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Foot and Ankle

Ankle Sprain/ Instability

An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle.  Ligaments provide stability by limiting side-to-side movement.  The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved.  

 

Causes

Sprained ankles often result from a fall or a sudden twist. Symptoms Symptoms may vary in intensity, depending on the severity of the sprain.

 

Symptoms

May include: Pain or soreness Swelling Difficulty walking Stiffness

 

Diagnosis

A thorough history and examination is performed. X-rays are often ordered to determine the severity.

 

Treatment

Early treatment includes rest, ice, compression, and elevation. Physical therapy is initiated as soon as possible to promote healing and increase range of motion. Bracing helps control swelling, limit excessive movement and stabilize the ankle. Medications to reduce swelling and provide pain relief may be recommended.  

What is Chronic Ankle Instability?

Chronic ankle instability is a condition characterized by a recurring “giving way” of the outer (lateral) side of the ankle. This condition of develops after repeated ankle sprains.

 

Symptoms

People often complain of a repeated turning of the ankle, especially on uneven surfaces or when participating in sports. The ankle feels unsteady and there is persistent pain or tenderness.

 

Diagnosis

A thorough examination of your ankle is performed to check for tender areas, swelling, and instability. X-rays and MRI may be helpful in further evaluation.

 

 

 

 

 

 

 

 

 

Treatment

Treatment is based on the results of the examination and tests, as well as on activity level. Non-surgical treatment may include: Physical Therapy, bracing, and medication.  

 

In some cases, your doctor will recommend surgery based on the degree of instability or lack of response to non-surgical care. Surgery usually involves repair or reconstruction of the damaged ligament(s). Occasionally, a neighboring tendon is used to reinforce the repair. The length of your recovery will vary, depending on the procedure performed. Physical therapy is often required to regain full use of the ankle.

Ankle Arthritis (Ankle Fusion and Total Ankle Replacement)

What is a Ankle Arthritis?

The ankle joint is composed of the bottom of the tibia and the top of the talus, which is completely covered with cartilage to allow for smooth motion. The breakdown and eventual loss of cartilage in the ankle can produce swelling and pain, and may eventually result in deformity, loss of joint motion, and decreased ability to walk.

 

Causes

Osteoarthritis of the ankle develops as a result of a structural abnormality in the foot or ankle or as a result of abnormal mechanics. A previous ankle injury, most often, an ankle fracture can result in arthritis.

 

Symptoms

Pain and swelling Difficulty walking

 

Diagnosis

The affected ankle will be evaluated and x-rays and other imaging studies may be ordered.

 

Treatment

Early treatment may include medications, orthotics/bracing, steroid injections and physical therapy. In situations when the pain has progressed or failed non-surgical care, surgery may be considered. In severe cases, an ankle fusion or ankle replacement surgery may be recommended. Dr. Bevilacqua will consider a number of factors when selecting the procedure that is right for you.

Bunion (Hallux Valgus)

A bunion is often described as a bump on the side of the big toe. But a bunion actually reflects changes in the bony framework of the front part of the foot. Rather than point straight ahead, the big toe leans toward the neighboring toe and gradually changes the angle of the bones which produces the characteristic bump. Bunions are a progressive disorder and symptoms usually appear at the later stages.

 

Causes

Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to develop a bunion.  

 

Symptoms

May include: pain or soreness, inflammation, a burning sensation and possible numbness.  

 

Diagnosis

Diagnosis begins with a careful history and physical examination by your doctor. Bunions are readily apparent, however x-rays will allow your doctor to measure several important angles to help determine the appropriate procedure.  

 

Treatment

Early treatment includes: changes in shoe- wear, padding, activity modification, medications, icing, injection therapy or orthotic devices. If all conservative measures fail to control the symptoms, then surgery may be suggested. A variety of surgical procedures are available and they are designed to remove the “bump”, correct the changes in the bony structure of the foot, and correct soft tissue changes that may have occurred. The goal of surgery is the reduction of pain. In selecting the procedure, Dr. Bevilacqua will take into consideration the extent of your deformity based on x-ray findings, your age, your activity level, and other factors. The length of your recovery will vary, depending on the procedure performed. 

Achilles Tendinitis/ Rupture

What is the Achilles Tendon?

A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the "heel cord," the Achilles tendon facilitates walking by helping to raise the heel off the ground.

What is an Achilles Tendon Rupture?

An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity.

 

Causes

Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear.  Achilles tendon ruptures are most often seen in "weekend warriors" – typically, middle-aged people participating in sports in their spare time.   Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to rupture.  

 

Symptoms

May include: Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf.  A popping or snapping sensation.  Swelling and difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes

 

Diagnosis  

The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through a thorough clinical examination.  In some cases (chronic or neglected ruptures), however, an MRI or other advanced imaging tests may be ordered.

 

Treatment  

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

 

Non-surgical 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. Non-surgical 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. 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.  Physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve the range of motion of the foot and ankle.

Acute Achilles tendonitis

Is an irritation or inflammation of the large tendon in the back of the lower calf that attaches to the back of the heel. In some, the thin tissue surrounding the tendon (paratenon) gets inflamed as a result of rapid acceleration and deceleration of the foot. The condition is often present in individuals who overpronate (roll their foot inwards).

Treatment

Treatment of acute inflammation begins with rest, physical therapy, anti-inflammatory medicine, and at times, immobilization. If these measures do not fix the problem, surgery may be required to remove the inflamed lining of the tendon. 

 

Chronic Achilles Tendnosis

This chronic condition is associated with gradual degeneration of the tendon. The tendon and the leg is painful, and pushing off may be painful and weak. The Achilles tendon is visibly thickened and swollen.

 

Treatment

Treatment includes physical therapy, and may include immobilization of the leg in a walking boot. The treatment of this condition is difficult because there is limited potential for the tendon to heal due to the lack of good blood supply. Nonetheless, there are patients who can manage without surgery , even though the tendon remains abnormal, it may not be painful. If pain and weakness persist, surgery may be necessary to repair and reconstruct the tendon and occasionally, a neighboring tendon is used to reinforce the repair.