What To Expect In Rehab
Your therapist will use a mix of techniques to relieve pain and boost your coordination, strength, and flexibility. You may need to use exercise equipment like bikes and treadmills.
You’ll probably get exercises and stretching routines to do at home. Stick with them. Along with the work you do at your therapy appointments, they’ll help you heal better, faster, and safer.
What To Expect After Your Surgery
Hoag Orthopedic Institute is recognized for our orthopedic-dedicated physical therapy team. Our expertise will be essential in helping you regain full motion and optimal use of your foot and ankle. Most patients go home the same day as the operation. You will have a plaster cast below the knee, and you wont be able to bear weight on the foot for about 10-14 days.
After the initial period, the cast will be replaced by a walker boot, which you will be able to remove in order to do exercises. The Hoag Orthopedic Institute physical therapy team will work together with your surgeon to help you return to your normal activities as quickly as possible.
How Is Foot Tendonitis Diagnosed
Your healthcare provider will perform a physical exam and review your symptoms. They may palpate on certain parts of your foot, ankle or calf. Theyre checking for areas of swelling and tenderness. Your provider may also ask you to perform certain movements to assess your range of motion, strength and the severity of your pain.
For many of the tendons in your foot, if not torn, an ultrasound is often the test of choice to see how the tendon moves and what types of injury or degenerative changes are causing your pain.
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Ligaments Stabilizing The Ankle Joint
The Anterior Talo-Fibular Ligament
The anterior talo-fibular ligament is often thought of as the ankle sprain ligament, because it is the one that is most often damaged when the ankle is rolled. It runs down from the fibula and to the outer front portion of the ankle, in order to connect to the neck of the talus. This ligament functions to stabilize the ankle joint and keeps it from rotating inward too much, which is what happens in a common ankle sprain. The ligament itself is very broad, more like a sheet than a rope, and when it is sprained, it tends to tear part of the way rather than into two pieces. Another possibility is that it becomes stretched out in places, which makes the ankle joint looser than normal, potentially leading to symptomatic ankle instability.
Figure 1: Lateral Ankle Ligaments
The Calcaneo-Fibular Ligament
The calcaneo-fibular ligament is almost the baby brother of the anterior talo-fibular ligament. It starts at the tip of the fibula and runs along the outside of the ankle, into the calcaneous. It is more rope-like in structure than the anterior talo-fibular ligament, and less susceptible to damage, although it can be damaged during a severe ankle sprain.
Posterior Talo-Fibular Ligament
The Deltoid Ligament
Figure 2: Medial Deltoid Ligament
Treating An Achilles Tear
Without proper healing of an Achilles tear, a persons ability to walk, jog, jump, and perform other high impact activity will be limited. A tear can be treated either with casting or with surgical repair. Cast treatment requires 6-8 weeks of non-weight bearing cast immobilization, followed by several weeks in a walking boot, to make sure the tendon is completely healed in proper position. Surgical repair of an Achilles can usually be performed through a small incision, and requires just 3-4 weeks non-weight bearing and an additional 2-3 weeks in a walking boot. Surgery results in a much quicker recovery and return to regular activities than non-operative treatment, and a slightly lower rate of re-rupturing the tendon. However, most studies show that at 1 year following the injury, functional results of cast treatment and surgical repair are about equal.
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What Is Plantar Fasciitis
The plantar fascia ligament stretches along the bottom of your foot from your heel. When the plantar fascia ligament overstretches or tears, the inflammation leads to pain on the bottom of the heel.
What Is Ligament And Tendon Reconstruction
Foot and ankle ligament and tendon reconstruction is surgery that repairs damaged ligaments or tendons in the lower extremity. Tendons are long thin bands that attach your muscles to bones. Ligaments connect bones to each other to support a joint. Tendons can tear partially or completely during a joint injury. Ligaments can tear or stretch and become loose after repeated strains. Tendon and ligament reconstruction can restore joint stability and range of motion.
Normal joint movement requires healthy nerves, muscles, ligaments and tendons. Nerves send signals to muscles to tell them to contract. A joint moves when muscles contract and pull on tendons, moving the bones. Ligaments span the joint and limit how far a joint can move. This protects against dislocation and hyperextension.
Ligaments and tendons are both made of connective tissue, but their structure is different. Ligaments are not designed to stretch. This helps them perform their passive function of limiting joint motion. Tendons, on the other hand, are designed to be elastic and stretch to allow active movement.
Injuries and other problems with ligaments or tendons can cause joint problems. It is difficult for severely damaged ligaments and tendons to heal on their own.
