You will walk thousands of miles during your lifetime. This is the reason that you need to wear proper footwear and avoid shoes that are too loose, too tight, or unsupportive. Uncomfortable shoes that do not fit properly can cause stress on the feet, ankles, lower legs, hips, and spine. Pain and injuries result from this ongoing pressure, and this can alter your sporting activities, work duties, and hobbies. Simply wearing appropriate shoes that fit your feet, body, and lifestyle can prevent many foot-related disorders and injuries.

Types of Shoes

• Children’s Shoes – Infants need only booties and socks in the first months of life. However, as the infant begins to walk upright, shoes are necessary to prevent injury and should be worn outside of the house at all times. For toddlers, a sneaker or soft-soled shoe is appropriate. These shoe types allow the child to develop the muscles and ligaments around the ankle that help with balance and foot stabilization. Be sure the toe box is wide enough for the toes to wiggle.

  A finger’s breadth of extra length allows for around 3 to 6 months of growth. Since young children’s feet grow fast, you should check the fit of your child’s shoes periodically. Signs that the shoes are too small include difficulty putting the shoes on and the child wanting the shoes off.

• Women’s Shoes – Wearing high heels with a narrow toe box causes deformities like corns and hammer toes, knee pain, bunions, and lower back pain. An ideal women’s shoe is one that has a square, wide toe box with a heel that is lower than two inches. If you must wear higher heels, choose a shoe with a platform under the toe box to decrease the overall stress on the foot pad.

• Men’s Shoes – Leather soled shoes are more stable and durable. A softer-soled shoe is often better if you walk long distances on a regular basis.

• Sandals – Many people prefer to wear sandals in warm weather. These shoes do not offer much stability and foot support. If you must wear sandals, choose a pair that has straps that secure around the ankle. Make sure the sandal has a cork midsole rather than a rubber sole, as these provide more support. Specially designed sandals for hiking and rafting have supportive arches and are good choices.

• >Athletic Shoes – There are many good brands of athletic shoes available. Choose one that allows flexibility and optimizes stability to minimize injury and improve performance.

• Rocker Sole Shoes – These shoes have a thick sole that curves upward at the toe and heel. Many find that wearing rocker sole shoes reduces arthritis pain in the heel or ball of the foot. You should avoid these types of shoes if you have balance difficulties or an unsteady gait.

Shoe Buying Recommendations

• To decrease the risk of developing foot problems, choose a shoe that conforms to the shape of your foot.
• If you have problems with swelling, purchase shoes toward the end of the day when your feet are the largest.
• Try on shoes to avoid purchasing ones that do not fit. Shoe size varies from brand to brand and style to style.
• Have your foot measured each year. Adult feet can grow and change with age. Make sure you are standing when you have your feet measured, as your body weight expands your foot size.
• Make sure there is a ½ inch space between your longest toe and the tip of the shoe. Also, do not wear shoes that are too long for your feet to avoid blisters and pain.
• Try your shoes out before buying them by walking around on different surfaces. Be sure that they are a comfortable fit before you leave the store.
• Do not purchase a shoe that requires stretching or pads to keep your feet from slipping.

Shoe Quality

The stability of a shoe is related to the material from which it is made. Leather shoes are considered sturdy and durable whereas mesh and other man-made materials often lose their shape and do not provide support. Shoes are divided into upper and lower parts. The upper section includes the toe box, the heel counter, and the vamp. The lower section consists of the insole, the shank, the midsole, and the outsole.

• Toe Box – This is the front area where the toes rest. Choose a shoe with a roomy toe box, especially if you have hammertoes or crossover toe.
• Vamp – This section covers the top of the foot and may be closed with snaps, laces, or fabric. The vamp should be snug to hold the foot firmly in place but loose enough to avoid pain and numbness.
• Heel Counter – This is the back of the shoe where the heel rests. A stiff counter is best, as it provides control and stability. People with pronated flat feet should choose shoes with a stiff counter.
• Insole – This is the area inside the shoe where the main part of the foot rests. Some shoes have removable insoles to provide more flexibility.
• Shank – This is the area under the arch of the foot. A stiff shank allows for more support for your foot.
• Midsole – The material that sits between the top area of the shoe and the outer sole is the midsole. Soft material should be used for the midsole to provide shock absorption.
• Outsole – This area is the hard bottom of the shoe. Choose a shoe where the outsole conforms to your foot.

