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Foot and Ankle Care

Foot and Ankle Pain

Bunions are a hereditary enlargement of the big toe joint in the foot. Often present in both feet, one can be larger or more painful than the other. Bunions don’t necessarily hurt, but typically become more prominent and painful with age. Bunions can often be associated with calluses and rubbing against shoes. High heels or pointed shoes do not cause bunions but they do exacerbate the condition. When bunions become severe and an arthritic condition develops, surgical intervention is recommended. A medical exam is necessary to determine the severity, type, and treatment options and surgical procedures are patient specific. 

Ankle Pain: Ankle pain may be caused by stress fractures, tendonitis, synovitis, or ankle sprains and sometimes pain in the ankle can be caused by a dysfunction of the foot. A medical exam is necessary to determine the best treatment option for ankle pain.
Hammertoes: Hammertoes are contractures of the toes which often causes calluses or corns that become painful. This problem tends to worsen over time and causes pain in shoes.

Heel Pain: Heel pain can present in various forms, however the most common type is most painful in the morning and at the end of a work day. It is called plantar fasciitis in medical terminology and it involves inflammation of the ligament that attaches to the heel bone. Various non-surgical treatment methods are available although sometimes surgery is performed.

Metatarsalgia/Neuroma: Pain on the ball of the foot is referred to as metatarsalgia. This can be attributed to various causes and an evaluation is necessary to assess the pain. A neuroma is an inflamed and enlarged nerve in the ball of the foot which can also cause pain.

Flat Feet/High Arches: These conditions are also hereditary. The treatment for this condition is very patient-specific. Oftentimes a custom-made shoe insert called an orthotic will help alleviate the symptoms.

Skin and Nail Problems: Most foot and ankle skin and nail problems are easily treated with topical medications. These include warts, calluses, ingrown toenails, athlete’s foot and toenail fungus. The resolution of these problems depends on their severity.

Procedures for Foot and Ankle Pain

Bunion Surgery: There are five major types of bunion surgery with minor variations within the procedures themselves.

  • Austin Bunionectomy: This is the most common type of bunionectomy involving cutting the first metatarsal bone at the "head" and fixing the cut with a screw. There are other names for this type of bunionectomy including tricorrectional, chevron, etc. Typically, patients are able to put some weight on the heel of the operated foot immediately post-operatively.
  • Lapidus Fusion: This procedure is typically reserved for the more severe bunions and involves fusing the first metatarsal bone to the medial cuneiform bone. Recovery from this surgery is much more prolonged, requiring strict non-weight bearing with a cast for 6-8 weeks after surgery.
  • Fusion (arthrodesis) of big toe joint: Fusion of the bunion joint is for severe osteoarthritis.
  • Keller Bunionectomy: Removal of part of the big toe joint. This procedure is performed mostly in older patients.
  • Silver Bunionectomy: Simple shaving of the bunion "bump." This procedure can only be done in minor bunion cases.

Ankle Arthroscopy: Ankle arthroscopy is a minimally invasive procedure that typically involves two one centimeter incisions at the level of the ankle joint. Arthroscopy is a very useful surgery to "clean up" a joint, to explore a joint for diagnostic purposes, and also can be performed to put off a larger ankle surgery.

Hammertoe Surgery: Hammertoe surgery is typically divided into three types. The most common is arthroplasty which involves removing the knuckle, or the joint of the toe. Arthrodesis involves fusion of the knuckle joint. Arthrodesis involves pinning the toe for 4 weeks.

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900 Hyde St
San Francisco, CA 94109
(415) 353-6000