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When Walking Is a Problem

June 8, 2007

Do you have difficulty walking on uneven ground, or in high heels? Have you sprained your ankle repeatedly? Do you sometimes feel your feet are giving way or are unstable? Do you have painful bone spurs?

Foot and ankle pain are often difficult to diagnose since the conditions may range from a common sprain to chronic lateral ankle pain or even arthritis. A sprain can result from a fall, a sudden twist, or a blow to the body that forces a joint out of its normal position and stretches or tears the supporting ligament.

Chronic lateral ankle pain is usually caused by incomplete healing after a sprain. Arthritis, however, is a little more serious. Osteoarthritis is the most common type of arthritis and is often exacerbated by the overuse of weight-bearing joints as people age or indulge in high impact sports.

In osteoarthritis, the cartilage covering the bone ends gradually wears away. In many cases, bone growths called "spurs" can develop in osteoarthritic joints. The joint inflammation causes pain and swelling. Some relief may be possible through rest or modified activity.

In finding solutions to foot and ankle pain, California Hospital surgeon Dr. Jonathan Saluta recommends a conservative approach to treatment, such as proper shoes, taping deformed toes, prescribing special orthotic inserts and, in some cases, injections to relieve pain.

"Good specialists will always consider the safest way to get their patients back to their routines, without jeopardizing their patient's wellbeing," says Saluta, who is based in Downtown Los Angeles.

Dr. Saluta, a Duke University fellow with an orthopedic specialty in foot and ankle surgery, also cautions that it is unwise to ignore untreated sports injuries, which may lead to joint arthritis, bony dislocation and arch collapse. Surgery is considered a last resort. "Great care must be taken to avoid damage to critical nerves and vessels in the foot." As such, Dr. Saluta says, "surgery is recommended only if all other conservative measures fail."

In the event surgery becomes necessary, more and more doctors are turning to arthroscopy, a diagnostic and minimally invasive procedure commonly used to evaluate knee disorders. This technology has now been adapted for foot and ankle pain. Ankle arthroscopy can be used for a variety of purposes; the most common is diagnosing injuries of the cartilage surface.

Once injuries are diagnosed, treatment can be implemented through the small arthroscopic portals. The outcome for arthroscopic patients is excellent with less pain and bleeding, with patients achieving an 84% success rate. These are results comparable to open treatment. Usually ankle arthroscopy can be performed as an outpatient procedure.

Arthroscopy can also be used to remove bone spurs, which may restrict the motion of the ankle. Large spurs may become very painful and impair the ability to walk. Problems such as synovitis and impingement from soft tissue scarring can also be treated by ankle arthroscopy.

A more recent development is the technique for arthroscopy of the posterior ankle. Through this approach, Achilles tendonitis as well as painful posterior heel spurs can be treated. Heel pain due to plantar fasciitis can be treated with an endoscopic approach through the bottom of the foot. Results for this procedure are usually as good as those performed with open techniques. Dr. Saluta strongly advises that a surgeon with proper training and experience with arthroscopic techniques should perform these procedures.

Dr. Saluta cautions that while the benefits of surgery are numerous - not least of which are increased mobility, pain reduction and overall improvement in the quality of life - it is important for patients to consult their orthopedic specialist and understand the options available and appropriate for their individual situation. "Surgery may be an option for many patients. At the same time, other therapies such as orthotic inserts, proper shoe fitting and physical therapy, should not be overlooked."

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