More than 3 million people are diagnosed with flat feet every year in the United States. Though this condition is usually painless, developing flat feet as an adult can lead to debilitating pain that inhibits the quality of life for some. Fortunately, non-invasive treatments are available to help those with flat feet support their natural arches and get back to the activities they love.

What are flat feet?

A person has flat feet when the arches on the inside of the feet are low enough to touch the floor when standing. Most cases of flat feet are painless and require no treatment. For some, especially those who acquire flat feet as adults, pain and mobility issues may result.

Symptoms of flat feet

Patients with flat feet are most likely to notice that their feet do not look like the feet of their friends, which have a higher arch in the middle of the foot. Sometimes a giveaway of having flat feet is walking next to a friend on the beach. The flat-footed person’s footprint will leave an impression in the sand from the toes to the heel on both sides of the feet. The person with a more average arch will leave a footprint that has a definite C shape, with a section of the foot not touching the sand where the arch lies.

Most people do not experience any symptoms related to their flat feet. But people who do experience flat foot symptoms may notice:

• Pain in the arch of the foot
• Pain in the heel of the foot
• Swelling along the inside of the ankle

What causes flat feet?

Flat feet typically develop when the arch of the foot does not properly develop during childhood. Children are born with flat feet, and the arch develops throughout childhood growth.  For patients with flat feet, the arch never develops. This is not a cause for alarm, but rather a natural variation in the shape of the human foot. Unless flat feet are causing problems, no treatment is necessary.

Flat feet can also develop during adulthood when a healthy arch falls and becomes flat. This can happen when the tendon that supports the arch of the foot is weakened through years of wear and tear. When flat feet develop during adulthood, this is referred to as having “fallen arches.” Adult-acquired flatfoot can cause significant pain and be debilitating in some cases.

Adult-acquired flatfoot is often caused by posterior tibial tendon dysfunction. The posterior tibial tendon’s job is to support the arch of the foot during movement. This tendon is located on the inside of the lower leg from the calf muscle to the inside of the foot. If the posterior tibial tendon becomes damaged or inflamed, it may no longer be able to support the arch of the foot, leading to flat feet.

Risk factors for developing fallen arches include:

Being overweight – Extra weight puts additional stress on the feet and tendons and can lead to a flattening of the arch.

Injury to the foot or ankle – Damage to the ligaments and tendons of the feet can lead to flat feet.

Rheumatoid arthritis – Inflammation that attacks the cartilage can cause the foot to lose its arch.

Aging – Over time, the arch can experience wear and tear that gradually flattens it.

Diabetes – Diabetic neuropathy may prevent a patient from noticing an injury to the foot that can lead to fallen arches.

Being pregnant – The excess weight associated with pregnancy can cause feet to flatten.

Being female – Women are more likely than men to develop adult acquired flat feet. This may be due to the prevalence of non-supportive women’s shoes.

Participating in athletics – Athletes are more likely to put a strain on their feet as well as acquire damage to the tendons and ligaments in the foot that support the arch.

Diagnosing flat feet

If flat feet or fallen arches are causing problems like pain and swelling, a physician will do a physical examination of the feet as well as order imaging tests to better visualize the inner mechanics of the feet. Tests that may be ordered to diagnose flat feet include:

X-rays – An x-ray will provide images of the bones in the feet and is helpful in determining if the fallen arches are due to arthritis.

CT scan – A CT scan provides more detail than an X-ray and may be used if X-rays are insufficient at providing diagnostic data about the feet.

Ultrasound – Ultrasounds are helpful for visualizing issues of the soft tissues of the feet such as tendons.

MRI – An MRI provides the most detailed image of the inner structures of the foot.

Treatment for flat feet and fallen arches

If flat feet or fallen arches are causing problems, many non-invasive treatments are available to support the arch of the foot and eliminate pain. Treatments for fallen arches and flat feet include:

Arch supports – Arch supports are a type of orthotic device worn as an insert in shoes. Arch supports lift and support the arch into a healthy position. Arch supports do not cure flat feet, but they can reduce symptoms such as pain.

Stretching exercises – When flat feet are caused by a shortened Achilles tendon, stretching exercises can help.

Orthotic shoes – Wearing shoes with proper arch support can help take the pressure off the arch and reduce pain.

Physical therapy – Flat feet caused by overuse or improper form during activities may be helped by learning proper form from a physical therapist.

Surgery for flat feet

Surgery is usually not necessary for the treatment of flat feet. Surgery to correct related health issues such as a damaged tendon may be part of an overall plan to treat fallen arches.

How to prevent fallen arches

Protecting the arch of the foot is paramount when preventing fallen arches. To prevent fallen arches, we recommend:

• Wearing the right shoes – Shoes that provide adequate arch support and cushioning help to reduce strain on the arch.
• Maintaining a healthy weight – Obesity can cause fallen arches because of the excess weight pressing down on the arch of the foot with each step.
• Take it easy – If certain activities cause pain in the arch of the foot, approach those activities with caution. Do not “power through” once pain starts to develop in the foot.

Looking for a second opinion about your fallen arches?

Schedule your appointment today with one of our board-certified flat feet physicians and get the answers you need to support the pain-free movement.

What is a neuroma in the foot?

A foot neuroma is often referred to as a “pinched nerve.” Neuromas are a disorganized growth of nerve cells, often identified as a benign (harmless) nerve tumor. The tumor is benign and frequently found between the third and fourth toes. Foot neuromas can be painful, causing tingling, numbness or a burning sensation in the ball of the foot and between the toes. Foot neuromas can cause significant loss of function in the toes and can limit the ability of the toes to flex and move properly. The experts at BICMD understand neuromas and can diagnose your foot pain through their state-of-the-art orthopedic telemedicine platform. They have extensive experience in identifying foot conditions and can offer you the best treatment options for your type of foot neuroma.

