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Wall Toms River Freehold

Treatments

The foot and ankle are complex. Together they have 26 bones, 33 joints, and over 100 muscles, ligaments, and other tissues. Any one or a combination of these areas can be subject to damage, defect, wear and tear, or disease. Dr. Shane M. Hollawell, DPM, FACFAS, is extensively trained in a comprehensive range of the most advanced techniques and technologies available. He can treat foot and ankle conditions stemming from work-related injuries, athletic injuries, accidents, arthritis, and other events. His patient-focused approach emphasizes conservative methods foremost, helping you regain strength and function in less time and with greater comfort than ever before.

If you have additional questions about our foot and ankle treatments, or if you’re ready to schedule a consultation with Dr. Hollawell, please contact our practice today.

Achilles Tendon Injuries

Tendinitis of the lower extremity is very common, as all tendons of the foot and ankle are load-bearing tendons and are under constant repetitive stress. There are different stages and degrees of tendinitis. Early recognition and treatment can lead to a more timely response to the symptoms of tendinitis. If symptoms of tendinitis continue to progress or are left untreated, it is likely that a period of rest from activity, immobilization, bracing, and/or physical therapy may be necessary to improve the condition.

Tendinitis symptoms take many forms; most commonly swelling, pain, and weakness can occur. If those symptoms progress and if activity continues, particular tendons may be at risk for a tear or outright rupture. If a tear or rupture occurs to a tendon of the foot or ankle, a period of immobilization may be necessary, and surgery may be indicated to return the tendon back to its proper length and normal strength.

Ankle Sprain

An ankle sprain is by far the most common joint sprain in the entire body. The anatomic structure of the outer (lateral) ankle predisposes the joint to inversion sprains, which occur when the foot rolls inward and the leg and ankle roll or buckle outward. There are varying degrees of severity of ankle sprains. The severity of sprain often dictates the treatment and timeliness of response to the injury.

A grade 1 sprain is considered fairly mild and consists of a stretching of the ligaments. This condition typically can be treated with a brace and a short period of rest. A grade 2 sprain is considered a partial tear of the injured ligaments and requires a longer period of rest or immobilization, as well as physical therapy. A grade 3 sprain is the most severe and consists of a tear of one or more ligaments. Treatment may consist of casting, a prolonged period of protective weight bearing, bracing, and physical therapy. In some instances, surgical repair of the injured ligaments is indicated if the stability of the ankle does not return to normal.

An undertreated ankle sprain or injury that does not respond to conservative treatment can lead to chronic ankle instability and weakness. An individual can repetitively sprain the ankle with sports or even routine activity. On occasion, a chronically unstable untreated ankle can lead to development of arthritis of the ankle joint. If chronic ankle instability develops, then surgical intervention can be very helpful in restoring the strength and stability of the ankle back to pre-injury status.

Arthritis

Arthritis of the lower extremity most often occurs after a traumatic injury such as a fracture or dislocation. Arthritis can also occur as a result of genetic predisposition, which is referred to as primary arthritis. It can also be caused by an inflammatory condition such as rheumatoid arthritis, prolonged, repetitive action, poor biomechanics, or a combination of factors.

Symptoms of arthritis can be often treated with anti-inflammatory medications, activity modifications, shoe wear modifications, orthotics, bracing, corticosteroid injections, and physical therapy.

Structural or permanent joint changes that occur as a result of arthritis can be successfully treated with surgery in the form of joint arthroplasty (replacement) or joint arthrodesis (fusion). When possible, spurring or bone fragments can be removed to provide pain relief.

Bunion

A bunion deformity is an abnormal joint condition of the first metatarsophalangeal joint. A bunion condition often involves several components. Typically, there is increased bone formation on the medial (inner) aspect of the first metatarsal head and deviation of the great toe toward the direction of the second toe. The big toe may rotate in more severe conditions, leading to the condition known as hallux abducto valgus. Additionally, joint range of motion may become restricted and/or painful.

The severity and symptoms of a bunion often determines the recommended treatment. Typically, the less severe bunion or joint deformity, the greater potential to improve symptoms with conservative treatment such as orthotics, injection, anti-inflammatory medication, temporary modification of activity, and shoe wear.

