Foot and Ankle2020-02-04T00:27:24-05:00

Foot and Ankle

ankle fracture Blacksburg, VA


Throughout life, your feet and ankles can take quite a pounding. The average person takes approximately 10,000 steps per day and walks about 115,000 miles over the course of a lifetime. But with 26 bones and 33 joints in the human foot, they’re pretty intricate shock absorbers.

At Sideline Orthopedics, we specialize in the diagnosis and treatment of foot and ankle injuries and conditions. You do not have to take any more steps in pain. We are here to diagnose your foot or ankle condition and offer minimally invasive treatments and rehabilitation to get you back in action. Some common causes of foot pain include plantar fasciitis which can cause heel pain and bone spurs that can limit activity. Do not hesitate to call Sideline Orthopedics for help with your foot pain or discomfort.

Foot, Ankle And Toe Care Services:

Heel pain, a common foot complaint among athletes and non-athletes alike, may occur for a variety of reasons, including heel spurs, plantar fasciitis and more.

Most sprains are minor injuries that heal with home treatments such as rest and icing. However, if your ankle is very swollen and painful to walk on, and you are having trouble bearing weight on it, be sure to see your doctor.


Tendons are the tough fibers that connect muscle to bone. The Achilles tendon is a large tendon that connects the calf muscle to the heel bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many micro tears to the tendon that have happened over time.


Ankle arthroscopy is a minimally invasive surgical procedure that uses a fiber-optic viewing camera and small surgical tools to operate in and around the ankle joint through small incisions. Ankle arthroscopy is performed for the surgical evaluation and treatment of a variety of ankle conditions, including ligament reconstruction and repair.


Ankle impingement is a condition that occurs when the soft or bony tissues within the joint are compressed at the extreme end of a motion, such as pointing the foot sharply downward. This type of injury usually affects athletes like dancers, gymnasts, or people performing kicking activities.


A foot sprain occurs when the ligaments, which connect the bones together, tear or stretch beyond their capacity. A Lisfranc injury involves the joints and/or ligaments of the middle of the foot. This injury can result from a major accident or a simple slip-and-fall. Sometimes this injury can be mistaken for a sprain.


The peroneals consist of two muscles as well as their tendons that attach along the outer edge of the lower leg. A fibrous tunnel encloses the peroneal tendons and runs behind the outside ankle bone. Damage or injury to the structures that form and support this tunnel may induce a condition in which the peroneal tendons snap out of place. This condition is called peroneal tendon subluxation or instability.


Ankle fracture is a painful condition in which a break has been sustained in one or more of the bones forming the ankle joint. The ankle joint is stabilized by several ligaments and other soft tissues, which may also be injured during an ankle fracture.


A stress fracture is a small crack in the bone resulting from overuse. It usually develops in the weight-bearing bones of the lower leg and foot. If the muscles of the foot are overworked or stressed, they will be unable to absorb that stress and transfer it onto the bone, which literally cracks under the pressure.


Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).

Claw toe is similar in appearance to hammertoe, but the distal joint of the foot is also bent, giving your toes a claw-like appearance. Tight, improperly fitted shoes may be a factor of claw toe, but nerve damage, diabetes, alcoholism, and other vascular and muscle damaging conditions also can cause the muscle constriction. Failure to treat claw toe may result in permanent toe malformation that requires surgical intervention.


Claw toe may begin as a slight curve affecting multiple joints of the toe. It advances to the curved, claw-like appearance in which your toes bend upward from the metatarsal bones at the ball of your foot and downward from the middle joints. Unlike hammertoe, with claw toe the distal joint continues to bend and curls the distal phalange under the foot. That two-part curve is a clear sign of later stages.

Additionally, the tops of toes or ball of the foot may develop corns and calluses.

Claw toe may also indicate, or be caused by, neurological disorders that weaken foot and toe muscles, resulting in imbalance and bending. Curvature after trauma may also indicate the beginnings of claw toe.


Like hammertoe, the joints affected are flexible at first, but can become rigid over time. Non-surgical treatments such as better-fitting shoes, therapy, splints, and orthotics can help relieve symptoms. Additional treatment is necessary for other neurological conditions that cause claw toe. If surgery is required, your surgeon may recommend one or more procedures to restore toes to their appropriate alignment and movement.

Floating toe is a common complication of Weil osteotomies. With Floating toe, also known as flail toe and elevated toe, the toe sticks up in the air rather than in the aligned, biomechanical position of other toes. At times, the affected toe will even “cross over” an adjacent toe, causing more pain, discomfort and problems with footwear.

This complication occurs if the osteotomy of the metatarsophalangeal bones and joint surgery did not address the underlying cause of the initial problem, such as hammertoe.


  • Toe sticks up in the air, rather than flat and aligned like other toes.
  • Toe is inflamed, red, and painful.
  • Joint is unstable, either too stiff or too loose.
  • Floating toe may be seen with crossover toe.


Non-surgical physical therapy of floating toe may help. If surgery is required, your surgeon may recommend one or more procedures to restore toes to their proper alignment and functionality.

Hammertoe is a condition caused by the joints of the metatarsal and phalanges contracting and bending the toe into an arched position that resembles a hammer. A common cause of hammertoe is a tight toe box in shoes, typically found with high heels that may be too small. The size, angle, and structure of the shoes force the toes into a compromised position, causing poor circulation, restricted movement, plus aggravation to the bones and ligaments in the foot and toes. Trauma is also a cause of hammertoes, and heredity may play a factor.