What is Morton’s Neuroma?

The most common foot neuroma is called Morton’s Neuroma and frequently develops between the third and fourth toes. Morton’s neuroma is not technically a tumor but involves a thickening of the tissues around one of the nerves leading to the toes. It occurs where the nerve passes under the ligament that connects the metatarsals (toe bones) in the forefoot.

What causes Morton’s neuroma?

Morton’s neuroma is caused by a damaged or irritated nerve that sits between the bones of the toe. Morton’s neuroma is more common in women, in fact 8 out of 10 cases of Morton’s neuroma are seen in women. Athletes are also more prone to this foot condition. Other causes linked to foot neuromas are:

• Pointy or high-heeled shoes
• Shoes that are too tight
• Sports that require a lot of pressure on the foot and toes
  • Running
  • Ballet
  • Golf
  • Football
  • Tennis
• Foot deformities such as bunions, hammertoes, high arches, or flatfeet

What are the symptoms of a foot neuroma or Morton’s neuroma?

There is not often an outward sign of a foot neuroma, such as a lump or bump. Instead, patients often report the following symptoms:

• Feeling as if you are standing on a marble or pebble in your shoe
• Numbness or tingling in the toes
• Burning sensation in the ball of the foot that may radiate to the toes
• Pain that intensifies with activity or when wearing shoes

How are foot neuromas or Morton’s neuroma diagnosed?

Our orthopedic experts in foot neuromas can diagnose your foot condition through our telemedicine platform. X-rays are often needed to rule out stress fractures or other bone anomalies. Our “best in class” specialist will obtain your history and will ask you about your symptoms. An MRI may be requested to make the most accurate diagnosis and to help devise a treatment plan.

What is the foot neuroma treatment options?

The treatment for Morton’s neuroma and other foot neuromas can vary, depending on the severity of each neuroma. The goal for non-surgical treatment is to relieve symptoms and allow the condition to diminish.

Non-Surgical treatments include:

• Changes in footwear that allow the toes more room and have a lower heel
• Medication – NSAIDs (Non-steroidal anti-inflammatory drugs)
• Corticosteroid injection
• Orthotics
• Padding and taping

Surgical options:

Surgical options may be considered if conservative measures have failed to relieve the painful symptoms of foot neuromas. The goal of orthopedic podiatry surgery is to remove the inflamed or enlarged nerve; this is called excision of neuroma. Our experts at BICMD can discuss this simple surgical procedure and offer expert advice for the best treatment plan that suits your individual foot condition.

For more information on foot neuromas and Morton’s neuroma, or to receive an expert consultation for your foot pain, please contact our experts, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

What is Hallux Valgus?

Hallux is Latin for “big toe”, or “first toe” and valgus means the displacement away from midline. Hallux Valgus is the most common foot deformity and is represented by a widespread misalignment of the big toe. Approximately 25% to 35% of the population have hallux valgus in varying degrees and it often causes foot pain and functional disability. Our orthopedic telemedicine experts have extensive experience in diagnosing and treating hallux valgus. They can consult with you through our state-of-the-art telehealth platform and give you the best medical advice for the treatment of your foot and toe pain associated with hallux valgus.

How are hallux valgus and bunions different?

Hallux valgus is often called a bunion, or protrusion on the big toe. Technically, they are two different deformities. The term “bunion” is often used to describe a variety of deformities in the toe that include a painful bump and swelling at the base of the big toe. The bump, or bony prominence causes inflammation in the toe and the bursa.

Orthopedists define hallux valgus as a condition where the big toe deviates from the normal position and angles inward toward the second toe. The bone malformation doesn’t always include a bunion, or protrusion. However, this bone irregularity can (and usually does) accompany a painful bunion and is why they are grouped together to mean the same thing.

Certainly, a patient can have hallux valgus without a bunion and vice versa, but often the two conditions go hand in hand and are called one term: bunion.

What causes hallux valgus or bunions?

The exact cause of hallux valgus and the development of bunions is not well established. However, there are certain factors that contribute to the development of hallux valgus such as:

• Gender – Women have hallux valgus and bunions 10-times more frequently than men.
• Heredity – Condition can be congenital
• Footwear – Tight, pointed shoes
• Wearing high-heels – Especially during the ages of 20-40, can effect the development of hallux valgus in later years.
• Severe flatfoot
• Higher body mass index

What are the symptoms of hallux valgus and bunions?

Symptoms of hallux valgus and a bunion most often occur when wearing shoes that crowd or pinch the toes. Heels, or shoes with a tight toe box can exacerbate symptoms which may include:

• Pain and tenderness at the side of the toe
• Inflammation
• Redness
• A burning sensation
• Possible numbness, radiating to the toe

How are hallux valgus and bunions diagnosed?

The severity of hallux valgus can be measured on x-ray. Bunions are often visible at the base of the big toe, or on the side of the foot. Our orthopedic foot and ankle specialists recommend an x-ray to determine the degree of deformity. They can review your x-rays and assess the degree of malformity, then advise a treatment plan suited to your needs. It may be of value to receive an expert opinion on how to treat hallux valgus and bunions. You can connect with an expert on our orthopedic telemedicine platform.

What is the treatment for hallux valgus and bunions?

