Column: Good Health Begins with Your Feet

By Elizabeth Cody, MD

Good foot health is essential for an active life, helping ensure balance, posture, mobility and overall well-being. But many people don’t think about their feet until a problem arises, whether it’s an injury or chronic pain.

I treat all kinds of injuries and conditions of the foot and ankle, including fractures, sprains, ankle instability, foot/ankle deformities, Achilles tendon injuries, arthritis and bunions.

The pandemic has led to more foot problems, which I’ve seen in my practice. Many people have been spending more time at home barefoot, which puts added strain on the ligaments and tendons that support the arch and ankle. Others are going for long walks and runs after months of limited activity. We’re seeing rising numbers of foot and ankle injuries among young athletes who train more intensely for sports.

Here are some of the most common foot and ankle conditions I encounter among patients and recommended treatments.

Flatfoot Deformities

Flatfoot deformities occur when the foot gradually loses its arch and the bones progressively flatten. These deformities are caused by the shape of a patient’s bones. Sometimes patients are born with a flatfoot, and other times it develops or worsens over time. Over a lifetime of activity, the ligaments and tendons that hold the foot bones in place can become strained and start to fail. The breakdown of these restraints causes bone collapse, leading to foot deformities that worsen over time.

For treatment, we almost always begin with a non-operative approach. This can include arch supports for shoes, supportive footwear, bracing, and physical therapy. A period of rest and avoiding exacerbating activities is also usually recommended.

If conservative treatments don’t help, we turn to surgical options. Surgery for a flatfoot problem is usually major, since it involves cutting and re-aligning the bones of the foot. Patients need to stay off the foot for six weeks and full recovery can take up to one year.

Foot/Ankle Arthritis

Arthritis is the loss of cartilage in a joint, which leads to restricted range of motion (stiffness), pain, and sometimes swelling. You can develop arthritis in the ankle or any of the other many joints in the foot and toes. Most people with arthritis have had it for a long time before it bothers them. If your parents had foot arthritis, you’re more likely to have it, too. Ankle arthritis is most often found in people who have had an ankle fracture or who have a history of many ankle sprains. However, there are many other conditions and injuries that can lead to arthritis.

Initial treatments aim to calm the inflammation and pain by limiting motion in the affected joints with supportive shoes or a brace. Injections and anti-inflammatories can help ease pain as well. Surgery is a last resort when other treatment options have failed.

Ankle Replacement Surgery

Ankle replacement surgery is a good option for those who have bad ankle arthritis that is no longer responding to conservative treatment. Surgery replaces the damaged bone in the ankle with implants made of titanium and cobalt chrome. A plastic (polyethylene) insert goes in between the metal components to allow for gliding motion that is similar to normal ankle motion.

Ankle replacement will not provide you with a new, normal ankle, but it is usually very successful at relieving pain and allowing return to low-impact activities such as walking, golfing, and cycling. Most patients can put some weight on the foot right away in a cast and are typically walking in a sneaker by six weeks after replacement surgery.

The Truth About Bunions

Most people think of bunions as a bony growth on the inside of the foot. However, the “bump” of a bunion is actually just a normal bone that has gradually shifted out of alignment so that it is abnormally protruding. You correct the bunion by putting the bones back in alignment, not just by shaving down the bone. Bunions are primarily caused by genetics, but your shoes and past activities can also play a role.

There are many different types of bunion surgery. One of the more recent innovations is minimally invasive bunionectomy, which uses small incisions to realign and straighten the affected bones. While this surgery allows for faster recovery, not all patients are good candidates for it. For more severe bunions, other types of surgery may be more likely to help long-term. After almost any bunion surgery, there is a chance of the bunion coming back, because the bones can still drift out of alignment again. The only bunion surgery that can guarantee your bunion will not come back is a fusion of the big toe joint (the metatarsophalangeal joint). However, this leads to loss of motion.

Because every bunion is different, there is no “one size fits all” option. Surgery is only recommended for painful bunions. If you are interested in correcting your bunion, you should have X-rays performed and discuss your options with an experienced surgeon.

Elizabeth Cody, MD, is an assistant attending orthopedic surgeon at HSS Orthopedics with Stamford Health, specializing in foot and ankle surgery.

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