A bunion, medically termed hallux valgus, occurs when the big toe leans too far into the second one and causes a swelling on the side of the big toe joint. Forming on the base of metatarsophalangeal joint (MTP) of your big toe, a bunion is a bony bump that forces your big toe to grow abnormally big and stick out.

Bunions can be various sizes and some aren’t even particularly painful. However, it is possible for the big toe to put pressure on the second toe, causing what is known as a hammer toe. It is also possible for the first two toes to cross over, resulting in difficulty in walking.

Other than the noticeable bony bump on the base on the outside of your big toe, other symptoms of bunions include:

Soreness or redness surrounding the big toe joint.

Restricted and limited movement of the big toe.

Calluses and corns, which may develop when the first and second toe overlap.

Skin thickening around the big toe joint.

Bunions generally occur when the big toe leans too far over into the second toe. The area swells and as shoes begin to rub against it, and inflammation and pain results. Bunions tend to be genetic, therefore many people who suffer from the condition have a family history already.

Individuals who are prone to bunions should never wear tight footwear. It’s this factor that results in the condition being far more of an issue for females than males. Pointed-toe, tight, and high-heeled shoes are not the primary cause of bunions, however, they can be a contributing factor.

Other causes of bunions include muscle imbalances and foot injuries. Arthritis, especially inflammatory types, such as rheumatoid arthritis, may also be a causal factor in developing bunions.

A Pensacola foot and ankle specialist can identify a bunion by a physical examination. This physical examination may reveal a bony bump, redness, swelling, and limited range of motion, which are hallmark signs of bunions. An X-ray will show the extent of the bunion and whether there is any associated arthritis in the affected area.

Treatment options for bunions including conservative non-surgical treatments and surgery.

As many as 50 percent of all bunion sufferers do not require surgery. Non-surgical treatments aim to prevent the development of ulcers and pressure sores, as well as relieve pressure on the foot.

In many cases, purchasing new, well-fitting and comfortable shoes alleviates pain. A Pensacola orthopedic specialist can also prescribe an orthotic. This is a device inserted within footwear, which can prevent the condition from deteriorating.

Other non-surgical treatments include ice, rest, steroid injections, and medications, as well as taping, padding, and/or splinting.

For some, surgery is the only way to correct their bunions and restore proper function to the big toe. Surgical procedures for bunions correction may include:

Removals of swollen tissue surrounding the big toe joint.

Removal of part of the bone to straighten the big toe.

Straightening of the abnormal angle of the big toe.

Joining of the bones of the affected joint.

For many years, bunion surgery had the reputation of being incredibly painful. Nowadays, however, modern surgery is far less invasive and more sophisticated. Each patient undergoing bunion surgery is assessed on their lifestyle as well as on the extent of the deformity of their bunion.

The best approach in terms of outcome, therefore, is to have a multi-disciplinary team of specialists working in tandem in order to achieve positive and lasting results.

Since you carry most of your weight and your joint flexes while you walk with every step, walking becomes difficult and painful when you have a bunion. This worsens the bigger your bunion is.

Narrow, pointed or tight shoes can cause bunions. Avoid high heels, especially those that have heels higher than two inches. These types of shoes also put you at risk of forming bunions. Tight footwear can contribute to the swelling and pain of bunions. Those complaining of bunions, tend to be those wearing closed shoes.

If your bunion is causing you pain or is disabling you and you've already tried conservative treatments with no luck, you may need surgery. Your orthopedic surgeon may perform a bunionectomy if your bunions are mild. This is where your North Florida Bone & Joint Specialists - Ankle and Foot Center orthopedic surgeon shaves off any extra bone from your first metatarsal bone on its outside. They then realign your tendons, ligaments and muscles of your big toe.

If you have a moderately deformed bunion, your surgeon will likely cut your bone that's near your metatarsal head in order to place it into the correct position. Pins and screws will hold your bone in place while you're healing.

If your bunions are severe, your surgeon cuts the extra bone of the first metatarsal head away as well as the bone at your first wedge-shaped metatarsal base.

You may be seen by a podiatrist who practices podiatric medicine. They specialize in diagnosing and treating ankle and foot problems, including bunions. However, you may need to see an orthopedic specialist or surgeon, depending on the severity of your bunion.

To prevent bunions, being proactive is key. Learn your risk factors and if you have any mechanic issues with your feet.

