Foot & Ankle Injuries and Treatments in New Jersey
A complicated part of the body, feet and ankles are comprised of 26 bones, 33 joints, 107 ligaments, 19 muscles, and tendons.
NJ Foot & Ankle Doctors
Every day, the average person utilizes this structure to walk between 8,000 to 10,000 steps. The repeated pounding and side-to-side motion performed in sports, exercise, and regular daily movement provides an understanding of why this part of the body is the most common site of injuries. From basketball to dance to simply walking around, feet and ankles are subjected to the rigorous demands that the body and legs place on them.
Many fractures and sprains of the foot and ankle occur during sports. Football and basketball players are particularly vulnerable to sprains and fractures, along with runners, who are prone to stress fractures, tendonitis and plantar fasciitis. Gymnasts and dancers may also develop stress fractures.
Pain, swelling, bruising, and difficulty bearing weight or walking on the affected foot or ankle are the most common symptoms of a sprained or fractured foot or ankle. Unresolved, ongoing pain or other foot or ankle abnormalities experienced during sports or exercise activity are reasons to visit an orthopaedist. It is particularly important to seek timely care in order to prevent worsening of the condition.
NJOI provides comprehensive diagnostic, surgical and rehabilitative services for foot and ankle conditions, from the most common to the most complex. These include but are not limited to the following conditions below
While many conditions can be treated non-surgically with medication, bracing and/or physical therapy, surgery can be the most effective method of treating serious or prolonged, chronic injuries. Surgical methods can offer a quicker road to recovery and decreased odds of re-injury.
Ankle Instability: ligament strains, sprains tears
A sprained ankle is a very common injury. In fact, approximately 25,000 people experience it each day. A sprained ankle can happen to anyone, from an athlete to person stepping on an uneven surface.
The ligaments of the ankle hold the ankle bones and joint in position. They protect the ankle joint from abnormal movements-especially twisting, turning, and rolling of the foot.
A ligament is an elastic structure. Ligaments usually stretch within their limits, and then go back to their normal positions. When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers.
If the ankle ligaments do not heal adequately, a person may end up with ankle instability. This can cause the ankle to give way and feel unreliable on uneven terrain. A Grade 1 sprain is a slight stretching and minor damage to an ankle ligament; a Grade 2 sprain is a partial tearing of the ligament; Grade 3 sprain is a complete tear of the ligament.
At NJOI, we treat ankle sprains conservatively, as well as surgically if they require ligament repair or reconstruction.
Ankle Fractures and Dislocations:
Fracture and syndesmosis repair surgeries (ORIF)
There are a variety of types of ankle fractures. Ankle fractures can be classified by the mechanism that caused the fracture, or the number of locations that have fractured, or by the location of the fracture of the fibula (the bone on the outside of the ankle) relative to the ankle joint line.
In some fractures, the ligament structures (called the syndesmosis) are torn. These structures hold the two leg bones (the tibia and the fibula) that form the ankle socket together. With an unstable syndesmosis, the tibia and fibula are not held together properly, causing instability. If left untreated, this can cause chronic disability and arthritis. Therefore, in an ankle fracture with an unstable syndesmosis, surgery is typically recommended.
Fractures that will not heal with splinting or bracing may require surgery. In this case, we may perform an open reduction and internal fixation (ORIF), a type of surgery used to fix broken bones. In this two-part surgery, the broken bone is reduced, or put back into place. Next, an internal fixation device is placed on the bone to hold the broken bone together.
Cartilage injuries: treatment of osteochondral defect (OCD)
Osteochondral defect (OCD) is an area of damaged cartilage found in a joint. In the foot and ankle, this is usually seen in the ankle joint. OCD is when an area of normally healthy cartilage has been damaged and is either partially or completely detached, or has developed into an area with no cartilage present at all. The ankle joint is comprised of three bones: the tibia and fibula (longer bones), and the talus (connects to the heel bone). The talus bone is the most common location to find an osteochondral defect in the foot and ankle.