Types of Athletic Shoes

• Running Shoes – Running shoes are grouped into three categories. Cushioned running shoes (also called neutral shoes) are made for the runner with high-arched, rigid feet. These shoes have a cushioned midsole made up of ethylene vinyl acetate. Stability running shoes provide support to the arch.These shoes are best for the pronator runner. Motion control running shoes are designed for severe pronators. These shoes support flat feet and heavier body weight. To determine if you are a pronator or a supinator, have a professional evaluate your feet.
• Barefoot Running Shoes – These specially designed shoes are made for those who prefer running without shoes, or barefoot running.
• Cross Trainers – These shoes are designed to take you from sport to sport. Good cross trainers are made of a combination of leather, fabric, and mesh materials.
• Walking Shoes – These provide shock absorption, have a smooth tread, and allow for stability in the arch.
• Court Shoes – These shoes are specially made for tennis, basketball, and volleyball. Court shoes are made of soft leather with a solid tread.
• Hiking Shoes – These shoes provide stability for walking across uneven surfaces. Most hiking shoes have a cushioned insole and good tread.

What are Bunions

A bunion is a bump that forms at the joint of the big toe that is made up of bone and soft tissue. This abnormal bony mass forms when your big toe pushes against your other toes, making the big toe joint go in the opposite direction. This abnormal position causes the toe joint to enlarge, and this crowds your other toes and leads to pain. This deformity is also known as hallux valgus.

What causes bunions?

Tight-fitting narrow shoes and high heels can cause bunions. When a bunion forms, the big toe joint grows in size and protrudes outward. The skin over this toe gets tender and red, and bursitis or arthritis may occur. Bunions can also develop from foot injuries, and sometimes are congenital in nature.

Several factors increase your risk of developing bunions:

High heels – Wearing high heels can overcrowd your toes and can lead to bunions.
Ill-fitting shoes – People (particularly women) who wear shoes that are too tight, too narrow, or too pointed are at risk for bunion formation.
Arthritis – Pain from arthritis could alter the way you walk and lead to bunions.
Heredity – An inherited structural foot defect can cause bunions.

What is an adolescent bunion?

An adolescent bunion forms at the base of the large toe and affects girls aged 10 to 15 years of age. Unlike the adult bunion, the teen can move the affected joint normally but has pain wearing certain shoes. Treatment involves having the child’s shoes stretched or buying wider-sized shoes. Surgery is almost always avoided until growth is complete.

What is a bunionette?

A bunionette is a swollen, painful lump on the outside of your foot near the base of your small (fifth) toe. Also called a tailor’s bunion, bunionettes have a hard corn and painful bursitis. Just like bunions, bunionettes are caused from wearing ill-fitting shoes. For those cases of persistent pain and deformity, surgical correction is necessary.

Nonsurgical Treatment for Bunions

Most bunions are treatable without surgical intervention. If the bunion causes you to have difficulty walking, the orthopedic specialist will recommend special shoes, avoidance of certain shoe types, padding and taping, shoe inserts, and/or medications.

• Changing Shoes – The orthopedic specialist will recommend comfortable, roomy shoes with adequate space for your toes. These special shoes will conform to your foot shape as well as have a wide instep, broad toes, and soft soles.
• Avoiding Shoes – Treatment involves avoidance of pointed shoes, tight-fitting shoes, and high heels.
• Padding and Taping – Your doctor will show you how to tape and pad your foot to hold it into normal position. These measures reduce stress on the bunion and relieve pain.
• Shoe Inserts – Padded shoe inserts help redistribute the pressure evenly to reduce your symptoms. In addition, these devices may prevent your bunion from getting worse. Some people also find relief with the use of over-the-counter arch supports.
• Medications – Our orthopedic specialists recommend acetaminophen (Tylenol), ibuprofen (Motrin), or naproxen (Aleve) to control bunion pain

Bunion Surgery

When your bunion causes you to have difficulty walking and persistent pain exists, the orthopedic specialist may recommend surgery. Bunion surgery realigns the bone, tendons, ligaments, and nerves so your big toe is in the correct position. Surgery is typically done on a outpatient basis using ankle-block anesthesia. The reasons for bunion surgery include:

• Chronic large toe inflammation and swelling that does not improve with conservative treatment
• Severe pain that affects walking and everyday activities
• Toe stiffness and inability to straighten or bend the toe
• Toe deformity with a drifting in of the big toe

What are the types of bunion surgeries?

