How to

Shoes serve many functions. They protect our feet. They cushion our body weight. They can make our feet feel comfortable or fashionable — hopefully both! Finding the proper shoes and making sure they fit are important for keeping your feet and your body happy. Poorly fitting shoes can be painful and cause foot problems like bunions, corns, calluses, hammertoes, plantar fasciitis, stress fractures, and more.

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.

CN occurs when bones and joints in the foot fracture, break up or pop out of place with minimal or no known direct injury. In the United States, this deformity most commonly occurs in people with diabetes. The foot first enters an acute stage of swelling, warmth and redness, that can be mistaken for an infection. Broken bones and dislocations can occur, causing severe deformities of the foot and ankle. Some patients develop pain or ulcers when the affected foot becomes deformed. CN can affect the other foot or happen again in the same foot. The foot does not regain its normal shape. 

People who suffer from diabetes can have problems with circulation, nerves, immunity, and deformity. Occasionally one or more of these may exist as an isolated issue but often people suffer from more than one at the same time.

• Circulation: People with circulation problems don’t have as much oxygenated blood supplying their feet as other individuals and therefore have difficulty healing any wounds.
• Nerves: Those who have nerve problems can develop a blister and oftentimes not even know it is there until they take off their shoes.
• Immunity: Some individuals with diabetes have a diminished response of their immune system. Because of this, they can get an infection from a cut or blister more easily and have more difficulty treating it.
• Deformity: People who suffer from diabetes can have collapse of the arch of their foot or other deformities which makes the foot more difficult to place into off-the-shelf shoes because of the risk of blisters developing over areas of high pressure.

Proper footwear is therefore very important for people with diabetes. Your foot and ankle orthopaedic specialist can help you choose proper footwear and recommend shoe modifications to protect your feet.

About 30 million people in the US have diabetes, according to the American Diabetes Association. A possible complication of the disease is nervous system impairment (neuropathy), which may cause you to lose feeling in your feet or hands. This means you won't know right away if there is a problem. Diabetic neuropathy affects about 60 to 70 percent of people with diabetes.

People with diabetes are at risk for developing foot problems that can be severe. If you have diabetes, make sure to learn about these potential conditions, monitor your feet regularly, and see your foot and ankle orthopaedic surgeons if you suspect a problem.

Diabetes can cause serious foot problems. These conditions include the loss of nerve function (diabetic neuropathy) and loss of circulation (peripheral vascular disease). These two conditions can lead to: 

• Diabetic foot ulcers: wounds that do not heal
• Infections: skin infections (cellulitis), bone infections (osteomyelitis) and pus collections (abscesses)
• Gangrene: dead tissue resulting from complete loss of circulation
• Charcot arthropathy: fractures and dislocations that may result in severe deformities
• Amputation: partial foot, whole foot, or below-knee amputation

There are 26 bones in the foot, all of which can be fractured. There are different types of fractures. Sometimes a bone breaks but stays in place (non-displaced). Sometimes a bone breaks into two pieces that move apart from one another (displaced). Other types of fractures include a bone that is broken in multiple places (comminuted) and a bone that breaks through the skin after fracturing (open fracture).

If you injure your foot, your orthopaedic foot and ankle specialist will take X-rays to see if you have a fracture. X-rays will identify most fractures but some smaller and more subtle fractures may require CT or MRI scans to be seen. Not all fractures require surgery, and your foot and ankle orthopaedic surgeon will help determine how your fracture should be treated.

If you need surgery for your foot fracture, the goals are to restore the fractured bone to its correct position, stabilize the bone in this position, encourage healing, restore function and reduce the risk of future problems such as persistent pain, loss of motion, and arthritis.

Patients with diabetes are prone to major foot problems. This is because the foot expresses many of the underlying effects of diabetes, including neuropathy, vascular disease, and diminished response to infection.

As a result of the neuropathy, the foot can develop an ulcer. This happens for two reasons. The first is that the neuropathy causes paralysis of small muscles in the foot, which results in clawing of the toes. Clawing of the toes causes prominence of the metatarsal heads (bones closest to the toe) on the bottom of the foot as well as the knuckles on the dorsum (top) of the foot.

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.

Tightness in the calf can limit how for the ankle can flex up. This may make it difficult to walk with the heel on the floor. Over time this can cause problems such as pain and deformity. Calf tightness may contribute to many foot problems, including heel pain, Achilles tendon pain, flatfoot deformity, toe pain and bunions.

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.

Every mile you walk puts tons of stress on each foot. Your feet can handle a heavy load, but too much stress pushes them over their limits. When you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues, you may develop heel pain, the most common problem affecting the foot and ankle.

A sore heel will usually get better on its own without surgery if you give it enough rest. However, many people ignore the early signs of heel pain and keep on doing the activities that caused it. When you continue to walk on a sore heel, it will only get worse and could become a chronic condition leading to more problems.

If you're a smoker thinking about having surgery on your foot or ankle, there are some important things you should know. Cigarette smoke is filled with harmful chemicals including nicotine, hydrogen cyanide, and carbon monoxide. Smoking increases the chance that your bones and tissue may not heal well, that the area may become infected, or that you may have more pain after surgery than you did before.

Over time or through improper use or overuse, feet can change. Some of these changes are normal, such as a foot widening as a person ages. But other changes are abnormal and should be diagnosed and treated by a doctor. For instance, if a painful knob begins to develop near the big toe, it could be a bunion. Click below for information on how to assess your feet and know when you should see a doctor.

If you're considering foot or ankle surgery, your foot and ankle orthopaedic surgeon may have said you'll need to be non-weightbearing for a period of weeks after your procedure. What does that mean? 