Your podiatrist will analyze your foot, the wear pattern of your shoes and your stride if you're unsure if you have an issue. They'll then provide you with an honest evaluation.

Be sure you're making the right shoe choices. Women shouldn't wear footwear with high heels as much as possible. Ensure your shoes have a deep, wide toe box. Shoes shouldn't crowd or squish your toes. Purchase shoes that have rocker soles which will take the pressure off the area where your bunion is.

Regularly check your feet. Look for any swelling, redness or discoloration. Check for stiffness by flexing your toes. Call us if you notice any of these signs if they persist for several days.

Women commonly get bunions. People who wear shoes that are closed get bunions more than those who are barefoot. Arthritic diseases like RA and abnormal bone formation of your foot at birth are both risk factors. People who perform ballet tend to get bunions often.

Bunions may cause sores and blisters due to them rubbing against your shoe on the inside. If you don't have these wounds treated, they can become infected and even lead to life-threatening complications.

If you notice a bunion and treat it early, you can slow the deformity down or even stop it. Cold packs, rest and other palliative self-treatments are good. Large pharmacies or orthopedic shoe stores sell silicone bunion shields. While they don't correct the issue, they do relieve pain from bunions.

Bunions

Osteoarthritis is a type of arthritis that can cause pain and inflammation in any of the joints in the foot. Some of the common joints include the metatarsophalangeal joint, subtalar joint, or inter-joint. In total, your foot has 30 joints and 28 bones, so there are a lot of small areas of the foot as well as the ankle that can cause this condition. They might involve the joints closest to the toes, heel, ankles, or shins.

The main symptom of osteoarthritis in any part of the body, including the foot, is pain. However, depending on where the arthritis is located and how severe it is, that pain can anything from a dull throb to a severe ache or pinching-type pain.

When an arthritis joint becomes inflamed, you’ll often experience pain. You might notice that the pain starts very mildly, but gradually increases as you notice swelling and inflammation of certain parts of the foot. Some arthritis sufferers notice that the pain is worse in the morning after waking up and stepping on the floor for the first time.

In addition to tenderness of the foot, you might also notice swelling or stiffness in the joint. This can make it harder to move the foot, bear weight, and walk on it, both from the stiffness and the pain that this causes.

Walking, running, or doing other vigorous activities cause your pain to worsen. Having redness or warmth of the joints is also a prevalent symptom of osteoarthritis in the foot.

The most common cause of osteoarthritis of the foot is the aging process. It is known as a degenerative type of arthritis that occurs due to wear and tear of the joint. For this reason, it is more common in older adults. However, someone that is younger can also get the condition.

When the cartilage of the bone joints wears away, it causes the bones to rub together, leading to pain and inflammation. Other potential causes for osteoarthritis of the foot include:

For diagnosis of osteoarthritis of the foot, we begin with a physical examination and ask questions about your medical history. If you are an older adult or have relatives with osteoarthritis, diagnosis of this condition is typically a straightforward process.

To confirm the diagnosis, the doctor might want to perform X-rays of the foot. This might also include a weight-bearing X-ray to see how the joints and bones in the foot react. Some other imaging tests that help with the diagnosis process include CT and MRI scans.

The main goal of treating osteoarthritis in the foot is to reduce pain and get back proper movement. This is done with both non-surgical and surgical treatments.

Surgery, such as arthroscopic debridement, might be needed if the pain doesn’t subside.

Doctors may use an MRI test to determine if you have osteoarthritis and make a diagnosis. Once you've had an MRI, you'll go back to your orthopedist's office for a follow-up visit. During this visit, your doctor will go over your MRI results. If the MRI images show signs of osteoarthritis, they will give you a physical exam, go over your family history, review your symptoms and discuss treatment options.

Although OA affects a single joint, it involves other joints as it progresses. Sometimes, OA pain in one of your joints, such as your knee or ankle, can force changes in the way you stand, walk or move. It could even force your other joints like your spine or hip joints out of alignment.

Q: Why does osteoarthritis become worse over time and what causes that?

The release of degradative and debris enzymes can irritate your joints. The degradative enzymes produce more synovial fluid than normal to lubricate your damaged joint and dilute troublesome substances. When you have a flare-up of OA, lesions can get worse and persist if you don't rest the joint and receive treatment.