Our orthopedic specialists use different surgical approaches to treat bunions. These procedures include:

• Arthrodesis – This is the removal of the damaged joint surfaces and insertion of wires, screws, or plates to hold the joint together as it heals. This measure is used for those with severe arthritis.
• Osteotomy – This procedure involves the cutting and realignment of the joint.
• Repair of the Tendons and Ligaments around the Big Toe – The structures around the big toe could be causing the toe to drift toward the others. This procedure, often combined with an osteotomy, shortens the loose tissues and elongates the tight ones.
• Exostectomy – This technique involves the removal of the bump on the toe joint and is used only when there is no drifting of the large toe.
• Resection Arthroplasty – The orthopedic specialist will remove the damaged part of the joint. This is mostly used for those who have had previous surgery that failed or for those with severe arthritis.
• MIS Bunion Surgery – Minimally invasive bunion surgery
. This surgery involves small “pokehole” incisions that can be as small as a few millimeters as opposed to the larger incisions associated with more traditional bunion correction techniques. Special instruments and x-ray’s are used to perform surgery.

What is involved in the recovery process?

Your recovery will be successful if you follow your orthopedic specialist’s instructions the first few weeks following your procedure.

• Bearing Weight – Your doctor will advise you to use a cane, crutches, or walker after your surgery. You will be allowed to gradually put weight on your foot as it heals.
• Dressing Care – After surgery, you will have bandages holding your toe in position. Also, you will wear a special surgical shoe or cast to protect your foot. The sutures are removed approximately two weeks after the procedure. To allow proper healing, you should keep your dressings dry and clean. The doctor will advise you on changing the bandages.
• Swelling and Shoe Wear – You should keep your foot elevated for the first week following surgery, and ice is recommended to relieve pain and swelling. Expect your foot to have swelling for about six months.
• Exercises – To strengthen your foot, the orthopedic specialist may recommend particular exercises. The doctor could also prescribe a course of physical therapy for you.
• Medications – The doctor may prescribe antibiotics and pain medications following your procedure. The antibiotics are used to prevent infection. It is important that you follow the instructions and complete this medication.

Ankle Sprain

An ankle sprain can happen to anybody: athletes or non-athletes, children or adults, men or women. An ankle sprain involves ligaments that have been stretched beyond their normal position. The ligaments are structures that hold the bones of the ankle and joint in alignment, and they protect the ankle from abnormal twisting, rolling, or turning.

These elastic ankle components become sprained when there is actual tearing of the fibers. Recurrent sprains can result in long-term joint damage with pain and weakness. Proper treatment of an ankle sprain is necessary to prevent ongoing ankle problems.

What causes ankle sprains?

The ankle gets sprained when you make a fast, shifting movement with your foot planted on the ground. Many times, the ankle rolls outward while the foot turns inward, causing the ligaments on the outside to stretch and tear. The ligaments on the inside of the ankle can be injured when the ankle rolls inward as the foot goes outward. Any movement that causes the ligaments to stretch beyond their normal capacity causes an ankle sprain.

How is an ankle sprain diagnosed?

Ankle sprains are “graded” by our orthopedic specialists as mild (grade 1), moderate (grade 2), or severe (grade 3). With a grade 1 sprain, there is only slight stretching of the fibers with minimal damage to the ligament. With a grade 2 sprain, there is partial tearing of the ligament and laxity (looseness) of the ankle joint. An ankle sprain is a grade 3 when there is a complete tear of the ligament.

If you suspect you have an ankle sprain, see our doctors to be properly evaluated. He may order X-rays or an MRI. Also, doctors diagnose ankle sprains based on your injury history, the appearance of the ankle, and other physical examination techniques.

How is an ankle sprain treated?

If you have a sprained ankle, proper treatment and care is necessary for it to heal correctly. Most ankle sprains only need rest in order to heal while others require casting, a special splint or boot, or even surgery.

For a grade 1 ankle sprain, you should use R.I.C.E (rest, ice, compression and elevation):

• REST – Don’t walk on your ankle for a specified amount of time. Use crutches to get around.
• ICE – Apply ice wrapped in a soft cloth to the ankle. Do this for 20 minutes, four or five times a day to reduce swelling and ease pain.
• COMPRESSION – Use an ace-wrap type of dressing to immobilize the ankle and give it support.
• ELEVATE – Raise your ankle above the level of your heart. This is especially useful during the first 48 hours after the injury.

If your doctor tells you your sprain is a grade 2, the RICE method should be observed. Also, this level of injury takes more healing time. In addition, the orthopedic specialist may use a device to splint or immobilize your ankle while it heals. Grade 3 sprains are often associated with long-term instability.

