Treatments

First MTP medial capsulorrhaphy is a procedure that tightens the soft tissue on the inner side of the big toe joint. This procedure is done along with other procedures to help correct a bunion deformity. It should not be performed alone due to the likelihood of the bunion returning. Bunions involve both an altered position of the bones of the foot as well as a stretching of the soft tissue around the joint, which allows the big toe to turn inward toward the second toe. Both of these should be addressed to allow long-term correction of a bunion.

The goal of tightening the soft tissue is to restore normal tension of the previously stretched out tissue, aiding in pain relief pain by straightening the big toe. Bunion procedures also may improve the cosmetic appearance of the foot but should not be done for this reason alone.

Adult flatfoot is a condition that is characterized by the collapse of the arch of the foot. Surgery will improve alignment of the foot and restore more normal pressure during standing and walking. A combination of procedures often is needed to repair the ligaments and tendons that support the arch. Bone cuts are made to help restore the arch. Proper correction of flatfoot deformity can help reduce pain and improve walking ability.

The flexor digitorum longus (FDL) is one of the tendons responsible for bending the toes down to the floor. The goals of a FDL tendon transfer surgery are to relieve pain and to help restore the arch in patients with painful fallen arches. A fallen arch occurs when the foot loses its support and flattens out, generally due to weakening of tendons and ligaments in the foot.

A flexor hallicus longus (FHL) tendon transfer to the proximal phalanx of the big toe is used to treat clawing of the big toe.

Small muscles in the foot help to stabilize the big toe. When those muscles are weakened by disease, an imbalance occurs that leads to clawing. The clawing puts abnormal pressure on the ball of the foot that can cause an ulcer to form. In addition, clawing may lead to pressure on top of the toe from shoes. Clawing is associated with a variety of underlying disorders, including Charcot-Marie-Tooth disease, diabetic neuropathy, traumatic brain injury, polio, and stroke.

The primary goal of an FHL tendon transfer is to decrease the abnormal pressures on the big toe. This will prevent ulcer formation, or in the case of an existing ulcer, promote healing. An FHL tendon transfer often is done at the same time as other foot procedures.

The flexor hallicus longus (FHL) is the primary flexor muscle of the big toe. It originates at the back of the leg, transitions into a long tendon as it enters the foot and attaches on the bottom of the big toe.

The peroneus brevis (PB) muscle starts in the leg and continues along the outside of the ankle. It then takes a sharp turn and ends on the outside of the foot. The peroneus brevis works with the peroneus longus (PL) to turn the ankle and foot outward. 

The FHL to PB tendon transfer is a surgery to improve the function of the foot. The FHL is passed behind the ankle to the outside of the foot to either assist or replace the damaged PB tendon.

The goal of this surgery is to restore the power of the ankle and foot to turn outward, which is required for cutting and turning movement. 

Foot drop occurs when the muscles and tendons that flex the foot up are no longer working. Commonly, it is the result of a nerve injury, stroke, or nerve disease (neuropathy). It also can occur after an injury to a muscle or tendon. If a person is unable to flex the foot up when walking, the foot or toes can drag on the ground. This can make walking difficult and lead to frequent falls. 

There are 26 bones in the foot, all of which can be fractured. There are different types of fractures. Sometimes a bone breaks but stays in place (non-displaced). Sometimes a bone breaks into two pieces that move apart from one another (displaced). Other types of fractures include a bone that is broken in multiple places (comminuted) and a bone that breaks through the skin after fracturing (open fracture).

If you injure your foot, your orthopaedic foot and ankle specialist will take X-rays to see if you have a fracture. X-rays will identify most fractures but some smaller and more subtle fractures may require CT or MRI scans to be seen. Not all fractures require surgery, and your foot and ankle orthopaedic surgeon will help determine how your fracture should be treated.

If you need surgery for your foot fracture, the goals are to restore the fractured bone to its correct position, stabilize the bone in this position, encourage healing, restore function and reduce the risk of future problems such as persistent pain, loss of motion, and arthritis.

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.

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.

The gastrocnemius and the soleus are two muscles that make up the calf. The gastroc is the larger and more superficial of the two muscles. The soleus is a deeper muscle within the lower leg. The gastroc tendon combines with the soleus tendon to form the Achilles tendon.

Tightness in the calf can limit how for the ankle can flex up. This may make it difficult to walk with the heel on the floor. Over time this can cause problems such as pain and deformity. Calf tightness may contribute to many foot problems, including heel pain, Achilles tendon pain, flatfoot deformity, toe pain and bunions.