The term non-weightbearing, sometimes prescribed simply as N.W.B., refers to restrictions placed on you immediately after surgery. You will be advised to avoid putting the surgically repaired foot on the floor. This typically means no weight whatsoever, not even for a second or two whether standing or seated.

Ankle sprains are very common injuries -- some 25,000 people do it every day.​​​ Sometimes, it is an awkward moment when you lose your balance, but the pain quickly fades away and you go on your way. But the sprain could be more severe; your ankle might swell and it might hurt too much to stand on it. If it's a severe sprain, you might have felt a "pop" when the injury happened.

People with diabetes are at risk for foot problems. However, building regular healthy habits, practicing proper daily care, and carefully protecting the feet can go a long way towards avoiding more serious issues, like gangrene, infection, deformity, and amputation. Click the button below for a list of important care recommendations for people with diabetes.

One step you can take to help keep your feet healthy is to consume plenty of calcium. Calcium keeps bones strong, and the amount your body needs varies at different times in your life. Dairy products like cheese and yogurt are examples of foods high in calcium. Click the button below to find out how much calcium you should have each day and for more tips to ensure you get enough in your diet.

To understand if an ankle is fractured (broken), it helps not only to know the symptoms but also to understand how the bones, muscles, and other soft tissues work together. Click the button below to learn more about the anatomy of the ankle as well as signs that indicate it may be broken.

When you take time to do a few foot flexibility exercises each day, it not only helps reduce any current discomfort you may have, but it can also help you avoid foot pain and injury in the future. Click the button below for diagrams and instructions on how to perform several foot flexibility exercises that can be practiced at home, such as towel curls and toe raises.

Use this three-part guide to help make your orthopaedic foot or ankle surgery and recovery go smoothly. You achieve the best results when you work with your surgeon to prepare for surgery and post-surgical recovery. Part 1 will focus on what to do before your surgery.

Use this three-part guide to help make your orthopaedic foot or ankle surgery and recovery go smoothly. You achieve the best results when you work with your surgeon to prepare for surgery and post-surgical recovery. Part 2 will focus on what to do the day of your surgery.

Use this three-part guide to help make your orthopaedic foot or ankle surgery and recovery go smoothly. You achieve the best results when you work with your surgeon to prepare for surgery and post-surgical recovery. Part 3 will focus on what to do in the days immediately after your surgery.

Most children learn to walk at about the time of their first birthday, although some learn months earlier or later. As your child begins to walk, you may have your first questions about what shoes he or she should wear. A growing child will need new shoes frequently, and more questions will arise.

You should ask yourself the following questions when selecting your child's shoes:

• How does the shoe fit?
• How is the shoe made?
• Is the type of shoe appropriate for your child's age? 

Following an ankle sprain, you should start strengthening exercises once you can bear weight comfortably and your range of motion is near full. There are several types of strengthening exercises. It is easiest to begin with isometric exercises that you do by pushing against a fixed object with your ankle.

Once you have mastered isometric exercises, you can progress to isotonic exercises. In isotonic exercises, you use your ankle's range of motion against some form of resistance. The photos below show isotonic exercises performed with a resistance band, which you can get from your local physical therapist or a sporting goods store.

High-heeled shoes are a popular fashion choice, but wearing them can lead to foot pain and injury. Some common injuries and pain associated with wearing high heels may be prevented with the following steps. 

Vitamin D is important for maintaining bone health. It affects bones by controlling the body’s levels of calcium and phosphate, which are critical for building new bone. Vitamin D controls calcium and phosphate levels in three ways: by regulating how much we absorb from our diet, how much is within our bones, and how much we excrete.

We get vitamin D from our diet, sun exposure, and oral supplements like multivitamins. Only a few foods naturally contain vitamin D. These include some oil-rich fish, certain mushrooms, and egg yolks. Most of our dietary vitamin D comes from fortified dairy products, cereals, and bread products. The sun provides a major source of vitamin D, but sunscreen, which protects against sunburn and skin cancer, decreases the skin’s production of vitamin D.

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.

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.

The goal of the procedure is to safely remove the hardware without causing damage to the surrounding soft tissues. These tissues often are scarred from previous surgery. Nerves and blood vessels and other soft tissue structures in this area may be at greater risk than at the time of the original surgery. A larger incision than the original surgical incision may be required to safely remove the hardware.

Sesamoids are bones that develop within a tendon. The one most people are familiar with is in the kneecap, however they most commonly occur in the foot and hand. Two sesamoids, each about the size of a corn kernel, typically are found near the underside of the big toe.

A stress fracture is a small crack in a bone. These fractures most often are a result of overuse and can occur with an increase in activity. Stress fractures most commonly occur in the weight­bearing bones of the legs. When a bone is subjected to a new stress, such as a new exercise routine, it may not be prepared for the increased workload, and as a result, may develop a stress fracture.

Tendoscopy is a procedure that allows an orthopaedic surgeon to see the inside of a tendon sheath to treat tendon disorders of the foot and ankle. Tendoscopy is very similar to arthroscopy. A small camera and special instruments are placed through small incisions along the course of a tendon. Sterile fluid is used to expand the sheath and provide direct exposure to the tendon.

The goal of tendoscopy is to treat tendon disorders without using large incisions. Patients have less pain and smaller scars than with traditional open surgery. Patients also can return to work and exercise sooner with this procedure versus open surgery.

People with diabetes are at risk for foot issues, including the possibility of losing a leg. The risk increases when a person has diabetic neuropathy, a type of nerve damage that causes foot numbness, since problems can go unnoticed. Click the button below to learn how to reduce the risk by properly caring for diabetic feet and seeing a doctor as soon as possible if there is an issue.