Soft tissue tumors are cell growths that can occur nearly anywhere in the body:
in tendons, muscles, ligaments, cartilage, nerves, blood vessels, fat and other tissues. They usually present as a lump or a bump. Most often these are benign but they can be cancerous referred to as sarcomas. They can feel firm or soft. Malignant tumors in the foot or ankle are rare.
The most common soft tissue mass that we see in the foot is a ganglion or synovial cyst which are best thought of as contained leaks of lubricating fluid of tendons or joints. They are generally not harmful but can become painful especially making it difficult to wear shoes. Other common soft tissue masses that we see in the foot or ankle include bursas which are sacs of fluid, inclusion cysts, fibromas or fatty tumors called lipomas. Any time you notice a new lump or bump it should be looked at.
Often we will aspirate or drain the mass if it appears to be fluid filled. Sometimes if it appears suspicious it is important to send this fluid for cytology which involves having the fluid evaluated by a pathologist for malignant cells. The mass can be injected with corticosteroid which may shrink it. An MRI examination or ultrasound may be helpful to determine the quality and location of the lesion. Definitive treatment quite often involves excising the mass and sending it for a biopsy to determine the diagnosis.
Any joint in the foot or ankle can be sprained. One of the most common ankle joint injuries is the "ankle sprain". They are very common athletic injuries. It is the most common injuries seen in basketball players. The lateral ankle sprain occurs when the foot inverts or turns inward. Usually this involves injury to a ligament most commonly the anterior talofibular ligament. Commonly the patient will feel or hear a pop. Swelling and bruising occurs shortly after the injury. And sometimes it is quite difficult to walk on the affected foot. This can become a chronic problem.
It is quite common to also sprain the midfoot and sometimes this is associated with a dislocation of the midfoot known as a Lis Franc's fracture dislocation. This is a serious injury often requiring surgical repair.
X-rays are usually obtained to make sure there is no fracture. It is common to fracture the fifth metatarsal during an ankle inversion sprain. A grade 1 sprain involves ligament stretch, grade 2 involves partial tear of the ligament and grades three involves a completely torn ligament.
The medial ankle or eversion sprain is possible but it is much less common and usually involves a more serious mechanism of injury.
Immediate treatment involves "RICE" rest, ice, compression, and elevation. Sometimes a seemingly simple ankle sprain can lead to chronic problems. It is therefore important to seek medical attention.
Sometimes chronic problems can occur such as fractures of the cartilage or osteochondritis, tendon tears and nerve injuries can occur as well. It is important to rehabilitate the ankle following an injury with strengthening and proprioception exercises.
A tendon is a tough yet flexible band of fibrous tissue. Tendons connect your muscles to bones. When a muscle contracts it pulls on the bone to cause movement. Although there are hundreds of tendons throughout our body there are a small handful of tendons that commonly cause problems. Some of these occur in the foot and ankle. Most tendon injuries occur in an area known as the watershed where there is a poor blood supply. This makes it difficult for the body to deliver oxygen and nutrients necessary for tendon healing.
Most of the tendon injuries that we see in the foot and ankle are related to overuse or improper biomechanics. There will be pain directly over the tendon and pain with movement. Often time's the tendons will become swollen.
The most common tendon injury seen in the foot and ankle involves the Achilles tendon. This is the large tendon that attaches to the back of your heel. Quite often the tendon will become swollen a few inches up the leg from where it attaches to the heel bone. This usually means that the tendon is degenerating and some of it is tearing and turning to a gelatinous material. This is known as tendinosis. This is the area where the tendon may rupture completely or partially. This is usually seen in middle-aged weekend warriors. Sometimes steroids or quinolone antibiotics have been linked to Achilles tendon rupture. Other tendons that we commonly see injured are the posterior tibial tendon on the inner side of the ankle or peroneal tendons on the lateral or outside part of the ankle. The tibialis anterior is a muscle in the front of the ankle that attaches to the top of the foot and this may become degenerated and sometimes ruptures. With the advent of MRI we can see longitudinal tears in tendons with degeneration that is commonly associated with tendon injury.
Treatment involves correcting any biomechanical abnormalities. Physical therapy modalities are quite often prescribed. Rest and immobilization are utilized if necessary. Correcting muscle imbalances with stretching and in the case of the Achilles tendon emphasis is placed on eccentric stretching exercises. Anti-inflammatory medications are often utilized.
In the case of acute rupture or severe tendon degeneration surgical intervention is necessary.
Foot and ankle trauma is extremely common no matter how young or old you are. This commonly involves fractures, torn ligaments and tendons, sprain and strains, puncture wounds and toenail trauma. Quite often patients are seen with fractures or torn tendons without realizing how serious the problem is. Long-term foot and ankle pain is often linked with ignored trauma.
The most common foot trauma that we see are toe fractures, metatarsal fractures, calcaneus fractures, ankle fractures, ankle and midfoot sprains, tendon tears, sesamoid injuries, hematoma, foreign bodies and lacerations.
Many of these injuries are referred from the emergency department. Patients with diabetes will quite often have injuries that they will not notice such as burns and blisters. It is important for those patients to make sure that they wear shoes whenever they are up and around.
Quite commonly the more severe foot and ankle trauma requires the expertise of a specialized trauma surgeon and we frequently make those referrals.