Non-Surgical Treatment:

Conservative treatments should be explored before surgical intervention and may include:

• Footwear adjustment that eliminates pinching at the toe and friction at the site of the bunion.
  • Choose a shoe with a wider, deeper toe box.
• Padding – Placing pads over the site of the bunion can help minimize rubbing pain
• Activity modification – Standing for long periods of time can aggravate bunions
• NSAIDs – Non-steroidal anti-inflammatory drugs can help with bunion or hallux valgus pain
• Ice – Helps reduce inflammation

Surgical Treatment:

If conservative treatments fail to relieve pain and when bunion pain interferes with daily activities, surgery should be considered. There are several surgical procedures available and our experts can help you decide which one is right for you.  Some surgical treatments are:

• Bunionectomy – Removes the “bump” of bone on the toe
• Chevron Osteotomy
• Scarf Osteotomy
• Crescent Osteotomy
• Lapidus Procedure

For more information about hallux valgus, bunions and bunion pain, or to receive an expert consultation for your foot pain, please contact our experts, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

What is ankle arthritis?

The term “arthritis” means inflamed joint and can occur in any joint in the body. There are over 100 forms of arthritis, many of which can affect the ankle. The ankle has three bones that make up the ankle joint: the lower end of the tibia (shin bone), the fibula (smaller bone in the lower leg), and the weight-bearing bone called the talus which fits into the socket formed by the fibula and tibia. Ankle arthritis causes pain and stiffness in the foot and ankle and can be debilitating. Currently, there is not a cure for arthritis, however there are many treatment options our experts at BICMD can recommend to help slow the progress of ankle arthritis and relieve painful symptoms. Through our orthopedic telemedicine on demand platform, you can obtain the best diagnosis, second opinion and individualized treatment options for your ankle arthritis.

What are the most common forms of ankle arthritis?

Arthritis comes in many forms and can attack individual joints differently. Ankle arthritis is less common than arthritis in other major joints like the shoulder, hip and knee. When arthritis in the ankle does occur, there are three main forms of ankle arthritis:

• Post-Traumatic arthritis – The most common form of ankle arthritis, occurs after a trauma that causes the cartilage to wear away. Post-traumatic can occur years after an injury or ankle dislocation. Studies show an injured ankle is seven-times more likely to become arthritic than an uninjured joint.
• Osteoarthritis –Also known as “wear-and-tear” arthritis and is commonly found in older patients. Ankle osteoarthritis occurs when the cushioning cartilage between the bones of the ankle wears away and allows bone to rub on bone.
• Rheumatoid arthritis – An auto-immune disease that attacks multiple joints in the body at the same time.

What are the symptoms of ankle arthritis?

Patients who experience ankle arthritis often report similar symptoms:

• Pain and stiffness in the ankle
• Pain that gets worse with use or motion
• Tenderness when pressure is applied
• Difficulty walking
• Swelling in the morning or after resting
• Joint swelling
• Warmth or redness around the joint
• Decreased range of motion

How is ankle arthritis diagnosed?

The orthopedic ankle experts at BICMD can diagnose your ankle condition through a state-of-the-art telemedicine platform. They will obtain a thorough medical history which includes symptoms and previous care. X-rays may help determine the severity of ankle arthritis and a CT scan or MRI will help them determine how much cartilage has been damaged. They have extensive experience in diagnosing and treatment ankle arthritis and will give you the best advice for the joint affected by arthritis.

What is the treatment for arthritis in the ankle?

Non-Surgical treatment:

The type and severity of your ankle arthritis will help us determine the best treatment plan. Conservative measures may include:

• NSAIDS – Non-steroidal anti-inflammatory drugs
• Weight loss
• Ankle brace or other assistive device
• Corticosteroid injections
• Hyaluronic injections
• Lifestyle modification – minimizing activities that aggravate the condition
• Physical therapy

Surgical Treatment:

Surgery for ankle arthritis should be considered when conservative treatments fail to relieve pain and restore mobility. Surgical treatments may include:

• Ankle arthroscopy
• Arthroscopic debridement
• Ankle replacement (arthroplasty)
• Ankle arthrodesis (fusion)

For more information about ankle arthritis, or post-traumatic ankle arthritis, or to receive an expert consultation for your foot pain, please contact our experts, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

What is a hammertoe?

A hammer toe is a deformity in the foot that causes the toe to curl or bend downward instead of pointing forward. It is called a hammer toe because the downward bend of the middle joint in the toe resembles a hammer. Most often affecting the second or third toe, hammertoes can affect any of the toes on the foot. Hammertoes usually start out as mild deformities, but the abnormal bending can eventually put pressure of the toe when wearing shoes. Over time, the toe may become hard to move or painful and can develop calluses, blisters or corns. The experts at BICMD provide a secure telemedicine platform and can diagnose hammertoes and offer the best individual treatment options for your foot condition. They have extensive experience in helping patients decide the best treatment for their hammer toe.

What causes hammertoe?

The toes have two joints that allow it to bend at the middle and the bottom. The muscles in the toes work in pairs to bend and straighten the toes. If the toes are bent and held in place long enough, the muscles tighten and lose their ability to straighten out. A hammer toe, sometimes called mallet toe can be caused by the following:

• Shoes that do not fit, pinch the toes or are too tight. Heels with pointy toes can cause severe pressure on the toes.
• Arthritis
• An unusually high arch of the foot
• Tightened tendons or ligaments in the foot
• Spinal cord or peripheral nerve damage
• Trauma to the toe such as a severe stub, jam or break
• Abnormal balance of the muscles in the toe

What are common symptoms of hammertoe?

The most common symptom of hammertoes is a physical deformity that shows the toe pointing downward. Other common symptoms may include:

• Blister on the top of the toe from rubbing on a shoe
• Corns or calluses also caused from rubbing on the inside of a shoe
• Pain in the toes
• Pain that makes it difficult to wear shoes
• Inflammation, burning or redness
• In extreme cases – open sores caused by rubbing the inside of shoes or footwear

How are hammertoes diagnosed?

