Injections and Other Procedures

Below-Knee Amputation

The goal of amputation is to remove unhealthy tissue and create a remaining leg that is less painful and more useful. Just like many reconstructive orthopaedic surgeries, the surgical goal is to improve a patient’s pain and function. Amputation can improve quality of life for many patients.

A below-knee amputation (BKA) is an amputation often performed for foot and ankle problems. The BKA often leads to the use of an artificial leg that can allow a patient to walk. A BKA is performed roughly in the area between the ankle and knee. This amputation provides good results for a wide range of patients with many different diseases and injuries.

Brisement

Brisement is the injection of fluid into the space between a tendon and its lining, or sheath. This procedure breaks up scar tissue and stimulates healing of a tendon. While most commonly used for the Achilles tendon, brisement can be performed in any tendon of the foot and ankle.

Correcting a Failed Bunion Repair

Most bunions can be treated without an operation, but sometimes surgical procedures are needed to relieve pain and deformity. Unfortunately, in some cases bunion repairs fail and the pain or deformity returns. There are multiple factors that can contribute to this challenging scenario. Bunions can recur because of medical conditions or non-healing of the bone after surgery. In some cases, there are technical aspects that can be improved to achieve the desired result with additional surgery.

The goal of correcting a failed bunion repair, using a procedure called revision surgery, is to relieve pain and deformity of the first toe that remains after the initial surgery. Sometimes arthritis develops after bunion surgery. This may require a different procedure than the first. It is important to figure out why the first surgery failed to prevent another failure.

Extracorporeal Shock Wave Therapy

Shock wave therapy is a non-invasive method that uses pressure waves to treat various musculoskeletal conditions. High-energy acoustic waves (shock waves) deliver a mechanical force to the body’s tissues.

Flexor to Extensor Tendon Transfer (Girdlestone-Taylor)

This surgery is used to treat flexible hammertoe deformity. A hammertoe deformity is one in which the toe is bent and looks like a hammer. A flexible deformity is one in which the toe can be manipulated into a straight position. This deformity can cause shoe problems, corns, and pain with walking.

Foot Ulcers and the Total Contact Cast

Patients with diabetes are prone to major foot problems. This is because the foot expresses many of the underlying effects of diabetes, including neuropathy, vascular disease, and diminished response to infection.

As a result of the neuropathy, the foot can develop an ulcer. This happens for two reasons. The first is that the neuropathy causes paralysis of small muscles in the foot, which results in clawing of the toes. Clawing of the toes causes prominence of the metatarsal heads (bones closest to the toe) on the bottom of the foot as well as the knuckles on the dorsum (top) of the foot.

Ganglion Resection

A ganglion is a cyst that forms on top of a joint, ligament, or tendon. The cyst is filled with fluid. Because the ganglion is not cancerous and may disappear in time, if you do not have symptoms such as pain, your doctor may recommend observation only to make sure that no unusual changes occur.

The procedure to remove a ganglion is called ganglion resection. The initial treatment of a ganglion is not surgical, but if pain becomes a problem, your orthopaedic foot and ankle specialist may recommend aspiration, a procedure to remove the cyst’s fluid through a needle. If the cyst returns, surgery to remove the ganglion might be an option.

Joint Injections

A joint injection is a procedure your doctor uses to introduce medication into a joint. The injection is done under sterile conditions using a syringe and needle.

The goals of a joint injection are to relieve pain and improve joint function. Your foot and ankle orthopaedic specialist also may confirm your diagnosis when giving a joint injection.

Plantar Fascia Injection

The plantar fascia (PF) is a thick band of tissue that connects your heel bone to your toes. It helps support the overall shape of your foot, especially when standing, and helps with shock absorption. Irritation and scarring of the plantar fascia, known as plantar fasciitis, is one of the most common causes of heel pain.

Ten percent of people have pain in the bottom of the heel at some point in their life. The most common cause is plantar fasciitis, which can result from overactivity, improper shoes, flat feet or excessive weight on the feet.

Platelet-Rich Plasma Injections

Platelets are small cells in the blood that help form clots to stop bleeding. Platelet-rich plasma (PRP) is a patient’s own concentrated platelets. PRP contains a large number of growth factors. These growth factors are thought to stimulate healing.

When PRP is injected, it can aid the body’s natural healing of injuries. The goal is not only to relieve symptoms but also to create actual healing. In some cases, PRP injections may reduce the need for medication and/or surgery.

PRP injections have been used to treat tendon, ligament, cartilage and bone injuries, as well as arthritis. Around the foot and ankle PRP is used for treatment of tendon and ligament injuries such as plantar fasciitis, Achilles tendon and ankle ligament injuries.

PRP injections are not recommended for the treatment of infections or cancer.