Most foot and ankle problems stem from wear and tear of daily life. But they may also arise from diseases such as diabetes, nervous system disorders or congenital defects, or from accidents and sports injuries.
At Mills-Peninsula Medical Center, fellowship-trained foot and ankle surgeons, orthopedic specialists and podiatrists offer a wide range of treatment options to reduce pain and improve mobility, including pain-relieving injections and specialized physical therapy. If you need surgery, we offer the latest techniques to correct persistent ankle and foot problems, including fusion, ankle replacement, ligament repair, cartilage regeneration, foot realignment procedures and more.
We treat many conditions including:
- Achilles tendon injury
- Ankle cartilage injuries
- Cavus foot
- Diabetic foot complications
- Flat feet
- Nerve pain
- Plantar fasciitis
- Sprains and strains
- Stress fractures
Arthritis can wear down the cushion of cartilage that lines joints in your ankle, hindfoot or midfoot. It can cause pain, stiffness, swelling and difficulty walking.
Many problems can cause ankle arthritis, including:
- Wear and tear (osteoarthritis)
- An immune system attack (rheumatoid arthritis)
- Trauma such as a fracture or dislocation
- Prior surgery or infection
We specialize in surgeries to minimize your pain and restore function and activity. We work closely with you, providing all the information you need to decide which procedure is right for you.
Total ankle replacement is similar to hip and knee replacement. It replaces a painful, arthritic joint with metal and plastic implants. Studies show that ankle replacements safely ease pain and maintain mobility in people with severe arthritis.
Fusion, or arthrodesis, removes arthritic joint surfaces and uses pins or rods to hold the bones until the joints fuse into one bone. This surgery reliably eases pain, but does result in some loss of motion in the ankle. Ankle fusion may also cause increased stress on adjacent joints, leading to arthritis in those joints 10 to 20 years later.
Distraction arthroplasty is a newer procedure that preserves the joint. It is most often used in younger people who want to prolong the life of their ankle joint before needing a joint replacement or fusion. The joint surfaces are pulled apart and held with an external fixator (Ilizarov technique) for several weeks. This helps give the joint cartilage time to heal, and may restore space to the ankle joint.
This arthroscopic surgery helps remove painful bone spurs, inflamed tissue, cartilage flaps or loose bodies in the early stages of ankle arthritis. Arthroscopy allows surgeons to work with a small camera and instruments inserted through tiny cuts. This surgery does not cure arthritis, but can provide years of pain reduction and improved function.
Fractures of the Ankle and Lower Leg
Fractures are breaks or cracks in the bone. Acute ankle fractures typically occur during a trauma, such as an accident or a twist. Stress fractures occur after overuse, when light or moderate force is repeatedly put on the bone. This can cause a fine crack in the bone.
Some ankle fractures heal easily in a cast or functional brace, while others require surgery. Regardless of the treatment, most bone fractures heal in six to 12 weeks.
During surgery the broken bones are repositioned and held in place by metal pins or screws. This is called open reduction and internal fixation.
Nonunions and Malunions
When a fracture does not heal in six to 12 weeks, it’s called a delayed union or nonunion. More time in a cast sometimes helps the bone finally mend, but typically surgery is required. This surgery often involves grafting bone onto the ankle and revising the original fixation with screws or pins. It may also require re-breaking the bone to correct the alignment so the ankle can heal properly.
Of all the long bones in the body, the tibia - your shinbone - is fractured most often. If it does not heal property, the shinbone can become misaligned.
To fix this problem, we use the Ilizarov technique to lengthen shortened bones, correct bone misalignment, and fill in areas of traumatic bone loss. Small pins and wires are put through the bone and attached to circular rings outside the leg. These rings are gradually moved farther apart, then held in place until bone has grown to fill in the gaps. The technique is often used with Taylor Spatial Frames to increase versatility and precision.
Ankle Fusion (Arthrodesis)
Fusion, or arthrodesis, removes arthritic joint surfaces and uses pins or rods to hold the bones until the joints fuse into one bone.
This surgery reliably eases pain, but does result in some loss of motion in the ankle. The loss of motion does not interfere with the daily activities of most people.
For decades, ankle fusion was the recommended surgery to treat ankle arthritis, and for many it still is the best choice.
However, ankle fusion may cause increased stress on adjacent joints, leading to arthritis in those joints 10 to 20 years later. Ankle replacement surgery is an alternative that puts less stress on adjacent joints.
For more information on considering or preparing for a joint replacement surgery, or to find out more about the Joint Center at Mills-Peninsula, please call the patient navigator at (650) 696-5522.
Ilizarov and Spatial Frame Techniques
The Ilizarov technique allows crooked or severely damaged bone in the lower leg and ankle to be straightened and lengthened.
Gavril Ilizarov developed the method in Russia more than 50 years ago. It’s used worldwide today, often with other devices such as the Taylor Spatial Frame.
The technique is based on the fact that bone naturally heals itself by growing, or regenerating. A deformed or short bone is broken, then positioned properly. Small pins and wires fixed through the bone connect to circular rings outside the leg. Over time, these rings are slowly moved farther apart. Bone grows in to fill the tiny gaps.
The Ilizarov technique can straighten misaligned bones and help repair complex fractures or bones that never healed properly.