Types of ligament and tendon reconstruction
The types of ligament and tendon reconstruction include:
Your doctor may perform other procedures in addition to ligament and tendon reconstruction. These include:
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How To Treat Tendon And Ligament Injuries
Telling the difference between a ligament or tendon injury on your own can be hard. Whenever you have pain and swelling, see your doctor for a skilled diagnosis and effective treatment plan.
In the meantime, however, whether its a strain or a sprain, immediate treatment is generally the same. Doctors recommend:
- Rest. Try to keep your injured body part immobilized until healing is well underway. This may be easier with the use of immobilization braces and crutches, if needed.
- Ice. Wrap ice in a towel to protect the skin and then ice the injured area for 20 minutes at a time, several times a day, while you recover.
- Compression. Reduce swelling by wearing a compression bandage. Wrap the bandage so its snug but not uncomfortably tight.
- Elevation. Keeping your injured body part higher than your heart can help reduce swelling and promote healing.
- Medication. Over-the-counter anti-inflammatories and pain relievers, taken as needed, may help reduce your pain and swelling.
What To Do If You Have Tendinitis Or Tendinosis Of The Feet
Tendinitis is the inflammation of a tendon. The American Podiatric Medical Association recommends treating tendinitis by icing the area and getting plenty of rest. If your foot tendinitis doesnt feel better after a week, its time to visit a podiatrist. You are more likely to get tendinitis again once youve gotten it already. Take proper precautions, such as stretching before exercise, getting used to exercise gradually. and wearing proper shoes, to prevent repeated cases of tendinitis.19
Tendinosis occurs when a tendons collagen degenerates over time, making the tendon weaker.20 This can happen as a result of chronic tendinitis. Treatment for tendinosis varies according to severity and may include surgery in severe cases.21 Your podiatrist can examine you to see if you have tendinosis and recommend treatment options.
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How Is Foot Tendonitis Treated
In most cases, your healthcare provider will recommend at-home treatments such as RICE to manage foot tendon pain:
- Rest: Stop physical activity to avoid further damaging the tendons in your foot.
- Ice: Put an ice pack or cold compress on your foot for up to 20 minutes at a time. Dont apply ice directly to your skin.
- Compression: Reduce swelling by applying a compression bandage or wrap around the injured tendon.
- Elevation: Lift your foot into an elevated position, preferably above the level of your heart.
Once your healthcare provider diagnoses your injury, they may recommend additional treatments such as:
- Calf stretches or exercises.
- Orthotics to reduce pain and support your foot as you get back to physical activity.
- Physical therapy to regain range of motion, strength, stability and flexibility in your foot, ankle and calf.
- Soft cast or boot to immobilize your foot and let the tendons heal.
How Do Ligaments And Tendons Work
You can think of ligaments as rope, with a series of tough, intertwined cords that bind bones. Ligaments also have some elastic fibers that allow the joint to move, but not so much that it moves beyond its capacity.
The knee joint, for instance, has four major ligaments, one on each side of the knee and two that run diagonally across the front and back of the kneecap. These ligaments help stabilize the knee and keep it from moving too far to the left or right, forward or backward.
Tendons are also tough cords, but they have a little more give than ligaments. As a muscle contracts, the attached tendon pulls the bone into movement. Think of what happens to your bicep when you bend your elbow. Tendons also help absorb some of the impact muscles take as they spring into action.
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How Can You Treat Tendonitis At Home
You can treat some cases of extensor tendonitis at home. Rest the affected foot for two to three days. Use it as little as possible to give the tendons a break.
While you are resting your foot, put ice on it for 20 minutes every two or three hours.
Wrap an elastic bandage around the injured area to reduce inflammation, or use a brace. Make sure the bandage or brace is not too tight and take it off before you go to sleep.
Try loosening your shoelaces or trying different shoes to see if that helps. You can also add some padding under the tongue of your shoe before you return to activity.
Symptoms Of A Torn Ligament In The Foot
Torn ligaments can occur following a range of physical activities from dancing to snowboarding, and several common symptoms can help identify a torn ligament as the cause of your foot pain.
- Swelling and bruising will occur at the site of injury.
- Pain and tenderness are concentrated on the top, bottom or the sides of your foot near the arch.
- Pain intensifies when walking or during other physical activity.
- Inability to bear weight on the injured foot.
In order to correctly diagnose a torn ligament, your doctor will usually take an x-ray of your foot to confirm the location and severity of the injury.
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Repairing Torn Or Damaged Ligaments Through Surgery
Your doctor may determine that your ligament tears or ankle instability are severe enough to require surgery. The type of surgery depends on the injury to the ligaments. In some cases, ligaments can be tightened and strengthened again by placing them back onto the bone in their anatomic position, possibly using a small anchor to attach the ligaments into the bone.