The main symptom of osteoarthritis is joint pain. Joint pain occurs when your affected area cartilage wears away and exposes the ends of your bones leading them to rub against one another. Other reasons OA can become worse include:

Increased pain sensitivity and lack of sleep

Q: Are osteoarthritis and rheumatoid arthritis the same?

They aren't the same thing. Osteoarthritis is a degenerative disorder developing due to extreme cartilage wear between your joints. Rheumatoid arthritis is an autoimmune disorder causing your immune system to attack a healthy body. RA affects your whole body, while OA only affects your joints.

Q: Why does osteoarthritis cause fatigue?

When you have OA, you typically need to put in extra effort to perform your basic everyday activities, which can make you feel tired. Also, cytokines (chemical mediators) cause inflammation leading to fatigue.

Q: Will osteoarthritis go away or is there a cure?

Although your OA doesn't go away, the pain associated with it can. You can treat the symptoms, but you should also realize that you don't necessarily need to treat OA's bony anatomy. If you treat the inflammation and your muscles are strengthened and stretched properly around your joints, your symptoms won't come back despite your bony anatomy remaining unchanged.

The only real way to change OA's bony anatomy is to change them surgically. This, however, will not provide a guarantee that future OA changes won’t impact your joints.

Research shows that combining standard OA therapies with a nutritional program just may reverse your OA. In fact, there is significant evidence of OA being completely reversible. There have been spontaneous human remissions reported. Long-term medications and intense physical therapy can stop juvenile chronic arthritis.

OA can limit joint motions and cause pain that's so severe it can be disabling. You may not be able to carry out your routine daily living activities like bending over, getting dressed or walking. However, most OA patients don't become disabled from the condition. And you can manage your OA and prevent future disability by exercising, losing weight and taking other steps.

Q: Why is osteoarthritis pain worse at night?

If you're experiencing night pain, it usually indicates how severe your OA is and if you need more treatment like surgery, for instance. Your pain may get more noticeable when you're not doing anything and you may have trouble getting to sleep. If pain wakes you up during the night, this could be an indication that your OA is at a stage that's more advanced.

Foot Osteoarthritis

The accessory navicular (os navicularum or ostibiale externum) is an extra bone or piece of cartilage located on the inner side of the foot just above the arch. It is incorporated within the posterior tibial tendon, which attaches in this area and can lead to Accessory Navicular Syndrome. An accessory navicular is congenital (present at birth). It is not part of normal bone structure and therefore is not present in most people.  

People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated. This can result from any of the following:

Chronic irritation from shoes or other footwear rubbing against the extra bone

Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular.

Signs & Symptoms of Accessory Navicular Syndrome

Adolescence is a common time for the symptoms to first appear. This is a time when bones are maturing and cartilage is developing into bone. Sometimes, however, the symptoms do not occur until adulthood. The signs and symptoms of accessory navicular syndrome include:

A visible bony prominence on the midfoot (the inner side of the foot, just above the arch)

Redness and swelling of the bony prominence

Vague pain or throbbing in the midfoot and arch, usually occurring during or after periods of activity

Diagnosis of of Accessory Navicular Syndrome

To diagnose accessory navicular syndrome, the foot and ankle surgeon will ask about symptoms and examine the foot, looking for skin irritation or swelling. The doctor may press on the bony prominence to assess the area for discomfort. Foot structure, muscle strength, joint motion and the way the patient walks may also be evaluated.  

X-rays are usually ordered to confirm the diagnosis. If there is ongoing pain or inflammation, an MRI or other advanced imaging tests may be used to further evaluate the condition.

The goal of nonsurgical treatment for accessory navicular syndrome is to relieve the symptoms. The following may be used:

Immobilization. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation.

Ice. To reduce swelling, a bag of ice covered with a thin towel is applied to the affected area. Do not put ice directly on the skin.

Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed. In some cases, oral or injected steroid medications may be used in combination with immobilization to reduce pain and inflammation.

Physical therapy. Physical therapy may be prescribed, including exercises and treatments to strengthen the muscles and decrease inflammation. The exercises may also help prevent  recurrence of the symptoms.

Orthotic devices. Custom orthotic devices that fit into the shoe provide support for the arch and may play a role in preventing future symptoms.

Even after successful treatment, the symptoms of accessory navicular syndrome sometimes reappear.  When this happens, nonsurgical approaches are usually repeated.