The foot and ankle experts at BICMD can diagnose hammertoes through their telemedicine platform. They will take a patient history and obtain pictures of the foot. An x-ray can help the specialist to further evaluate the bones of the toe and to identify the extent of the deformity. Once a proper diagnosis is made, our “best in class” physicians can help you determine the best treatment for your hammertoes.

What is the treatment for hammertoe?

Non-Surgical Hammertoe Treatment:

Our experts may suggest several conservative measures to treat hammer toe and often recommend the following:

• Switch to footwear with a soft, roomy toe box
• Select footwear that extends a half-inch beyond your longest toe
• Discontinue wearing pointed shoes, especially high heels that pinch the toes
• Gentle toe massage can relieve pain
• Over-the-counter pain medication such as ibuprofen
• Ice can help decrease swelling and relieve pain
• Padding that is made for hammertoes and can protect them from rubbing on a shoe
• Foot exercises and physical therapy

Surgical treatment:

Surgical treatment may become necessary if conservative measures fail to relieve pain and if symptoms persist. Surgical treatment for hammertoe may include:

• Tendon release – allows the toe to lay flat
• Proximal interphalangeal (PIP) joint fusion – Straightens the toe surgically and fuses the two bones of the toe together
• Joint resection – removes a tiny piece of bone and cutting the tendons and ligaments, allowing the toe to lay straight with the use of rods or pins which are removed later.

For more information about hammertoes, mallet toe or continuing foot or toe pain, or if you would like to receive an expert consultation, please contact our specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

A sprained ankle is a common injury that occurs when you turn, roll or twist your ankle to such an unnatural degree that the ligaments holding the ankle together become torn or stretched. Though quite common, a sprained ankle can represent a serious injury is not treated correctly in an adequately short amount of time.

With BICMD, you are able to access the best orthopedic specialists in the country to make sure you are receiving the care you need to keep your sprained ankle from becoming a lifelong mobility setback. If you think you have sprained your ankle, schedule your telemedicine appointment with one of our orthopedic specialists right away. The sooner you receive proper diagnosis and care, the sooner you’ll be on the road to recovery.

Symptoms of a sprained ankle 

Symptoms of a sprained ankle can range from mild to severe, depending on the extent of the damage to the associated ligaments. If you have a sprained ankle, you may experience some or all of the following symptoms:

• A popping sensation at the time of the injury
• Hearing an audible snap sound when the injury occurs
• Pain that worsens with weight bearing movements
• A feeling of instability in the ankle when standing or walking
• Tenderness to touch
• Swelling of the ankle joint
• Bruising of the ankle
• Limited range of motion

Contributing factors to spraining an ankle

Some people are more likely to experience a sprained ankle than others. Those who are more active are more likely to suffer from sprains because the physical activities they take part in provide greater opportunities to roll, twist or turn their ankles. In addition to greater physical activity, other contributing factors to the prevalence of sprained ankles include:

• Athletics – People who participate in sports that include jumping, running, and quick turns are more likely to experience a sprained ankle. Our BICMD physicians often treat sprained ankles in patients who participate in trail running, basketball, soccer, tennis and football.
• Activity on Uneven Surfaces – Jogging, hiking, running or even walking on uneven surfaces such as unpaved trails, older pavement, backcountry trails, mountains or even poorly-maintained fields results in an increased risk of sprains.
• Prior injury to the ankle – An ankle joint that has previously experienced a sprain is more likely to become sprained again, and the ligaments that hold the ankle together may be slightly permanently weakened or elongated.
• Lack of conditioning – Weaker muscles in the legs, feet and ankles are less adept at keeping the body stable during movement, increasing the odds of acquiring a sprain.

Treatment for minor ankle sprains 

Properly treating your sprained ankle now can help you heal sooner and more completely to avoid long-term complications and pain. For a mild sprain, the R.I.C.E. method is typically the recommended treatment. The R.I.C.E. method includes rest, ice, compression, and elevation that allows the sprained ankle to heal on its own.

Your BICMD physician will let you know if this at-home method is your best course of treatment for your sprained ankle. If your doctor determines that your sprain is mind, he or she will devise a custom treatment plan for your unique anatomy and injury that helps you heal faster and more completely.

Surgical treatment for severe ankle sprains 

For severe sprains or those that do not respond to non-surgical methods, surgery may be the best option for complete healing. Surgical treatment for severe ankle sprains typically involves reconstructing the damaged or torn ligament in the ankle, either with stitches or a graft that allows new ligament tissue to grow. Your BICMD physician will let you know if your sprain is severe enough to require surgery and help you understand your options.

During surgery, your surgeon will look inside your ankle with a small camera known as an arthroscope to find any loose fragments of bone or cartilage, which would be removed. Then, the damaged ligament will be reconstructed using stitches if the tear is minor. If the tear or damage is more severe, a graft will be installed on which new ligament tissue will grow.

After surgery, you’ll be asked to keep your ankle immobilized for a period of time designated by your doctor. You ankle may be placed in a cast or a post-surgery boot to help with immobilization during this period.

The goal of rehabilitation after ankle sprain surgery is to restore your ankle to pre-injury function. Some patients are able to achieve full range of motion after ankle sprain surgery. Rehabilitation can last for weeks or months depending on the severity of the injury. It is important to stick to the rehabilitation schedule recommended by your doctor, as it is designed to help you heal more completely and preserve as much function as possible in your ankle.

Ankle sprain prevention 

When BICMD doctors treat a patient with a sprained ankle, they always stress the importance of preventing future sprain injuries by using these methods listed below. Prevention is a key factor that we attempt to impart in all of our patients.

• Warm up before physical activity – Before doing any kind of physical activity, it’s critical to properly warm up and stretch the muscles and ligaments to prevent injury.