When the ligaments are too weakened or destroyed to repair, your doctor may recommend ligament reconstruction. Ligament reconstruction surgery involves harvesting a tendon to replace your damaged ligament. The most common source is your peroneus brevis tendon The tendon will be routed through the bones of the ankle to reinforce the ankle and provide the support that the ligament had previously provided.
Of the many different types of ankle ligament procedures or modifications of procedures performed, the more common ones are direct lateral ligament repair, peroneus brevis tendon rerouting, peroneus brevis tendon loop, and peroneus brevis tendon split and rerouting.
Muscular And Tendon Anatomy Of The Ankle
The posterior side of the lower leg houses the calf muscles. These muscles attach to the Achilles tendon, which is the largest tendon in the body. This is exposed to large amounts of force in activities such as running or jumping, making it prone to injury. The Tibialis Posterior muscle also lives in the posterior side of the lower leg. Continuing, the tendon associated with this muscle crosses over the middle portion of the ankle and is called the Posterior Tibialis Tendon. Those with flat feet may be at risk for additional strain on this tendon, which if not addressed, can lead to tendonitis.
The lateral compartment of the lower leg contains two muscles, the Peroneal Brevis and the Peroneal Longus muscles. Subsequently, the tendons of these muscles travel on the outside of the ankle and can also be subject to strain with overuse. Other important structures over the lateral ankle include three lateral ligaments: the Anterior Talofibular Ligament , the Calcaneofibular Ligament , and the Posterior Talofibular Ligaments . These structures are vital for stability of the ankle. Injury to these ligaments, as commonly seen with ankle sprains, can lead to long-term instability if not treated properly. Visit our blog What to do for a Sprained Ankle to learn more about how to treat an ankle sprain.
What Are Foot Ligaments
Foot ligaments are strong bands of tissue that connect various bones in your foot. The ligaments in your foot help stabilize it. They also provide necessary support to the arches in your feet.
Because there are so many bones in the foot, there are also numerous ligaments connecting them. Some of the main ligaments in the foot are:
- Plantar fascia ligament: Runs underneath your foot from the heel to the base of your toes.
- Plantar calcaneonavicular ligament: A strong ligament that connects bones in the ankle and foot, gives your arch structure and helps support your body weight.
- Calcaneocuboid ligament: Connects your heel bone to your tarsal bones that make up your foots arch.
- Lisfranc ligaments: Located beneath the Lisfranc joint in the midfoot.
What Happens If You Tear An Ankle Ligament In Your Foot
A tear or sprain in a ligament is much more common that a tendon tear in the foot. Ankle sprains are the most common orthopedic injury. When you tear a ligament in the foot or ankle, there is usually immediate swelling. You can typically still stand on it. The severity and number of ligaments involved will impact the swelling and recovery.
Ligaments do not receive much blood supply. This makes the healing process slower than other injuries.
If you would like to learn more about ankle sprains, this video may help.
Ankle Ligament sprain and a foot tendon strain
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What Are Heel Spurs
A heel spur is a bone growth on the heel bone. It is usually located on the underside of the heel bone where it attaches to the plantar fascia, a long band of connective tissue running from the heel to the ball of the foot. This connective tissue holds the arch together and acts as a shock absorber during activity. If the plantar fascia is overstretched from running, wearing poor-fitting shoes, or being overweight, pain can result from the stress and inflammation of the tissue pulling on the bone. Over time, the body builds extra bone in response to this stress resulting in heel spurs. Treatment options may include:
How Is Ligament And Tendon Reconstruction Performed
Your foot and ankle ligament and tendon reconstruction will be performed in a hospital or outpatient surgery setting. Ligament and tendon reconstruction is an open surgery involving at least one incision. Procedures vary depending on your diagnosis and the ligaments and tendons that need repair. The number of incisions and the use of hardware to secure the repair will vary depending on your condition.
Types of anesthesia
Your surgeon will perform your ligament and tendon reconstruction using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your ligament and tendon reconstruction
The day of your surgery, you can expect to:
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Why Is Ligament And Tendon Reconstruction Performed
Your doctor may recommend foot and ankle ligament and tendon reconstruction if you have ligament and tendon damage causing severe pain, joint misalignment, joint instability, deformity, or disability. Your doctor may only consider ligament and tendon reconstruction if other treatment options have not relieved your symptoms. Ask your doctor about all of your treatment options and consider getting a second opinion.
Your doctor may recommend foot and ankle ligament and tendon reconstruction to treat damage to ligaments and tendons due to:
Acute injuries, causing strains and partial or complete tears
Bone spurs, which can rub against a tendon
Degenerative changes, which weaken the ligament or tendon with age
Overuse injuries, which places repetitive stress on the ligament or tendon