If nonsurgical treatment fails to relieve the symptoms of accessory navicular syndrome, surgery may be appropriate. Surgery may involve removing the accessory bone, reshaping the area and repairing the posterior tibial tendon to improve its function. This extra bone is not needed for normal foot function.

From:
 https://www.foothealthfacts.org/conditions/accessory-navicular-syndrome-(1)#:~:text=The%20accessory%20navicular%20(os%20navicularum,lead%20to%20Accessory%20Navicular%20Syndrome. 

Accessory Navicular Syndrome

A bunionette (also known as a tailor's bunion) is a painful bony prominence, or bump, on the outside of the little (pinky) toe. Over time, the bunionette may worsen as the little toe moves inward and the fifth metatarsal (the bone connected to it) moves outward. Rubbing between the bump and tight shoes may also cause a callus to grow over the area. All bunionettes can cause pain and pressure on the outside of the foot, though often they do not cause symptoms.

The initial treatment of a bunionette is non-surgical. This can include wearing shoes that are roomier with a wide toe box to avoid rubbing on the bony prominence. Padding the little toe using a toe sleeve may reduce discomfort as well.

If your bunionette is painful even after wearing wide, comfortable shoes, if you cannot wear comfortable shoes because of the size of your bunionette, or if you continue to have problems after non-surgical treatment, your foot and ankle orthopaedic surgeon may recommend surgery. The goals of this surgery are to remove the bony prominence and correct alignment to decrease pain. Surgery should be avoided if you have poor circulation or uncontrolled diabetes, if you are a chronic steroid user, or if you smoke cigarettes. These are risk factors for delayed healing of incision and bone.

Bunionette surgery is usually an outpatient surgery, meaning you can go home the same day as the surgery. It involves removing the bony prominence of the bunionette. In a larger bunionette that is causing an alignment problem, breaking the fifth metatarsal bone and restoring normal alignment may be necessary. Your foot and ankle orthopaedic surgeon will explain what kind of surgery is needed for you and why.

The type of surgery to correct the bunionette depends on the shape of the fifth metatarsal bone, type of bunionette, and patient's wishes. 

If you have a painful prominence without a bony growth, the surgery usually involves removing the painful soft tissue of the little toe. 

If you have a Type 1 bunionette, it means you have an enlarged bump at the outer end of the fifth metatarsal head (where the toe meets the foot). During surgery, this bony growth is removed. 

Sometimes the bony protuberance is so big that the bone of the fifth metatarsal needs an osteotomy, which means your surgeon will break the bone to realign it. The bone is cut and moved towards the fourth metatarsal to correct the alignment.    

If you have a curved shape to your little toe (Type 2 bunionette) or angle (Type 3 bunionette) between the fourth and fifth metatarsal, your surgeon will often do an osteotomy. This osteotomy is done to straighten out the fifth metatarsal. 

If a bunionette deformity is treated with an osteotomy, the bone may be held straight with a steel wire, screw, or plate and screws, depending on the surgeon's preference. 

Above: An X-ray image of a patient with a Type 1 bunionette

Below: An X-ray image of the bunionette after surgery. The patient was treated with an osteotomy, which was fixed with one screw.

After the surgery, patients may need to stay off their operated foot with no weight or heel weight bearing on it for a period of weeks. Patients will need to wear a post-surgical shoe or a short CAM boot on their foot to keep it protected after surgery. You may also need to use crutches or a walker depending on your activity level and pain. In severe deformities, some surgeons will place a short leg splint to better protect the surgical correction. The specific amount of time that your foot needs to be protected after surgery depends on the type of surgery and the surgeon's protocol. The operated foot will need to be elevated above the level of the heart as much as possible for at least the first few days. This will help to decrease swelling. 

Your stitches are usually taken out 2-3 weeks after surgery. You will be asked to not soak your foot or get the surgical area wet until your stitches are out.

Your foot and ankle orthopaedic surgeon may ask you to do knee and ankle exercises at home after surgery. This can help maintain your joint motion and flexibility. If your doctor thinks that you need physical therapy after the soft tissue and bone is healed, he or she will discuss that with you.

Swelling is the last thing to improve for most patients after bunionette surgery. It can take 6-12 months for your foot's swelling to completely improve after surgery.

All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

Potential complications after bunionette surgery are rare. Possible problems include bleeding from the wound, injured nerves around the little toe, poor wound healing or bone healing if an osteotomy is done, and the possibility of recurrence of the bunionette.

If my bunionette deformity is treated without surgery, can I ever wear high heels and pointed shoes?