Early stages of hammertoe are mild, and the compromised joints are still flexible. At this stage, non-surgical treatment and appropriate footwear can help. Without treatment, however, the condition will worsen and joints will become stiff and inflexible. At that point, surgery is the only option.


Earliest stages are unsightly and uncomfortable but may not yet resemble the curved appearance of later stages. The appearance of hammertoe and its distinct shape is an indicator.

Symptoms of hammertoe include:

  • Wearing shoes causes pain and irritation on toes.
  • Corns and calluses appear between two toes, the ball of the foot, or on an affected toe that rubs against the shoe.
  • Long-term friction also can cause open sores on toes.
  • Burning sensation and a red, and inflammed appearance.
  • Curved appearance that progresses if left untreated.
  • Stiff, inflexible joints.

Diagnosis and Treatment

Early stages of hammertoe may appear as simple foot problems, but the curved appearance indicates a condition that must be treated or it will worsen.

A foot and ankle surgeon or podiatrist will review your symptoms and thoroughly examine your toes and foot. Manipulation of foot and toes and degree of toe contraction will show whether the toe joint is flexible or rigid. X-rays may be required to diagnose how severe the toe or toes are deformed.

Early stage hammertoe may be treated non-surgically with better-fitting shoes, therapy, splint, tapes, and orthotics. If surgery is required, your surgeon may recommend one or more procedures to restore toes to their proper alignment and functionality.

Mallet toe is similar to hammertoe, except the distal joint near the end of the toe, rather than the middle joint, contracts downward. The bend of the toe can cause severe, painful corns and possibly ulcers on the tip of the toe. Because of its length, the second toe is most at risk for developing mallet toe.

Mallet toe can be caused by injury, tight shoes, muscle and bone imbalances, and arthritis.


In early stages of development, mallet toes still have joint flexibility. As time progresses without treatment, the joint and tendons contract and freeze, causing misalignment and creating the mallet shape and position. Symptoms include:

  • Swelling, redness and irritation
  • Corns, calluses, and possible ulcers in diabetic patients


Non-surgical treatment of mallet toe includes better-fitting shoes, callus shaping and care, toe pads, low heels and therapy.

Your Metatarsophalangeal joint (MTP) connects your phalanges (bones of the toes) to the longer metatarsal bones in your foot. This joint forms the ball of the foot. Deformities of the lesser toes (all but the big toe), can cause the MTP joint to become unstable, causing the second toe to either cross over the big toe or push against the third toe in a sweeping effect. Either of these situations can result in a condition known as hammertoe, one of the most common deformities. Hammertoe causes difficulty and pain in walking and can cause the joint to stiffen if left untreated.

If your MTP joint requires surgical intervention, we offer a state-of-the art approach to treatment that may help reduce some complications common in standard toe surgery:

  • Floating toes
  • Loss of range of motion
  • Stiffness and residual pain1,2

The HAT-TRICK MTP Joint Repair System provides a complete repair of the lesser MTP joint that is less invasive and more anatomically correct than current surgical standard of care techniques.

Less Invasive

Traditional MTP surgery requires a metatarsal osteotomy. This means bone (“osteo”) removal (“otomy”) in order to shorten the metatarsal bone and re-align your toe. The bone removal is held in place with screws and wires that cause additional pain and discomfort during the healing process.

The Proximal Interphalangeal Joint, or PIP Joint, is the second joint of your lesser toes. Hammertoe and claw toe conditions can cause this joint to become fixed and unable to straighten. This is a gradual deformity and cannot be straightened by any means other than surgery.

The surgery required to straighten your toes typically involves removal of bone portions through an incision on top of your toe. The bone removal allows your toe to be straightened. Once straightened, a long wire known as a K-wire is pushed through the front of your toe, with a portion sticking out of the end of your toe. This wire helps keep your toe in a fixed position for four to six weeks, and is then removed.

These types of surgery have multiple issues with pain and fusion, and 10 to 46 percent of patients are dissatisfied post-surgery. 1

The complications of a K-wire type of surgery are many and include2:

  • Increased swelling and pain
  • Pin-tract (site of wire insertion) infection
  • Delayed or incomplete joint fusion
  • Painful removal of wire

Less Invasive

The HAT-TRICK PIP Fusion system provides an alternative to wires sticking out of your toes. The HAT-TRICK PIP Fusion system consists of a device known as a PEEK (polyetheretherketone) implant, which is a technology that has been used in orthopaedic and spine procedures for many years. The PEEK implant is radiolucent, which allows your surgeon – and you – to see the fusion progress on an x-ray. By contrast, metal implants such as wires and screws appear solid on an x-ray and do not always allow a full view of your healing. The HAT-TRICK PIP Fusion system also provides your surgeon with a technology designed to achieve a better fusion and, ultimately, a less invasive healing process.

The surgery involves an incision to gain access to the joint and minimal bone removal. Your surgeon will implant the HAT-TRICK PIP device into your toe with half in the middle phalanx and half in the proximal phalanx. This unique compression technology is exclusive to the HAT-TRICK PIP Fusion System and holds your toe in place, allowing full fusion to occur.

Ingrown toenails are a common condition in which the corner or side of a toenail grows into the soft flesh. The result is pain, redness, swelling and, sometimes, an infection.

Custom Orthotics

Orthotics are used to treat heel pain, flat feet, bunions, knee pain and just plain old tired feet. Sideline Orthopedics and Sports Medicine offers custom orthotics, including sandals and flip-flops so your feet can feel good all year long. Custom footwear is designed personally for each patient by using a 3-D scanner to learn the exact contour of each arch.


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