Foot and ankle problems usually fall into the following categories:

• Acquired from improper footwear, physical stress, or small mechanical changes within the foot.
• Arthritic foot problems, which typically involve one or more joint.
• Congenital foot problems, which occur at birth and are generally inherited.
• Infectious foot problems, which are caused by bacterial, viral, or fungal disorders.
• Neoplastic disorders, usually called tumors, which are the result of abnormal growth of tissue and may be benign or malignant.
• Traumatic foot problems, which are associated with foot and ankle injuries.

Well, fractures can occur in feet because they have – are exposed to a number of sources of trauma.

For example, in cars, it’s the part of your body that’s no longer protected by air bags and so a lot of bad foot fractures come in as a result of that. We also see people who’ve fallen from height or had twisting injuries when they’ve been doing sport and so those are typically lower energy injuries, but a lot of those can also benefit from surgery.

There’s a number of bones in the feet that can be broken. I’m going to show you on a skeleton here. So this is the distal tibia and high-energy injuries often involve this area of the bone and it can collapse and cause arthritis of the joint.

So, in an injury that’s just happened we try and put this bone back in it’s anatomic position because it’s continuous of the ankle joint and if we don’t get the ankle joint completely restored into it’s normal position you’ll end up with pain and it’ll be difficult to get your mobility back again and you may require further surgery in the future.

The indication for surgery is if you have deformity in your foot or you have pain. And the

front of the foot needs to be straight to the ground. The back of the foot needs to be correctly placed underneath the long access of your leg and so all of it has to be straight  and it should be pain free.

After an injury, we can’t restore range of motion easily  because there’s so much stiffness and some of the time we’ve even got to take range of motion away so that you have a pain free foot.

The best way to look at the combination of pain against range of motion is if you wore your favorite sneakers and you put a pin in them you’d limp a lot and you wouldn’t go very far, but if you wore a pair of rigid hiking boots you’re going to walk a long way even though your foot’s not going to move much.

So the goal of surgery is to try and make sure that your foot is straight and that it is pain free, but the range of motion may not come back. And you do that once all other techniques have failed so once you’ve finished physiotherapy, and bracing, and shoe wear changes then you think about doing an operation.

So after an injury you may require a number of joints to be sorted out or a number of bones to be straightened out so sometimes after an injury the joints are destroyed.

It’s called post-traumatic arthritis and so we may end up having to make the ankle solid – do a fusion or make a fusion of this joint, or this joint, or this joint – the calcaneocuboid joint – and straighten the foot at the same time.

On occasion, we’ll also do fusions through this part of the foot. That is used both to get rid of arthritis, but also to get the foot straight so that once you finish your operation your painful joint should be gone and if the bones successfully knit together then your foot should be straight and less painful than it was.

So there are a number of other areas in the middle and the front of your foot that can benefit from plates and screws being put in or the bones correctly aligned at the time that you have the original injury within the first two or three weeks.

If you’ve had a bad injury to your foot or ankle and you have resulting pain and deformity there are a number of surgeries particularly more recently that can be helped by doing a later operation and it – and you can always talk to your physician and see if one of those operations might be applicable for you. Local Physiotherapist

Presenter: Dr. Alastair Younger, Orthopaedic Surgeon, Vancouver, BC

 Now Health Network Local Practitioners: Orthopaedic Surgeon