Wear pointed-toe shoes as little as possible. This does not mean that you cannot ever wear these shoes, but you should limit the time wearing them in order to decrease pain and the chance that the bunionette will get worse.

If I'm treated with surgery, will the deformity come back?

Most bunionettes do not come back after being treated with the right type of surgery. The surgery should correct the underlying cause of the problem. However, wearing shoes that are too narrow can still cause irritation and inflammation at the operated little toe.

From https://www.footcaremd.org/conditions-treatments/toes/bunionette-deformity-correction 

Original article by Umur Aydogan, MD
 Contributors/Reviewers: Wen Chao, MD

Bunionette

A Pump Bump or Haglund's deformity is a bump in the back of the heel bone. The Achilles tendon runs over this bump. Patients with a Haglund's deformity may or may not have pain. Sometimes, people will have pain due to shoes rubbing against the bump. At other times the pain is related to degeneration in the Achilles tendon. It is not always clear how much of this Achilles tendon problem is due to the Haglund's deformity.

If prominence is the main issue, then the goal of Haglund's deformity surgery simply is to make the heel bone less prominent. If the Achilles tendon has degenerated as well, then the procedure may involve removing or repairing a portion of the Achilles tendon.

Patients should consider Haglund's deformity surgery if they don't get relief from non-surgical treatments such as medication, exercises, or changing shoes. Patients at high risk for wound issues should avoid this surgery. If the Achilles tendon is degenerative, there is a low risk of rupturing the tendon. You should discuss your options with your foot and ankle orthopaedic surgeon before proceeding with surgery.

This surgery is usually an outpatient procedure, meaning you can go home the same day as your surgery. General anesthesia or a nerve block at the knee to make the leg numb will be given. If the prominent bone is being removed, the surgeon does this by making an incision at the heel next to the Achilles tendon and then removing the prominent bone. If the Achilles tendon is degenerative, then the incision often is made in the midline, and the degenerative portion of the Achilles tendon is removed along with the prominent bone. Sometimes, a tendon is transferred to replace a portion of the Achilles tendon that cannot be repaired.

If the surgery consists of removing the prominent bone only, you will be in a splint for approximately two weeks. After that your sutures will be removed and you will be allowed to begin bearing some weight.

If the surgery involves repair of the tendon to any degree, then weight bearing may be delayed. A boot with a heel lift is used and physical therapy may be started at two to six weeks after surgery. Over the following weeks, you will take the lift out of the boot and then come out of the boot altogether.

The most significant complication with surgery in this area of the body is that sometimes the wound can be slow to heal. If the wound is slow to heal or does not heal, there may be infection requiring further surgery. 

How did I get this bony prominence in my heel?
 It is unclear what causes the bone growth in this area. The severity of the symptoms depend on the types of shoes people wear and the activities they perform. Some people may experience swelling related to the Achilles tendon or structures around the bone.

From https://www.footcaremd.org/conditions-treatments/heel/haglunds-deformity-surgery 

Original article by J. Turner Vosseller, MD / Last reviewed by Sudheer Reddy, MD

Pump Bump

The peroneal tendons are on the outside of the ankle just behind the bone called the fibula. Peroneal tendinosis is the name for the enlargement, thickening, and swelling of these tendons. This usually occurs with overuse, such as a repetitive activity that irritates the tendon over long periods of time. 

People with peroneal tendinosis typically have tried a new exercise or markedly increased their activities. Characteristic activities include marathon running or others that require repetitive use of the ankle. Patients usually have pain around the back and outside of the ankle. There usually is no history of a specific injury.

Improper training or rapid increases in training and poorly fitting shoes can lead to peroneal tendinosis. Also, patients who have high arches may be more susceptible because their heel is turned inwards slightly, which requires the peroneal tendons to work harder to turn the ankle to the outside. The harder the tendons work, the more likely patients are to develop tendinosis.

Tendons connect muscle to bone and allow them to exert their force across the joints that separate bones. Ligaments, on the other hand, connect bone to bone. There are two peroneal tendons that run along the back of the fibula. The first is called the peroneus brevis. The term "brevis" implies short. It is called this because it has a shorter muscle and starts lower in the leg. It then runs down around the back of the bone called the fibula on the outside of the leg and connects to the fifth metatarsal on the side of the foot.

