon ruptures or tears occur when individuals are not properly
conditioned and they are participating in recreational
Achilles tendon injuries are usually immediately
known to the patient.
Upon injury, the pain is often instant and
Even walking with an Achilles tendon rupture
is excruciating and difficult.
The most prominent immediate symptoms are pain
in the back of the calf muscle as though something
has hit or struck the back of the calf muscle.
This is usually accompanied by leg weakness.
Retraction occurs during an achilles tendon rupture, causing the
calf muscle (gastronemius muscles) to continue to
pull on the Achilles tendon, as the end of the ruptured
tendon pulls back into the leg.
After the tendon retracts, it is almost impossible
to gain sufficient return of strength without surgical
repair of the Achilles tendon.
Once a tear or retraction occurs, the tendon
is stretched beyond its normal limit and without surgical
repair. It will not be at the correct anatomical length
to allow proper function.
Fasciitis is a frequent occurrence among people active
in high impact sports, especially running. Symptoms
often start as a dull, intermittent pain in the heel,
progressing to increased and constant pain. Symptoms
of plantar fasciitis are usually worse in the morning
or after inactivity, and then decrease as the patient
However, the pain from plantar fasciitis usually
increases after standing or walking for long periods
of time, as well as at the beginning of a sports activity.
is an inflammation of the plantar fascia. An injury
to the plantar fascia is usually the underlying cause
of the inflammation of the tissue.
Repeated trauma typically results in microscopic
tearing of the plantar fascia near the junction where
it attaches to the calcaneus.
The plantar fascia
is a thick, broad, elastic band of fibrous tissue
that courses along the bottom (plantar surface) of
the foot. It is attached to the heel bone (calcaneus)
and fans out to attach to the bottom of the metatarsal
bones in the region of the ball of the foot. Because
the normal foot has an arch, this tight band of tissue
(plantar fascia) is at the base of the arch. In this
position, the plantar fascia acts like a bowstring
to maintain the arch of the foot.
Fasciitis is usually treated nonoperatively.
The treatment time will vary among patients
and can last up to six months or longer. The most common forms of treatment include, activity modification,
shoe inserts under the heel area, icing, stretching,
change of foot wear, anti-inflammatory medications,
and sometimes cortisone injections.
When nonoperative protocols fail, surgical
removal or release of the fascia can be performed.
The recovery time for surgery varies among
individuals, but due to the weight bearing load of
the foot, recovery time can take several weeks.
are actually a calcium deposit and are most frequently
a secondary condition to plantar fasciitis.
When plantar fasciitis continues for a long
time, a heel spur may form where the fascia tissue
band connects to your heel bone. In most cases the
bony protrusion is visible on x-ray. Treatment is
usually the same as for plantar fasciitis.
When you select Iowa Ortho Foot
and Ankle Division, you can be assured of receiving
excellent treatment and management from our orthopaedic
and podiatric physician team.
Iowa Ortho offers both surgical and non-surgical
treatment options, our surgeons are leaders in the
field of foot and ankle. Take the
first step…. come see one of the
foot and ankle experts at Iowa Ortho by calling 515.247.8400,
or toll-free 800.642.6381.