In cases of more severe deformity, surgical treatment may be indicated in the form of realignment osteotomy and soft-tissue balancing procedures. Often bunion/hallux abducto valgus deformity will progress or worsen with time, regardless of conservative treatment. Surgical treatment most times can provide durable pain relief and long term joint correction.

Flatfeet

Flatfoot is a condition characterized by a decrease in the height of the longitudinal arch of the foot. It is often accompanied by a malpositioned or everted (moving away from the center) heel/calcaneus. This change in heel position can potentially lead to further changes of the foot. Pes planovalgus (medical term for flatfeet) is often termed a condition of hyper or over pronation. This excessive pronation can lead to a painful, weak, and progressively widening foot. Flatfoot can be caused by several conditions, and in an adult it is often characterized by having a weak posterior tibial tendon. The posterior tibial tendon is an arch-supporting tendon on the inner/medial aspect of the foot, which crosses the ankle joint.

Flatfeet can occur in all age groups. A pediatric flatfoot often responds favorably to custom-molded orthotics and conservative treatment. In some cases, adult acquired flatfoot can be treated similarly and with physical therapy. Anti-inflammatory medications and, in some cases, corticosteroid injection may be appropriate if the condition is recognized and treatment is sought in earlier stages.

If flatfoot symptoms worsen and the foot position deteriorates further, surgical treatment can be very helpful. This usually involves realignment osteotomy and soft-tissue balancing. In severe cases, a combination of osteotomy, arthrodesis/fusion, and soft-tissue balancing through tendon transfer, lengthening, and/or repair may be recommended.

Fractures & Dislocations

Fractures of the foot and ankle are fairly common skeletal injuries. Many fractures can be treated without surgery. However, when a fracture is displaced or a joint is dislocated, such as in certain ankle fractures and higher-energy foot fractures, then surgical treatment in the form of open reduction and internal fixation is often indicated.

Open reduction and internal fixation means gaining access to the fracture or dislocated bone and/or joint, re-establishing the anatomic/normal alignment, and placing bone screws or a combination of screws and plates to maintain the corrected alignment of the joint and/or bone.

Often open reduction and internal fixation will allow for earlier weight bearing and rehabilitation with certain fracture dislocation types. After surgery, a short period of immobilization in the form of a cast or splint is followed by a walking boot or brace and a course of physical therapy.

Hallux Limitus/Rigidus

This is the second most common condition or ailment of the foot, behind a bunion deformity. It is often characterized by arthritic changes of the first metatarsophalangeal joint and presents with pain, swelling, and loss of range of motion of the first metatarsophalangeal joint.

This condition can be caused by a prior traumatic injury, poor biomechanics of the foot, or simply a general propensity to form joint arthritis or a combination of factors. This arthritic condition is often progressive, similar to a bunion deformity.

Hallux limitus/rigidus treatment options can include non-surgical treatment such as injection, anti-inflammatory medication, orthotics, and temporary modification of activity. Surgical treatment may be recommended in certain situations, and may take the form of cheilectomy/joint cleanup/removal of arthritis, arthroplasty (joint replacement), or arthrodesis (fusion) to resolve the condition and the associated symptoms. A successful surgical procedure can significantly improve one’s function and overall activity level.

Hammertoe

Hammertoe is a condition in which the lesser toes contract or take on a clawed appearance. This can be due to an imbalance in a number of tissues and is a progressive disorder. If left untreated, the plantar plate (cartilage-like ligament structure that stabilizes the metatarsal-phalangeal joint) may tear. Pain, weakness, and difficulty walking or exercising can result. This concern can be treated with taping, injection, anti-inflammatories, orthotics, and surgical correction. An operation can involve direct reattachment and repair of the plantar plate, joint realignment, and straightening of the digits/toes.

