Treatments

A flexor hallicus longus (FHL) tendon transfer to the proximal phalanx of the big toe is used to treat clawing of the big toe.

Small muscles in the foot help to stabilize the big toe. When those muscles are weakened by disease, an imbalance occurs that leads to clawing. The clawing puts abnormal pressure on the ball of the foot that can cause an ulcer to form. In addition, clawing may lead to pressure on top of the toe from shoes. Clawing is associated with a variety of underlying disorders, including Charcot-Marie-Tooth disease, diabetic neuropathy, traumatic brain injury, polio, and stroke.

The primary goal of an FHL tendon transfer is to decrease the abnormal pressures on the big toe. This will prevent ulcer formation, or in the case of an existing ulcer, promote healing. An FHL tendon transfer often is done at the same time as other foot procedures.

The flexor hallicus longus (FHL) is the primary flexor muscle of the big toe. It originates at the back of the leg, transitions into a long tendon as it enters the foot and attaches on the bottom of the big toe.

The peroneus brevis (PB) muscle starts in the leg and continues along the outside of the ankle. It then takes a sharp turn and ends on the outside of the foot. The peroneus brevis works with the peroneus longus (PL) to turn the ankle and foot outward. 

The FHL to PB tendon transfer is a surgery to improve the function of the foot. The FHL is passed behind the ankle to the outside of the foot to either assist or replace the damaged PB tendon.

The goal of this surgery is to restore the power of the ankle and foot to turn outward, which is required for cutting and turning movement. 

This surgery is used to treat flexible hammertoe deformity. A hammertoe deformity is one in which the toe is bent and looks like a hammer. A flexible deformity is one in which the toe can be manipulated into a straight position. This deformity can cause shoe problems, corns, and pain with walking.

Foot drop occurs when the muscles and tendons that flex the foot up are no longer working. Commonly, it is the result of a nerve injury, stroke, or nerve disease (neuropathy). It also can occur after an injury to a muscle or tendon. If a person is unable to flex the foot up when walking, the foot or toes can drag on the ground. This can make walking difficult and lead to frequent falls. 

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.

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 procedure to remove a ganglion is called ganglion resection. The initial treatment of a ganglion is not surgical, but if pain becomes a problem, your orthopaedic foot and ankle specialist may recommend aspiration, a procedure to remove the cyst’s fluid through a needle. If the cyst returns, surgery to remove the ganglion might be an option.

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.

A Haglund's deformity is a bump in the back of the heel bone. The Achilles tendon runs over the bump. Patients with a Haglund's deformity may or may not have pain. Sometimes, the pain is caused by shoes rubbing against the bump. At other times it can be part of pain of degeneration in the Achilles tendon due to the pressure placed there. It is not always clear how much of this Achilles tendon problem is due to the Haglund's deformity.

If prominence is the main issue, then the goal of Haglund's deformity surgery simply is to make the heel bone less prominent. If the Achilles tendon has degenerated as well, then the procedure may involve the Achilles tendon directly.

A hammertoe is a deformity that causes a toe to become bent upward in the middle so it resembles a hammer. This can cause the toe to rub against the top of the shoe or irritate the end of the toe by jamming it into the ground. Hammertoes often occur in conjunction with other toe problems. It is possible to develop corns (calluses) on top of the middle joint of the hammertoe from rubbing against the top of the shoe.

Patients who have hammertoes try to manage them by treating the symptoms. This involves padding the toe and changing or stretching shoes for comfort. If you still experience discomfort from the hammertoe you may consider surgery.

The hammertoe can be flexible or stiff. Depending on the flexibility of the toe and the preference of your orthopaedic foot and ankle surgeon, several different surgeries are used to treat the hammertoe.

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.