The peroneus longus takes its name because it has a longer course. It starts higher on the leg and runs all the way underneath the foot to connect to the first metatarsal on the other side. Both tendons share the major job of turning the ankle to the outside. The tendons are held in a groove behind the back of the fibula and are covered by a ligament-type tissue called a retinaculum.

Your foot and ankle orthopaedic surgeon will take your history and perform an exam to make the diagnosis. Most patients with peroneal tendinosis will report overuse of activity, rapid increase in recent activity, or other training errors, along with pain in the back and outside of the ankle. During the exam, you may feel pain when the surgeon touches the peroneal tendons.

It is important to distinguish this from pain over the fibula, which might indicate a different problem. Pain on the fibula occurs directly over the bone. Pain in the peroneals occurs slightly further behind. You may also have pain when you turn the foot inside towards the middle of your body (inversion) and weakness when you try to bring the foot to the outside (eversion). Your surgeon also will look for varus alignment of the heel, which means that the heel is turned inwards.

X-rays for peroneal tendinosis usually are normal. Ultrasound is a very effective way to assess the tendons and can show an abnormal appearance or tear. An MRI also may show a tear. 

The vast majority of peroneal tendinosis cases will heal without surgery. This is because it is an overuse injury and can heal with rest. If there is significant pain, wearing a CAM walker boot for several weeks is a good idea. If there is no tenderness with walking, an ankle brace might be the next best step. You should limit how much you are walking or standing until the pain improves. This usually takes several weeks. After this period you can resume training, but very slowly and based on pain. For patients with varus alignment, an orthotic that tilts the ankle to the opposite side may help relieve pressure on the tendons. It is important to talk to your doctor about changing your training. This includes using new shoes for running or cross-training instead. Physical therapy also is very important to strengthen the tendons.

There is increasing use of platelet-rich plasma (PRP) and stem cell injections to assist with healing, however the research on this is limited. Steroid injections are not routinely performed due to the risk of causing complete rupture.

Your foot and ankle orthopaedic surgeon may recommend surgical treatment if the pain continues. Non-surgical treatment could last up to a year before considering surgery. If there is a tear, meaning a split that runs along the length of the tendons, your surgeon could consider repairing the tendon. Sometimes, making the groove in the back of the bone of the fibula deeper allows the tendons more space and can help as well. Finally, if the tendon is very diseased, your surgeon may need to resect the tendon and connect both the longus and brevis together. Only the specific tendon involved should be addressed. Occasionally, both may be involved and more complex reconstruction necessary.

Patients usually recover fully but this can take considerable time. You must be patient and allow the tendon to heal before going back to activity. If you need surgery, your recovery time may be substantial. You may be instructed not to bear weight for about six weeks. Your foot and ankle orthopaedic surgeon likely will order physical therapy once you're ready. 

In the case of surgery, as for all surgeries, there is a risk of developing an infection or wound complication. Nerve damage can occur, in particular the sural nerve, which runs along the outside of the ankle near the tendons and provides sensation to the outside of the foot.

What would happen if my peroneal tendinosis is not treated?

If the tendinosis is not addressed, your tendon can tear. Also, weakness of the tendons can lead to an ankle sprain or chronic ankle instability, which can cause damage to the cartilage inside the ankle joint.

What is the difference between tendinitis and tendinosis?
 With tendinitis, there is acute inflammation of the tendons. This usually happens directly after an injury for a short period of time or may be due to overuse. Tendinosis is a chronic process of pain and degeneration in the tendons that results in an enlargement and thickening of the tendon.

From https://www.footcaremd.org/conditions-treatments/ankle/peroneal-tendinosis
Original article by Scott Holthusen, MD / Last reviewed by Raymond Walls, MD, 2020

Peroneal Tendinitis

An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overpower the tendon and cause a tear. An injury to the tendon can also result from falling or tripping.

Achilles tendon ruptures are most often seen in "weekend warriors"—typically, middle-aged people participating in sports in their spare time that they normally wouldn’t do routinely. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.

A person with a ruptured Achilles tendon may experience one or more of the following: 

Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf—often subsiding into a dull ache

Swelling on the back of the leg between the heel and the calf

Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes       

These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the RICE method should be used. This involves:

Rest. Stay off the injured foot and ankle, since walking can cause pain or further damage.

Ice. Apply a bag of ice covered with a thin towel to reduce swelling and pain. Do not put ice directly against the skin.