• Pay attention to stepping surfaces – Roots, rocks, uneven pavement, and unexpected curbs are common catalysts to sprain injuries. If you’re in an area of uneven ground, slow down and keep your eyes on the path so you can avoid obstacles that can lead to a sprained ankle.

• Use a brace – Use a support brace or athletic tape to support a weak or previously injured ankle during physical activity.

• Wear the right shoes – Well-fitting shoes that provide the right amount of arch support and grip will help prevent awkward movements that lead to sprains.

• Pace yourself – When beginning a new sport or exercise program, slowly  increase the level of difficulty as your strength and ability increases. Pushing your body too far too quickly can increase your potential for injury.

• Take part in stability training – Stability training and balance exercises can help strengthen the muscles that keep your body balanced during movement.

For more information about ankle sprains or if you would like to receive an expert consultation, please contact our specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

What is an ankle fracture?

An ankle fracture is also called a broken ankle. Ankle fractures occur when one or more of the three bones that make up the ankle joint crack or break. The bones of the ankle joint include the tibia (shinbone), the fibula (outer ankle bone), and the talus (the bone that connects the leg to the foot). An ankle fracture is different from an ankle sprain or strain, which occurs when damage occurs to the ligaments, tendons or muscles. In an ankle sprain, the soft tissue can be damaged, but the bones remain intact without fracture or break. Ankle fractures need to be treated differently than ankle sprains and it is important to get a proper diagnosis. The experts at BICMD can diagnose an ankle fracture during a telemedicine visit. They will offer the best and most up-to-date treatment advice for your specific ankle injury.

What causes a broken ankle or an ankle fracture?

The causes of an ankle fracture can vary as drastically as the type of ankle fracture, rather it is a stress fracture, full break or displaced compound fracture. Some causes of a broken ankle include:

• Accidents or trauma
• Rolling the ankle
• Forceful twisting of the ankle
• Tripping or falling
• Impact during sports

What types of ankle fractures are there?

Three bones make up the ankle joint and any one of these bones can break. Because of this, there are several different types of ankle fractures.  Orthopedic ankle specialists think of the ankle as having 3 sides and a “roof.” The lower end of the tibia forms the roof and medial (inside) of the ankle. The lower end of the fibula forms the lateral (outside) and posterior (back) of the ankle. Doctors describe the types of ankle fractures based on these bones and where they are located. Common fractures include:

• Pilon fracture – An ankle fracture or break through the weightbearing tibia (or roof) of the ankle on the middle of the lower tibia. This type of ankle fracture is usually caused by a high-energy trauma like a fall from a great height
• Lateral malleolus fracture – The most common ankle fracture, which is a break in the lateral (outside) malleolus (the bump on the outside of the ankle on the end of the fibula).
• Bimalleolar ankle fracture – The second most common ankle fracture; when the both the lateral malleolus and the medial (inside) malleolus breaks. The medial malleolus is the bump on the inside of the ankle at the bottom of the tibia.
• Trimalleolar ankle fracture – A break or fracture in three of the ankle bones: the medial and lateral malleolus, and the posterior malleolus (back of the fibula, at the bottom).
• Maisonneuve fracture – A fracture that occurs in the fibula, closer to the knee instead of the ankle. This type of fracture involves the complete disruption of the ligaments in the ankle and may not always show up in an x-ray. Maisonneuve fractures are often found with an MRI Scan instead of an x-ray.

Displaced -vs- Non-Displaced Ankle Fracture:

Any of the above types of ankle fractures can be displaced or non-displaced. A non-displaced fracture occurs when the bone is broken, but still in its correct anatomical position and alignment. Displaced ankle fractures describe the broken bones which are out of correct alignment or separated from one another.

What are the symptoms of a broken ankle or ankle fracture?

The symptoms of an ankle fracture can vary greatly, depending on the type and area of fracture. Some fractures, like hair line fractures, are slight, and patients can walk on the ankle, others can cause extreme ankle instability and pain. General symptoms of a broken ankle are:

• Immediate and severe pain
• Pain, felt especially during weightbearing
• Swelling and tenderness
• Bruising
• Visual deformity, the ankle looking out of place
• Inability to place any weight on the ankle
• Feeling of ankle instability

How is an ankle fracture diagnosed?

Ankle fractures are usually diagnosed from the examination of an x-ray. Ankle fractures often go hand-in-hand with a soft-tissue injury, such as a ligament strain or sprain and can require further testing. Other diagnostic testing may include a CT Scan or an MRI Scan.

What is the treatment for an ankle fracture or broken ankle?

Non-surgical treatment:

The goal of ankle fracture treatment is for the broken bone to heal as closely to perfect as possible. The area, or level in which the bone breaks often dictates treatment. If the bone is stable, non-displaced and aligned properly, surgery may not be needed. It is important to obtain a second opinion and correct diagnosis for a broken ankle. The malalignment of a few millimeters can cause problems later, like arthritis, and early corrective treatment is important.

Surgical treatment:

The exact type of surgical treatment will vary, based on which bones are broken, where the break occurred and if it is fragmented or displaced. Surgery for a broken ankle, regardless of the location or type, usually includes the following:

• Reduction – The process of moving the non-aligned or misplaced bones back into their correct position.
• Immobilization – The bones are held together surgically using special screws, metal plates, rods or wiring techniques. This will secure the bones so they heal together properly. Terms associated with the immobilization of the bones during surgery and the names of treatments used may include:
  • Internal fixation of fractures
  • External fixation of fractures
  • Intramedullary nailing of fractures
  • Repair of malunions and non-union

The foot and ankle are then often placed in a cast or brace for several weeks so the bones can heal.

• Removal of hardware – This is only done if the hardware used to correct the break and displacement begins to be painful or irritating. A skilled surgeon will carefully remove the hardware after the bone has completely healed.

