The Foot 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.

The 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. 

The ankle is a rotational hinge type joint capable of free movement.  The ankle consists of a capsule containing fluid which both nourishes and lubricates the joint making motion possible between the foot and the leg.  The 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.

The 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 and extension.  Due to many factors, the foot and ankle are subject to many diseases and injuries.

Gravity 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.

Below is a brief description of frequent foot and ankle injuries and conditions.

Ankle Fractures
Fractures 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. 

The 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 have occurred.

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 Sprain
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 the joints.  Ambulating on a severely sprained ankle too soon can cause the band of supporting ligaments to be permanently elongate causing chronic ankle pain and problems.

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, and Elevation.  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 requiring treatment.  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 activities.  Achilles tendon injuries are usually immediately known to the patient.  Upon injury, the pain is often instant and extremely painful.  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.

Plantar Fasciitis

Plantar 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 begins walking.  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.

Plantar fasciitis 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.

Plantar 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.

Heel Spur 
Heel spurs 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.