Lisfranc Sprains & Fractures

Lisfranc sprains occur less frequently than ankle sprains. However, they can develop via a similar mechanism or an entirely different mechanism and often occur while participating in a sport or via a motor vehicle accident. The injury involves a sprain through the mid-portion of the foot, specifically at the tarsometatarsal joint complex. It is a large joint comprised of multiple small joints. A portion of the Lisfranc joint can be injured or the entire joint can be injured collectively.

Treatment consists of a period of rest, possibly non-weight bearing, followed by protected weight bearing and a course of physical therapy. Symptoms may take multiple weeks or beyond to improve. The injury may take a longer period of time to recover from than a standard ankle sprain.

An athlete may take an extended period of time to return to his or her sport after a Lisfranc injury. A custom-molded orthotic may be indicated in cases where refractory symptoms such as pain or weakness of the midfoot persist.

On occasion, when symptoms persist in spite of conservative care, surgical intervention can be performed in the manner of stabilizing the Lisfranc joint or fusing a joint of the Lisfranc complex. Surgical correction can improve the persistent symptoms of pain and weakness and can allow the individual to return to pre-injury activity.

Nerve Abnormalities

There are many nerves of the lower extremities. Motor-related nerves provide muscle power and sensory-related nerves provide sensation to the skin and tissue. Typical abnormalities of nerve dysfunction of the foot and ankle occur most commonly in the form of neuropathy, neuroma, or tarsal tunnel of the ankle, which is similar to carpal tunnel.

Tarsal tunnel symptoms are typically caused by injury, compression, varicose veins, and other unknown causes.

A Morton’s neuroma is a very common nerve abnormality of the foot caused by compression, pinching, and/or abnormal biomechanics.

Often caused by diabetes, the symptoms of a neuropathy are typically characterized by numbness, tingling, a burning sensation, and/or pain. Weakness is common when the condition becomes more advanced.

Diagnosis of nerve pathology can often be confirmed with electromyogram nerve conduction velocity studies, ultrasound, or MRI.

Sciatica nerve symptoms can also present in the foot and ankle with symptoms such as shooting pain. In more advanced cases of sciatica where disc herniation occurs, it can lead to muscle/tendon weakness, where one can develop a drop foot.

Treatment of these nerve disorders can often be relieved with conservative measures in the form of offloading to the area, orthotics, braces, improved biomechanics, injection, anti-inflammatory, rest, and physical therapy. Surgical treatment in the form of nerve release, and/or neurectomy may be recommended if symptoms remain unresolved in spite of conservative management. Tendon transfer can be helpful in certain cases of drop foot.

Osteochondral Injuries

Osteochondral injuries often occur alongside a sprain, such as in the ankle. An osteochondral defect is an injury to the cartilage and the underlying bone. There are different degrees of osteochondral injury. Lesions (damage) can be minor and superficial, deep and cystic, or even a complete separation of fracture from the larger body of bone.

Osteochondral injuries are often treated with casting or rest, and avoidance of impactful activity for a period of time. Treatment is often followed by a course of physical therapy, and bracing.

If symptoms persist, surgery can be very helpful in the form of arthroscopy, direct repair of the osteochondral fracture, and/or replacement of the osteochondral defect. The extent of recovery varies based on the repair or reconstruction of the osteochondral defect.

Surgery can be very helpful in restoring the normal architecture of the injured area, while simultaneously promoting a feeling of greater joint stability. Significant or complete resolution of any pain associated with the defect can be achieved with successful surgery.

Plantar Fasciitis

Plantar fasciitis is a condition of inflammation along a ligament-like tissue, which is located on the undersurface of the foot. The attachment is on the heel/calcaneus and it inserts into the heads of the metatarsals and base of the lesser toes. The typical area of irritation and inflammation occurs in the medial or center arch area, near the attachment of plantar fascia upon the calcaneus.

Treatment often consists of stretching, icing, avoidance of barefoot walking, supportive shoe wear, orthotics, corticosteroid injection, and/or physical therapy. Fortunately, the majority of symptoms of plantar fasciitis resolve with conservative treatment. Extracorporeal shockwave therapy and growth factor type injections can be helpful in refractory cases. However, in rare circumstances where symptoms persist beyond conservative treatments, surgical intervention may be indicated in the form of a partial plantar fascial release.