How long does it take an ankle fracture to heal?

Healing time is always dependent upon the patient’s health, age, activity level and underlying health conditions. The average time for a broken bone to heal is 6 weeks. Ankle injuries can take longer to heal if the ligaments and tendons were involved. X-rays should be repeated to understand the rate of healing and if the bones are aligning correctly. Overall, most patients can begin some form of physical therapy and strengthening after the bone has healed, at about 8 weeks. Return to sport and full strength of the ankle varies greatly, depending on the injury. Hairline fractures can take only 6-8 weeks where a complete break with internal or external fixation can take up to a year.

For more information about ankle fractures or a broken ankle or to obtain an expert 2^nd opinion before having a surgical procedure, please contact our orthopedic ankle specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

Coming soon...

For more information about 5th metatarsal base fractures or to obtain an expert 2^nd opinion before having a surgical procedure, please contact our orthopedic ankle specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

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For more information about lisfranc injuries or to obtain an expert 2^nd opinion before having a surgical procedure, please contact our orthopedic ankle specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

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For more information about calcaneus fractures or to obtain an expert 2^nd opinion before having a surgical procedure, please contact our orthopedic ankle specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

A partial or complete disruption of the tendon just above the heel, resulting in the inability to raise the foot.

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What are bunions?

The word “bunion” comes from the Greek word for turnip. A bunion develops on the inside of the foot on the joint at the base of the big toe, and typically looks red and swollen, like a turnip. A bunion is a painful, bony bump and is referred to medically as hallux valgus. Bunions develop at the metatarsophalangeal joint (MTP) where the first long bone of the foot (metatarsal) joins the first bone of the toe (called the phalanx). They are formed when the bones that make up the MTP joint move out of place and cause the phalanx bones of the big toe to angle toward the second toe. The MTP joint protrudes from the inside of the forefoot and enlarges, developing a bony bump. The experts at BICMD have extensive experience in diagnosing and treating bunions. They can consult with you through their state-of-the-art telemedicine platform and can give you the best treatment advice for your foot condition and bunions. Many individuals who are suffering with bunions consult them for a second opinion and to learn of the newest treatments available.

What causes bunions?

Bunions can be an inherited trait. Some individuals inherit feet that are more likely to develop bunions due to their shape and structure. Other causes of bunions include:

• Wearing poorly fitting shoes with a small toe box. Narrow, pointed shoes that force the toes into an unnatural position can contribute to the formation of bunions.
• Inflammatory conditions such as rheumatoid arthritis
• Having low arches, flat feet and loose joints
• Standing for long periods of time
• Deformities, often seen at birth
• Foot injury

Are there different types of bunions?

There are different types of bunions and the causes of them can vary. Other types of bunions are:

• Adolescent bunions – Formed in children, most commonly girls, age 10 to 15. Adolescent bunions are often genetic and run in families.
• Bunionette – Also called “tailor’s bunion” occurs on the outside of the foot, near the little toe. Bunionettes are caused by an inherited faulty mechanical structure of the foot.

What are the symptoms of a bunion?

The symptoms are similar in bunions, adolescent bunions and in bunionettes. Symptoms may include:

• Redness and irritation at the MTP joint
• Pain, tenderness, swelling
• Physical deformity – the big toe turns toward the second toe
• A bump or bone protrusion on the side of the foot
• Thick skin or a callus on the bottom of the big toe
• Corns or calluses on the second toe or where the toes rub together
• Limited movement of the big toe, stiffness
• Difficulty walking

How are bunions diagnosed?

The experts at BICMD can evaluate the condition and health of your foot through an x-ray. An x-ray will detail the severity of the bunion and pinpoint its cause. They will also check the alignment of your toes and look for damage to the MTP joint. Our “best in class” orthopedic foot specialists have extensive experience in diagnosing bunions and in helping you formulate a plan to correct this painful condition.

What is the treatment for bunions?

Non-surgical treatment:

Depending on the severity of your bunions, non-surgical treatments can often help relieve pain and restore mobility. Non-surgical treatment includes:

• Ice – Helps with inflammation and pain
• Medication – such as NSAIDs, or non-steroidal anti-inflammatory drugs
• Orthotic devices – Toes spacers or special shoe inserts can take the pressure off toes and relieve pain.
• Corticosteroid injections
• Padding
• Shoe modifications – avoiding shoes that are too tight, or pointed

Surgical treatments:

Surgery may be recommended if conservative treatments have failed to alleviate pain. There are many different types of surgical treatment for bunions and our experts can help guide you to choose the best one for your specific foot condition. Bunion surgery can cause a lot of time off work and off of your feet and should be carefully considered. A consultation and second opinion through our telemedicine platform can save you time, money and unnecessary treatment.

Surgical treatments that may be recommended are:

• Bunionectomy
• Osteotomy
• Shaving of the protruding bone
• Bone fusion

For more information about bunions, bunionettes, or if you would like to receive an expert consultation, and treatment options for your bunions, please contact our specialists, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

Congenital clubfoot is the term that describes an abnormality in which a shortened Achilles tendon causes the foot to be turned inward. In congenital clubfoot, the foot is twisted out of shape or position, and the tendons that connect the muscles to the bones of the foot are shorter than in a healthy foot. Half of all babies born with clubfoot have it in both feet.

Though discovering their baby has been born with a congenital clubfoot can be alarming to new parents, this diagnosis is usually an isolated problem in an otherwise healthy newborn, and it can be corrected.

What does congenital clubfoot look like?