Compression. Wrap the foot and ankle in an elastic bandage to prevent further swelling.

Elevation. Keep the leg elevated to reduce the swelling. It should be even with or slightly above heart level.    

In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear/rupture. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes.

The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests.

Treatment options for an Achilles tendon rupture include surgical and nonsurgical approaches. The decision of whether to proceed with surgery or nonsurgical treatment is based on the severity of the rupture and the patient’s health status and activity level.

Nonsurgical treatment, which is generally associated with a higher rate of re-rupture, is selected for minor ruptures, less active patients and those with medical conditions that prevent them from undergoing surgery. Nonsurgical treatment involves use of a cast, walking boot or brace to restrict motion and allow the torn tendon to heal.

Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient’s push-off strength and improves muscle function and movement of the ankle however carries inherent risks to surgery. 

Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient.

Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weight bearing. 

Complications such as incision-healing difficulties, re-rupture of the tendon or nerve pain can arise after surgery.

Whether an Achilles tendon rupture is treated surgically or non-surgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve range of motion in the foot and ankle.

From https://www.foothealthfacts.org/conditions/achilles-tendon-rupture 

Achilles Tendon Rupture

Osteoarthritis of the ankle is a type of arthritis that can cause pain and inflammation in the ankle. With 30 joints and 28 bones, the foot has a lot of small areas of the foot, including the ankle that can cause this condition. They might involve the joints closest to the toes, heel, or shins.

The main symptom of osteoarthritis in any part of the body. However, depending on where the arthritis is located and how severe it is, that pain can anything from a dull throb to a severe ache or pinching-type pain.

When an arthritis joint becomes inflamed, you’ll often experience pain. You might notice that the pain starts very mildly, but gradually increases as you notice swelling and inflammation of your ankle or other parts of the foot. Some arthritis sufferers notice that the pain is worse in the morning after waking up and stepping on the floor for the first time.

In addition to tenderness of the ankle, you might also notice swelling or stiffness in the joint making it more difficult to move the foot, bear weight, and walk on it, both from the stiffness and the pain that this causes.

Walking, running, or doing other vigorous activities cause your pain to worsen. Having redness or warmth of the joints is also a prevalent symptom of osteoarthritis in the ankle.

The most common cause of osteoarthritis of the ankle is the aging process. It is known as a degenerative type of arthritis that occurs due to wear and tear of the joint. For this reason, it is more common in older adults. However, someone that is younger can also get the condition. When cartilage of the bone joints wears away, it causes the bones to rub together, leading to pain and inflammation.

For diagnosis of osteoarthritis of the ankle, we begin with a physical examination and ask questions about your medical history. If you are an older adult or have relatives with osteoarthritis, diagnosis of this condition is typically a straightforward process.

To confirm the diagnosis, the doctor might want to perform X-rays of the ankle and foot. This might also include a weight-bearing X-ray to see how the joints and bones in the foot react. Some other imaging tests that help with the diagnosis process include CT and MRI scans.

The main goal of treating osteoarthritis in the ankle is to reduce pain and get back proper movement. This is done with both non-surgical and surgical treatments.

Research shows that combining standard OA therapies with a nutritional program just may reverse your OA. In fact, there is significant evidence around OA being completely reversible. There have been spontaneous human remissions reported. Long-term medications and intense physical therapy can stop juvenile chronic arthritis.

If you're experiencing night pain, it usually indicates how severe your OA is and if you need more treatment like surgery, for instance. Your pain may get more noticeable when you're not doing anything and you may have trouble getting to sleep. If pain wakes you up during the night, this could be an indication that your OA is at a stage that's more advanced

Ankle Osteoarthritis

Ankle instability or laxity is a condition in which the ankle has too much motion (“looseness”) and easily “gives out.” Other joints in the foot such as the subtalar joint (the joint directly below the ankle) may also be involved. Some people have looseness in multiple joints due to genetic conditions. In some instances, the ankle may give out even though the ligaments are stable. This is referred to as “functional instability” and may be due to other causes.

Patients with ankle instability have a variety of symptoms. Commonly, they complain of their ankle twisting easily, especially on uneven ground or during activities that involve turning or changing direction quickly, such as basketball. As the ankle ligaments become chronically damaged, you may actually experience less pain with these twisting episodes as it takes less energy (and injury) to roll the ankle.