While surgery is rarely necessary, a short leg cast or brace could be required for around three weeks. To prevent chronic ankle problems, the doctor may order physical therapy, ultrasound, or electrical stimulation.

A Grade 3 sprain can be associated with permanent instability. A short leg cast or a cast-brace may be used for two weeks to three weeks. If your ankle does not heal with conventional nonsurgical treatment and persistent instability exists, the orthopedic specialist may recommend surgery.

Reconstructive surgery involves repair of the torn ligament and grafting with other ligaments. Arthroscopic surgery is done when the doctor needs to look inside the joint for loose bone fragments or pieces of cartilage.

How does the ankle sprain resolve?

Ankle sprains recover in a stepwise method with three phases:

1. Phase 1 – resting and protecting the ankle while reducing swelling (one week)
2. Phase 2 – restoring range of motion, flexibility, and strength (one to two weeks)
3. Phase 3 – gradually returning to normal activities (weeks to months)

Ankle Fractures Causes, Symptoms, and Treatment

Ankle injuries are among the most common of the bone injuries. An ankle fracture is also known as a broken ankle. These types of fractures occur when one or more of the ankle joint bones separate into pieces. It is typical for the ankle ligaments to be damaged with an ankle injury. The types of ankle fractures and injury we cover include lateral malleolus fracture, medial malleolus fracture, posterior malleolus fracture, bimalleolar fracture, and trimalleolar fracture.

Ankle Anatomy

The ankle consists of three bones that come together: the tibia (shin bone), the fibula (small lower leg bone), and the talus (a foot bone). The medial malleolus is the inner portion of the tibia. The posterior malleolus is the back portion of the tibia. The lateral malleolus is the end of the fibula. The syndesmosis is the joint between the fibula and tibia, which connects together with ligaments.

Cause of Broken Ankles

Broken ankles occur in all age groups. They come about when there is twisting or rotating of the ankle during a fall or impact of a car accident. Many refer to this type of injury as a “rolled” ankle.

Symptoms of a Broken Ankle

A severe ankle sprain feels the same as a broken ankle. Common complaints include immediate, severe pain, bruising, tenderness to the touch, swelling, inability to bear weight, and a deformity of the ankle. For severe ankle fractures, the bone may protrude through the skin.

Diagnosis

Because it is difficult to tell a sprain from a fracture, our orthopedic specialists recommend an evaluation by x-ray. Depending upon the type of fracture the surgeon finds, he may order a “stress x-ray” for further evaluation. In some cases, the surgeon orders a computed tomography (CAT scan) or magnetic resonance imaging (MRI) for further evaluation.

Lateral Malleolus Fracture Treatment

A lateral malleolus fracture is a fracture of the fibula bone. Since there are different levels at which the fibula can be injured, the treatment depends on the severity.

Nonsurgical Treatment – When lateral malleolus fractures are not out of place, the surgeon will treat these without surgery. The surgeon places you in a short leg cast or other device for protection. Depending on the injury, you will not be able to put weight on the affected leg for 4 to 6 weeks, meaning you will have to use crutches.

Surgical Treatment – For lateral malleolus fractures that are out of place, the orthopedic specialist will perform surgery on the injury. To make the ankle stable, he uses a plate and screws or screws and a rod. These attach to the bone fragments to realign the fibula so it can heal properly.

Medial Malleolus Fracture Treatment

A medial malleolus fracture can also involve injury to the fibula, the posterior malleolus, and the ankle ligaments. Just like the lateral types, the orthopedic specialist treats medial malleolus fractures according to their severity.

Nonsurgical Treatment – If the fracture is in alignment, it can be treated without surgery. The doctor put you in a removable brace or short leg cast to be worn for 4 to 6 weeks. The doctor recommends crutches also for a period of time.

Surgical Treatment – The surgeon will perform a procedure if the medial malleolus fracture is unstable and out of alignment. If the injury includes impaction of the ankle joint (damage to the cartilage surfaces), the surgeon will sometimes apply bone graft to repair it and decrease later risk of arthritis development. Many different techniques are used for this type of surgery.

Posterior Malleolus Fracture Treatment

A posterior malleolus fracture is a break in the back of the shinbone near the ankle joint. These types of fractures often include ligament damage. Many times with a posterior malleolus fracture, a lateral malleolus injury occurs.

Nonsurgical Treatment – Like other ankle fractures, fractures that are in alignment can often be treated conservatively without surgery. The orthopedic specialist will place you in a short leg cast or other device and recommend crutches for 4 to 6 weeks.