Most of the time, as soon as a baby is born, doctors will be able to see that it has been born with congenital clubfoot. Here are some examples of what a clubfoot may look like:

• The top of the foot is twisted downward, increasing the arch and turning the heel of the foot inward.
• The foot may be so severely turned that it appears upside down
• The affected leg may be shorter
• The foot may be shorter
• The calf muscles of the affected leg may be underdeveloped

What causes congenital clubfoot?

Congenital clubfoot, also known as talipes equinovarus (TEV) or congenital talipes equinovarus (CTEV), often appears with no apparent cause. Most cases of clubfoot are idiopathic, meaning that the cause of the condition is unknown.

Certain risk factors increase the incidence of congenital clubfoot in newborns, including:

• Skeletal abnormalities such as spina bifida
• Advanced maternal age
• Maternal smoking while pregnant
• Diabetes in the mother
• Low level of amniotic fluid in the womb
• Being male – Boys are twice as likely to be born with congenital clubfoot as girls
• Having a parent that was born with congenital clubfoot

Clubfoot types

Clubfoot is divided into three different types based on the cause of the condition: idiopathic, neurogenic, and syndromic.

Idiopathic clubfoot is the most common type of clubfoot. This refers to clubfoot with no apparent cause. One out of every 1,000 babies is born with idiopathic clubfoot.

Neurogenic clubfoot is caused by an underlying neurological condition such as spina bifida. Neurogenic clubfoot can also develop later in life in patients with cerebral palsy or spinal cord compression.

Syndromic clubfoot occurs along with other conditions that are related to the same underlying syndrome.

Syndromes associated with clubfoot

Syndromes associated with clubfoot include arthrogryposis, constriction band syndrome, tibial hemimelia, and diastrophic dwarfism.

Arthrogryposis – Also known as AMC, arthrogryposis is a term used to describe a number of different conditions characterized by stiffness in multiple joints. Types of arthrogryposis include Gordon syndrome and Freeman Sheldon syndrome.

Constriction band syndrome – Constriction band syndrome is a rare condition in which a fetus becomes entangled in the amniotic membrane, leading to deformities such as clubfoot.

Tibial hemimelia – Tibial hemimelia is a condition in which a baby is born with a tibia that is shorter than normal. Sometimes with this condition, the tibia is missing altogether.

Diastrophic dwarfism – Diastrophic dwarfism is a skeletal condition that affects cartilage and bone development and results in short stature.

Clubfoot treatment

Clubfoot generally causes no distress or pain in infants and produces no adverse effects until the child is learning to walk. However, doctors usually recommend that congenital clubfoot be treated as soon as possible after birth so that the baby is fully prepared to learn to walk when they reach the appropriate age. Clubfoot does not improve with growth. Treatment is necessary to restore the function of the affected feet and legs.

Clubfoot treatment happens in two phases – Ponseti casting and bracing

Ponseti casting involves a series of casts that slowly stretch and manipulate the clubfoot into proper position. The first cast is usually applied in the first two weeks after a baby’s birth. Every seven to 10 days, the cast is removed, the foot is further stretched and manipulated, and then a new cast is applied.

At the fourth or fifth casting appointment, an in-office procedure is done to lengthen the Achilles tendon. The baby is then placed into the final casting of treatment, which remains on for two to three weeks.

Once the baby’s final cast is removed, he or she will be fitted with a supramalleolar orthosis brace with a bar. This brace is necessary to maintain the correction that was accomplished with the Ponseti casting technique. This brace will be worn for 23 hours every day for approximately two months. After two months, the brace will be worn for 12 hours a day until the child reaches kindergarten age.

Clubfoot surgery

For children who are not well suited or do not respond well to the Ponseti casting and bracing method of clubfoot treatment, clubfoot surgery may be recommended to align the foot into a more normal position. Clubfoot surgery generally includes releasing and lengthening the short tendons that are causing the deformity.

Once the surgeon lengthens and releases the tendons in the clubfoot, the corrections are held in place by pins. These pins will be removed in the office between four and six weeks after surgery. Once the pins are removed, the patient’s foot will be placed in a cast for the following six to 12 weeks. After the cast is removed, some patients will need to continue to wear a brace for a certain period of time.

Prognosis for children with congenital clubfoot

After clubfoot treatment is fully completed, the affected foot should look, act and function like a normal foot. Children born with congenital clubfoot go on to participate in sports, dance, cheerleading, and other activities after treatment. No special footwear is required after the completion of clubfoot treatment.

Need a second opinion about your child’s clubfoot diagnosis?

For more information on congenital clubfoot, or to have your child evaluated for congenital clubfoot, please click on Get Started to reach one of our board-certified orthopedic specialists. BICMD’s nationwide network of orthopedic surgeons can help you decide which treatment is best for your child. Our physicians are top orthopedic doctors hand-picked from reputable organizations nationwide and are extremely skilled with congenital clubfoot cases.

Foot fractures are a common injury that can occur in patients of any age, from children to the elderly. Like all bone fractures, a foot fracture needs immediate, professional medical care to preserve the healthy function and movement of the foot. By knowing the symptoms of a broken foot, patients will be better equipped to know when to see professional foot fracture treatment.

1 in 10 broken bones are foot fractures

Looking at the anatomy of the foot, it’s easy to see why foot fractures are so common. In fact, one in ten broken bones occurs in the foot. The human foot consists of 26 bones, many of which are tiny and delicate, making them more prone to fractures. Combined with all the wear and tear that the human foot undergoes on a daily basis, it’s no surprise that foot fractures are such a common occurrence.

The anatomy of the human foot

The human foot is made of 26 bones. Any of these bones may experience a fracture.

• The hind foot is comprised of two bones: the talus, which connects the foot to the leg; and the calcaneus, also known as the heel bone.
• The mid foot is comprised of five smaller bones – the navicular, the cuboid, and three cuneiforms.
• The forefoot is comprised of 19 bones – five long metatarsals and 14 phalanges, which are the bones of the toes.
• Some people also have extra pebble-like bones in their feet called sesamoid bones. Sesamoid bones do not have any purpose and are commonly referred to as accessory bones.

