Foot and Ankle

Mid-substance Achilles Tendon Tear

The Achilles tendon, also known as the calcaneal tendon, is a tendon at the back of the leg, and the thickest in the human body. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcaneus (heel) bone.

Acute mid-substance Achilles tendon ruptures are an increasingly common injury among athletic patients that can lead to significant functional limitations and decreased quality of life

Haglund’s Deformity

Haglund’s deformity is a bony bump that appears on the back of the heel bone. This bump forms where the Achilles tendon attaches to the heel. The condition often needs treatment if it causes pain or walking problems.

Treatments for Haglund’s deformity may initially include shoe modifications and physical therapy. If these do not relieve pain, a doctor may recommend surgery to remove the bony ridge or repair the Achilles tendon.

People also refer to the condition as Haglund’s syndrome or “pump bump.” The term “pump bump” followed doctors observing that women who wore high-heeled pump shoes had the condition.

Experts now know that Haglund’s deformity can happen to anyone, and pumps and other shoes are not necessarily exclusively to blame.

Anterior TaloFibular Ligament & Calcaneo Fibular Ligament

Ligament tears in the ankle represent the more severe forms of ankle sprains. These often occur in high energy ankle injuries such as car accidents, falls, significant sports injuries and ankle dislocations. These may also occur with ankle fractures as well.

The most common and significant ligament tears include tears in the Anterior TaloFibular Ligament (ATFL), CalcaneoFibular Ligament (CFL), and the large Deltoid ligament complex. These are the primary ligaments for ankle joint stability and when significant injury occurs to them, ankle joint instability, pain and dysfunction will occur.

The diagnosis of these injuries is made based on a physical examination to evaluate each ligament and an MRI. Typically these injuries (in the absence of a surgical fracture being present) can be treated with immobilization and a course of physical therapy. The type of immobilization, length of immobilization and length of physical therapy required will depend upon the specific ligaments that are injured and the extent of the injury to each. If the ligaments do not heal sufficiently by this method, then they typically will require a surgical reconstruction (replacement) of the damaged ligaments if symptoms from instability persist.

Deltoid & Spring Ligaments

Acute deltoid rupture is a relatively uncommon injury in isolation. Deltoid ligament ruptures are associated with ankle fractures with up to 40 percent of ankle fractures having an associated deltoid ligament injury apparent on arthroscopic examination.

Injury to the deltoid ligament can be a source of persistent pain or develop into a longstanding pronation deformity. Complete deltoid rupture is sometimes present in association with bimalleolar fractures and lateral malleolar fractures.

The plantar calcaneonavicular (spring) ligament  is a broad and thick band of fibers, which connects the anterior margin of the sustentaculum tali of the calcaneus to the plantar surface of the navicular.

The plantar calcaneonavicular ligament helps to maintain the medial longitudinal arch of the foot, and by providing support to the head of the talus, bears the major portion of the body weight

Plantar Plate

The plantar plate is a fibrocartilaginous structure that lies directly plantar to the lesser metatarsal heads and acts as a sesamoid-like mechanism for each lesser metatarsophalangeal joint (MPJ) of the foot. At its proximal aspect, the plantar plate is attached to the deep slips of the plantar fascia (i.e. central component of the plantar aponeurosis) and functionally, we may consider it to act as a distal extension of the plantar fascia. At its distal aspect, the plantar plate inserts onto the base of the proximal phalanx of the lesser digits via tightly interwoven collagen bundles. The dorsal surface of the plantar plate, which is slightly concave, is in direct contact and congruous with the plantar articular cartilage of each lesser metatarsal head.

Tibialis Anterior/Posterior

The tibialis anterior is a fusiform muscle found in the anterior part of the leg. Lying superficially in the leg, this muscle is easily palpable lateral to the anterior border of the tibia.

This muscle acts as the main foot dorsiflexor on the talocrural joint, but it also inverses the foot at the subtalar joint. Both actions play important roles in the gait cycle.

The tibialis posterior muscle is a relatively small muscle located within the back side of the calf. It is also the most centrally located muscle in the leg, arising from the inner borders of the fibula and tibia on the posterior (rear) side. The muscle’s tendon runs down behind the medial malleolus (bony protrusion on the inside of the ankle) and ends by segregating into the main, plantar, and recurrent portions.

The primary function of this muscle is to provide stability to the lower leg. It also facilitates foot inversion and aids the ankle’s plantar flexion. Additionally, the muscle performs a key role in providing support to the foot’s medial arch.

Hallux Varus Deformity

Hallux varus can develop due to several reasons. These include a congenital deformity, a tendon problem or some sort of trauma. The most common symptom is pain due to the toe rubbing against the inside of a shoe. It can also lead to an increased chance of ingrown toenail development.

Many children have hallux varus, typically because their abductor hallucis tendon (which attaches to the big toe) is either tight or too short. This tendon should work in concert with the adductor hallucis tendon and keep the big toe straight. However, if the abductor hallucis is too tight, it will overpower its counterpart. As a result, the big toe will be pulled out of position.

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