Chronic instability may cause the ankle bones to move excessively with daily activities. Some patients, particularly after modifying their activities, will have fewer sprains but continue to have pain. Changes to the ankle’s stability even without recurrent injuries can cause pain. 

The most common cause of ankle instability is recurrent ankle sprains. While most ankle sprains heal with non-operative treatment, repeated sprains may cause the ligaments to heal stretched-out and lose their ability to provide stability.

There are multiple ligaments in the ankle. Ligaments in general are the structures that connect bone to bone and act like rubber bands. Tendons, on the other hand, connect muscle to bone and allow the muscles to exert force on their associated bones. In the case of an ankle sprain, there are several commonly sprained (torn) ligaments. The two most important are the following:

The anterior talofibular ligament (ATFL), which connects the talus to the fibula on the outside of the ankle.

The calcaneal fibular ligament (CFL), which connects the fibula to the calcaneus.

There is a third ligament that is not torn as commonly. It runs more in the back of the ankle and is called the posterior talofibular ligament (PTFL). 

These types of injuries are often called low ankle sprains. This is different than a high ankle sprain, which is a more severe type of ankle sprain involving ligaments that connect the tibia (long bone on the inside of the leg) to the fibula (bone on the outside of the leg).

If a patient has a high-arched (“cavovarus”) foot, this can predispose them to repeated ankle sprains. Furthermore, this foot shape puts the peroneal tendons — which help support the ankle ligaments — at risk for tearing and weakness.

A foot and ankle orthopaedic surgeon can diagnose ankle instability by studying your medical history and performing a physical exam. During the exam, your surgeon will test the strength and motion of your joint. They will perform tests to check how loose your ankle is. They may order standing X-rays to check for any ankle arthritis or changes in your bone alignment that may have developed due to the instability. Stress X-rays may be used to show the amount of looseness present. While an MRI doesn’t show ankle looseness, it can be helpful to rule out other associated problems such as cartilage damage and tendon tears.

Your foot and ankle orthopaedic surgeon will determine the best course of treatment based on your pain and limitations on your day-to-day activities.

If you have modest instability with no other symptoms, you may not need surgery. Non-surgical treatment options include bracing of the ankle for "at-risk" activities (such as running, basketball, volleyball, and other jumping sports) and rehabilitation, either on a self-directed program or with a physical therapist. Rehabilitation consists of muscle strengthening, Achilles stretching, and balance training.

Based on your symptoms and your surgeon’s findings from the exam, surgery may be recommended. Surgery usually consists of either a procedure to tighten the existing ligaments or one that uses a separate tendon graft to reconstruct the ligaments. If you have a high arch or other deformities (cavovarus and/or cavus deformity), your surgeon may also recommend realigning the foot with additional procedures to decrease the risk of instability coming back after surgery. Ankle ligament reconstructions generally have a high success rate.

If you have surgery, there will be a period of immobilization in a cast or fracture boot, followed by a transition into a brace. Rehabilitation consists of strengthening and balance training. The length of recovery depends on the type of procedure you had done. Full recovery can take up to six months although most patients are able to resume many activities much sooner.

Risks from surgery include persistent pain or recurrent instability. This may happen despite proper reconstruction of the ligaments.

Usually, this happens because you have had many ankle sprains and your ankle ligaments are not functioning properly anymore. Sometimes weak muscles or an underlying foot deformity can be contributing causes. If your ankle gives out repeatedly, you may have chronic ankle instability. Talk to your foot and ankle orthopaedic surgeon to discuss your treatment options.

What will happen if I don’t have surgery?

If you do not have surgery, your ankle will likely continue to roll and you will be at increased risk for developing ankle arthritis. Ankle arthritis is a painful condition that potentially could require ankle fusion or ankle replacement surgery later on.

Will a brace and physical therapy make my ankle stable?

While bracing doesn’t strengthen the ankle ligaments, physical therapy and bracing may help your ankle feel more stable and prevent sprains if you have mild/moderate instability.

Will stem cells fix my ankle instability?

Stem cell therapy is not an evidence-proven effective treatment for ankle instability.

From https://www.footcaremd.org/conditions-treatments/ankle/ankle-instability  

Ankle Instability

Tendons connect muscles to bones and stretch across joints, enabling you to bend those joints. One of the most important tendons in the lower leg is the posterior tibial tendon. This tendon starts in the calf, stretches down behind the inside of the ankle, and attaches to bones in the midfoot (middle of the foot). 

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