Injections and Other Procedures

The goal of amputation is to remove unhealthy tissue and create a remaining leg that is less painful and more useful. Just like many reconstructive orthopaedic surgeries, the surgical goal is to improve a patient’s pain and function. Amputation can improve quality of life for many patients.

A below-knee amputation (BKA) is an amputation often performed for foot and ankle problems. The BKA often leads to the use of an artificial leg that can allow a patient to walk. A BKA is performed roughly in the area between the ankle and knee. This amputation provides good results for a wide range of patients with many different diseases and injuries.

Brisement is the injection of fluid into the space between a tendon and its lining, or sheath. This procedure breaks up scar tissue and stimulates healing of a tendon. While most commonly used for the Achilles tendon, brisement can be performed in any tendon of the foot and ankle.

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. 

Distraction arthroplasty is a distraction (stretching out) of the ankle joint. The ankle is held in this distracted position for a period of time. This technique is used to unload the ankle joint and allow healing of the damaged joint. It may be recommended for a patient who has ankle arthritis.

The major goal of this treatment is healing of damaged tissue that occurs from arthritis. Distracting and unloading the ankle joint, along with the use of range of motion activity, is believed to help restore some of the damaged tissue in the ankle. With this restoration, a patient may be able to avoid or delay a more invasive procedure such as an ankle fusion or total ankle replacement. This allows patients to maintain motion of the ankle joint, which would be lost with an ankle fusion, and potentially avoid activity restrictions that may be necessary after an ankle replacement.

Shock wave therapy is a non-invasive method that uses pressure waves to treat various musculoskeletal conditions. High-energy acoustic waves (shock waves) deliver a mechanical force to the body’s tissues.

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.

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.

A joint injection is a procedure your doctor uses to introduce medication into a joint. The injection is done under sterile conditions using a syringe and needle.

The goals of a joint injection are to relieve pain and improve joint function. Your foot and ankle orthopaedic specialist also may confirm your diagnosis when giving a joint injection.

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.