Symptoms of a foot fracture

Like any bone fracture, the first step toward diagnosing a foot fracture is knowing what symptoms to look for in the time directly after the original injury. Though not all of these symptoms will occur in every case, experiencing at least one of more of these symptoms points to the possibility of a foot fracture.

Symptoms of a foot fracture include:

• Tenderness at the spot of the break
• Pain that increases with activity
• Swelling
• Bruising
• Throbbing pain immediately after the injury
• Difficulty walking
• Difficulty standing
• Difficulty bearing weight
• Deformity of the foot

Common Foot Fractures

5th Metatarsal Base Fractures – Fractures of the 5th metatarsal account for nearly 25 percent of all metatarsal fractures. Most 5th metatarsal fractures happen at the base of the bone, which is located near the middle of the foot. Common variations of 5th metatarsal fractures include the Dancer’s fracture and the Jones’ fracture.

In a Dancer’s Fracture, the ankle is rolled inward, causing the break. Jones’ fractures are most often caused by putting repeated stress on the foot, such as in patients who play sports.

LisFranc Fractures – LisFranc fractures are fractures of the midfoot. The midfoot is the location of the arch of the foot, and it consists of a cluster of small bones and ligaments. These small bones connect to the five metatarsals of the foot. LisFranc fractures may happen in conjunction with LisFranc injuries such as torn or damaged ligaments in the midfoot.

Calcaneus Fracture – The calcaneus, also known as the heel bone, may incur a fracture after a car accident or fall from a high place. Calcaneus fractures are highly painful and often require surgery to reconstruct the normal anatomy of the heel. Even with treatment, some severe calcaneus fractures can cause long-term pain and mobility issues.

Causes of foot fracture

Any time part of the foot is bent, twisted, crushed or stretched beyond its natural capacity, a foot fracture is likely to occur. Common causes of foot fractures include:

• Broken toes often occur after a hard kick, either on purpose as in playing a sport or accidentally such as while hiking and kicking a large rock. Accidentally ramming a toe into a large piece of furniture is a common cause of a broken toe.
• Broken heels are most likely caused by falling from a height and landing on the feet.
• Broken ankles often occur along with sprains, when the ankle is twisted or turned an unnatural angle or degree.
• Stress fractures can build up over time from repeated stress on the bones of the foot. Stress fractures are common in runners, dancers, soldiers, gymnasts and athletes. Stress fractures are particularly common when the level of intensity of movement increases greatly over a short amount of time, such as when a soldier first enlists and begins heavy physical training.

Foot fractures are more common in children than adults

In an adult foot, the bones are fully formed and are therefore stronger than the tendons and ligaments that surround them. In children, the opposite is often the case. Children’s still-developing bones are often weaker than the surrounding ligaments and tendons, so if an injury occurs, it is more likely to damage the bone than a ligament or tendon. An injury that would cause only a sprain in an adult is likely to cause a foot fracture in a child.

How are foot fractures diagnosed?

A foot fracture is most often diagnosed via x-rays, though many times, a physical examination is all that’s needed to diagnose a foot fracture.

During the physical examination, the physician may press on different parts of the patient’s foot to assess the patient’s pain level. The patient may also be asked to take a few steps so that the physician can appraise movement and pain level while the foot is bearing weight.

On rare occasions, imaging such as a CT scan, MRI or ultrasound may be required to accurately diagnose a broken bone in the foot.

Treatment for foot fractures

Seeking treatment for a foot fracture should be done right away to help the bone heal correctly, reduce pain, and prevent future problems such as long-term pain and mobility issues due to an incorrectly healed break.

Treatment for foot fractures depends greatly on the location of the break and how the bone is broken. Common treatment for foot fractures includes splints, boots, crutches, casts, and sometimes surgery.

The R.I.C.E. method is also used to treat foot fractures, either alone or in conjunction with the treatments listed above.

• Rest – Keeping weight off the affected foot will help it to heal faster.
• Ice – Icing helps to control inflammation around the break.
• Compression – Keeping the injury wrapped helps to control swelling.
• Elevation – Elevating the broken foot also helps control inflammation and reduces pain.

Surgery for foot fractures

For more complex breaks that could not be properly treated with only a cast, split or boot, foot fracture surgery may be required to set the bones and promote proper healing and long-term health.

Foot fracture surgery involves realigning the broken bones and securing them into place with pins, screws, wires or plates. Once the bones are moved into the proper position for healing, screws, pins or wires are used to keep the broken ends of the bones held together securely while the bone heals. After surgery, the foot is typically placed into a cast, splint or postoperative boot to stabilize the area while the bones are healing. Occasionally, a bone graft may be used to help new bone tissue grow into place to heal the break.

Looking for foot fracture second opinion?

BICMD’s nationwide network of board-certified foot fracture surgeons can help you decide which treatment is best for your foot fracture. Make your appointment today.

An inflammation of a thick band of tissue that connects the heel bone to the toes. The inflamed tissue runs across the bottom of the foot.

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This list contains some of our most commonly seen conditions, but it is by no means exhaustive. Our foot & ankle doctors handle the same wide variety of conditions that an in-person physician would.

No one should have to live with foot & ankle pain. Today’s advancements in orthopedic care have made it possible for many to live a pain-free life while maintaining full function.  A consultation with one of our knee experts is the first step on your path to recovery. Let us discuss the options that will work for you and your specific issue.  Our physicians are committed to helping you feel better.

Click on “Get Started” to reach one of our orthopedic telemedicine experts.