Surgical Treatment – Surgery is necessary when the bones are not in proper position, and the break is serious. The surgeon can use screws and plates along the back area of the shinbone to hold the bones in place while they heal.

Bimalleolar Fracture Treatment

“Bi” simply means two. When fractures are bimalleolar, this means that two or more parts of the malleoli of the ankle are involved. These injuries typically involve the lateral malleolus and the media malleolus. Bimalleolar fractures are not stable, as they are also often associated with ligament damage. Many times, there is a break of the fibula along with other structure damage.

Nonsurgical Treatment – Bimalleolar fractures require surgery. However, if you have significant health problems, the surgeon will not operate and recommend conservative treatment. The doctor uses a splint or short leg cast to stabilize and protect the injury. Also, you will not be able to bear weight on the ankle for 4 to 6 weeks.

Surgical Treatment – Because of the complexity of these types of fractures, the orthopedic specialist may combine surgical techniques in order to repair the various structures. Often times, a plate and screws are used to align bone fragments. Also, it may be necessary for the surgeon to use bone graft in bimalleolar fractures.

Trimalleolar Fracture Treatment

“Tri” means three. Trimalleolar injuries involve all three malleoli of the ankle. These types of fractures are unstable injuries and dislocation is common.

Nonsurgical Treatment – Unless you are in considerable poor health, the orthopedic specialist will recommend surgery for trimalleolar fractures. However, if you cannot undergo surgery, the surgeon will place your lower leg in a cast or removable device for stabilization and place you on crutches.

Surgical Treatment – These types of fractures are complex and require a combination of surgical efforts for repair. The surgeon will often use plates and screws, bone grafting, and other techniques during the procedure. Because dislocation is common, the doctor will have to properly align the bone and ligaments.

Clavicle Fracture

The collarbone is also called the clavicle. A fracture to this bone is a common injury that occurs in people of all ages. Most breaks to the clavicle occur in the middle portion. The clavicle is located between the ribcage and the shoulder blade. This structure connects the arm to the trunk of the body and lies above several important blood vessels and nerves. These vital body components do not usually become injured with a clavicle fracture.

What causes clavicle fractures?

The collarbone gets broken when there is a direct blow to the shoulder. This can occur during a fall onto the shoulder or during a motor vehicle accident. A fall onto an outstretched arm can also lead to a fracture of the clavicle. Many infants are born with a fracture to the collarbone – an injury that occurs during a traumatic birth.

What are the symptoms of a clavicle fracture?

If you sustain a clavicle fracture, it will most likely be very painful and hard to move your arm. Other symptoms include:

• Shoulder sagging downward and forward
• A deformity or “bump” over the area of the break
• Inability to lift the arm without pain
• Bruising, swelling, or tenderness over the clavicle
• A grinding sensation when the arm is raised up

How is a clavicle fracture treated?

With some breaks, the ends of the bone have not shifted out of place and line up correctly. These types of fractures do not require surgery, and the orthopedic specialist can treat them with conservative measures.

These include the use of an arm support or sling (worn to keep the arm in proper position while the bone heals), mild pain medication, and physical therapy. Therapy is done to increase muscle strength in your shoulder and to prevent stiffness and weakness of the muscles.

The orthopedic specialist will recommend surgery if the bones are displaced (out of place) and do not line up correctly. During the procedure, the bone fragments are situated into their normal alignment and held that way with special screws and plates that are attached to the outer surface of the bone.

These structures are not removed until after the bone has healed. Some surgeons use pins to hold the fracture in proper position once the bone ends are put back in alignment.

AC Separation

The acromioclavicular joint (also called the AC joint) is the area where the clavicle meets the highest point of the shoulder blade. An injury to this structure that is common is an AC separation, where a force causes the ligaments that attach to the underside of the clavicle to tear.

What causes an AC separation?

The most common reason for a person to suffer an AC separation is a fall directly onto the shoulder. The force causes the ligaments to be injured and the collarbone separates from the wingbone (shoulder blade). This type of injury will cause the wingbone to move downward with the weight of the arm, creating a bulge above the shoulder.

How is an AC separation treated?

If the shoulder is not seriously deformed, and the AC separation is mild, the orthopedic specialist will recommend nonsurgical treatment modalities. These include the use of a sling, cold packs, and pain medications. Most people will return to full activity once the injury has healed without permanent, significant deformity.

If the pain of AC separation persists with conservative treatment, or the tears to the ligaments are severe, the orthopedic specialist will recommend surgery. This is done to trim back the end of the clavicle so that it will not rub against the shoulder blade. This procedure can be done long after the injury has occurred, too.