Injections and Other Procedures

The goal of amputation is to remove unhealthy tissue and create a remaining leg that is less painful and more useful. Just like many reconstructive orthopaedic surgeries, the surgical goal is to improve a patient’s pain and function. Amputation can improve quality of life for many patients.

Brisement is the injection of fluid into the space between a tendon and its lining, or sheath. This procedure breaks up scar tissue and stimulates healing of a tendon. While most commonly used for the Achilles tendon, brisement can be performed in any tendon of the foot and ankle.

The Charcot Restraint Orthotic Walker, or CROW, is a rigid boot designed to accommodate and support a foot with Charcot neuroarthropathy (CN).

CROW consists of a fully enclosed ankle/foot orthotic with a rocker-bottom sole. It is a common treatment used to minimize further deformity and prevent ulcer development after acute CN has calmed down.

Distraction arthroplasty is a distraction (stretching out) of the ankle joint. The ankle is held in this distracted position for a period of time. This technique is used to unload the ankle joint and allow healing of the damaged joint. It may be recommended for a patient who has ankle arthritis.

Shock wave therapy is a non-invasive method that uses pressure waves to treat various musculoskeletal conditions. High-energy acoustic waves (shock waves) deliver a mechanical force to the body’s tissues.

A ganglion is a cyst that forms on top of a joint, ligament, or tendon. The cyst is filled with fluid. Because the ganglion is not cancerous and may disappear in time, if you do not have symptoms such as pain, your doctor may recommend observation only to make sure that no unusual changes occur.

The gastrocnemius and the soleus are two muscles that make up the calf. The gastroc is the larger and more superficial of the two muscles. The soleus is a deeper muscle within the lower leg. The gastroc tendon combines with the soleus tendon to form the Achilles tendon.

Many patients have questions about the hardware that is used in foot and ankle surgery. If you are having foot or ankle surgery, ask your physician if you will need implants like those discussed below.

A joint injection is a procedure your doctor uses to introduce medication into a joint. The injection is done under sterile conditions using a syringe and needle.

The goals of a joint injection are to relieve pain and improve joint function. Your foot and ankle orthopaedic specialist also may confirm your diagnosis when giving a joint injection.

Orthotics, also called orthoses, are devices that are worn to relieve pain associated with foot and ankle deformities and help prevent or delay surgery. Most people think of shoe inserts or arch supports when they hear the word orthotics, but they can include devices such as foot pads, shoe inserts, ankle braces, and similar items. Treatment often can begin with less expensive off-the-shelf orthotics and progress to custom orthotics if the symptoms and diagnosis require it.

The plantar fascia (PF) is a thick band of tissue that connects your heel bone to your toes. It helps support the overall shape of your foot, especially when standing, and helps with shock absorption. Irritation and scarring of the plantar fascia, known as plantar fasciitis, is one of the most common causes of heel pain.

Ten percent of people have pain in the bottom of the heel at some point in their life. The most common cause is plantar fasciitis, which can result from overactivity, improper shoes, flat feet or excessive weight on the feet.

Bone grafts may be needed for various orthopaedic surgeries of the foot and ankle. Bone grafts provide bony support and/or fill in areas where bone is missing. Bone grafts are either taken from the patient (autograft), or taken from a bone donor (allograft). The best bone graft provides enough bone and healing with minimal problems for the patient.

Regional anesthesia makes a specific body part numb so that surgery can be performed. The goals are to make the foot and ankle numb during surgery and relieve pain after surgery. This helps patients need less medicine during and after surgery. 

Regional anesthesia may be considered for almost any surgery of the foot and ankle. It is not allowed in patients with certain medical conditions like blood clotting problems or active infections. Some surgeons prefer their patients not have this type of anesthesia. 

Many foot and ankle procedures require insertion of metal plates, screws, rods or similar implants for stabilization of the bones while they heal. There are a number of reasons why a foot and ankle orthopaedic surgeon will chose to remove this hardware. Hardware can be removed if it is painful, associated with an infection, or if your bone didn’t heal as hoped, which may require new hardware to be placed.

A Syme amputation is an amputation done through the ankle joint. The foot is removed but the heel pad is saved so the patient can put weight on the leg without a prosthesis (artificial limb). The goals of a Syme amputation are to remove diseased tissue or a non-usable foot and create a functional, painless limb.