A not uncommon history of OCD is that of a sprained or fractured ankle which has failed to properly heal and gives ongoing symptoms, such as pain or instability. Most often, though not exclusively, OCD occur safter some injury to the joint. However, more recent studies suggest the possibility of metabolic or genetic causes, which may alter the architecture or composition of the bone.
At NJOI, we treat cartilage injuries such as OCD with such arthroscopic techniques as microfracture, debridgement and OATS.
Ultrasound Guided Injections
As part of our comprehensive services, NJOI administers injections for a number of conditions requiring treatment or evaluation. These include injections for pain relief, joint lubricant, anesthetics, and PRP. Accurate administration of these injections is key. Traditionally, injections were administered by ‘feel’, and the experience of the physician in recognizing the precise location. Today, ultrasound guided injections ensure the greatest accuracy and thus highest quality of delivery. With ultrasound, a small probe attached to a video monitor is used to obtain a picture to allow the surgeon not only to locate the target area, but to view the administration of the fluids as they are injected.
There are a number of studies which verify the accuracy of ultrasound guided injections. According to one such study from The University of Birmingham (AL) in 2003 and quoted by National Institutes of Health, the use of high frequency ultrasound to guide needle placement within a small joint allows for significantly greater accuracy than a palpation-guided approach. The study determined that with ultrasound guidance, initial needle placement was intra-articular (entry into a joint) in 96% of cases.*
Arthroscopic compartment release for
exercise induced compartment syndrome
Exercise-induced compartment syndrome, also called exertional compartment syndrome and chronic compartment syndrome, is a painful condition due to a pressure build-up within the muscles. Muscles are enclosed within the fascia, a tight band of tissue. This fascia wraps around and contains the muscle. Normally, the fascia has enough extra room within it to allow the muscle to function without problems. However, in patients with exercise-induced compartment syndrome, the fascia is too tight due to the increase in muscle size, and it constricts the muscle during activity. The most common location of exercise-induced compartment syndrome is the leg, around the shin bone.
At NJOI, we perform arthroscopic surgery for exercise induced compartment syndrome, which entails release of the fascia (fasciotomy) of the lower leg. In recent times, newer techniques have been developed to minimize the skin incision and maximize the fascial release; the surgery has a very high success rate.
Treatment of tendinopathy/tendinitis (such as Achilles tendinitis)
Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Tendinitis is the inflammation of the tendon and results from micro-tears that occur with excessive force or overuse. Tendinitis is still a very common diagnosis, though research increasingly documents that what is thought to be tendinitis is usually tendinosis, (chronic tendon injuries), which is far more often responsible for these symptoms than tendinitis.
At NJOI, we treat tendinopathy/tendinitis with ultrasound-guided PRP injections or surgical debridement (removal of unhealthy tissue from to promote healing) and repair.
Treatment of shin splints, stress fractures, plantar fasciitis
Shin splints, medically known as medial tibial stress syndrome (MTSS), refers to pain in the shins – the front lower legs. It is an inflammatory condition of the muscles and tendons, causing pain in the front part of the tibia. The pain is brought on by strenuous activity, such as in stop-start sports like squash, tennis or basketball. Running too much on hard surfaces, downhill or with improper shoes is also a common cause of shin splints. Symptoms include a dull, aching pain in the front part of the lower leg, which can occur during or following exercise, or can be constant.
One of the most common sports injuries, a stress fracture, is an overuse injury that occurs when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone, causing a tiny crack called a stress fracture. More than half of stress fractures occur in the weight-bearing bones of the lower leg and the foot.
Plantar fasciitis is a painful inflammation of the plantar fascia, a flat band of tissue that connects the heel bone to the toes. It is the most common form of heel pain. Plantar fasciitis, which occurs in athletes or those who are on their feet for long periods of time, is caused by straining the ligament that supports the arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling.
NJ Foot / Ankle Doctors and Surgeons
The NJ foot and ankle specialists at The New Jersey Orthopaedic Institute are experienced in both surgical and non-surgical interventions of foot and ankle injuries and conditions including strains, tears, foot and ankle fractures, and many others. Contact us today to schedule an appointment. Serving patients in Wayne, Clifton, Butler, Bridgewater, Morristown and surrounding areas in New Jersey.