Whether you suffer severe chronic ankle sprains, mild fractures, or anything in between, an orthopedic foot and ankle specialist can provide the treatment you require. Proper joint and muscle mobility in the area is crucial for sports performance or even daily activities without pain. Therefore, choosing the right doctor is key for providing the best outcomes.
APEX Orthopedics & Sports Medicine offers quality, personalized care for each of our patients. Our foot and ankle specialist Dr. Kneidel diagnoses and treats musculoskeletal foot and ankle injuries and conditions. Through his years of experience, he provides conservative and surgical treatment options for patients ranging from early childhood to late middle-aged adults.
Read on for information on the orthopedic foot and ankle field, including conditions, treatment options, and what to expect when you visit Dr. Kneidel.
Foot and ankle anatomy: Understanding the basics
The complexity of injuries stems from the complexity of the foot and ankle themselves. As with other joints in the body, the foot and ankle is composed of bones, nerves, muscles, ligaments, and tendons to stabilize the area and promote a full range of motion. One of the biggest differences between the foot and ankle and other joints is the number of bones.
The hip joint, for example, is created by the ball-shaped head of the thigh bone (femur) articulating with the hip socket (acetabulum)—two pieces to create movement on various planes.
On the other hand, the foot and ankle are a collection of joints; you can imagine this as a cluster of small bones working in harmony. Some of the joints are essential, meaning they are more mobile; others are considered non-essential from a biomechanical standpoint (but it doesn’t mean they are less important).
With strong ligaments to support the joints, the foot and ankle can move properly without causing pain. However, that is not always the case. Whenever anatomical elements become injured or have abnormalities, that can greatly impact someone’s daily life, including the ability to walk.
Common foot and ankle conditions and treatments
Many conditions and injuries could lead you to an orthopedic foot and ankle specialist. While sports-related injuries are common sources of ankle and foot problems, children and adults who do not play sports can also have complaints. Dr. Kneidel is well versed in diagnosing and treating a variety of ankle and foot conditions such as:
Accessory Navicular Syndrome
In infancy and early childhood, many bones start as less durable cartilage that hasn’t been calcified, so an accessory navicular typically doesn’t cause issues until later. When the calcification process begins in the foot, the accessory navicular hardens into a bone sitting on the inner center arch. This usually begins during adolescence (around ages 12 and 13).
In many cases, patients come to Dr. Kneidel believing they have a sprain when it’s actually the extra bone. To treat the issue, he performs an accessory navicular excision, which removes the excess bone to alleviate pain and discomfort.
A tarsal coalition is an abnormal connection between the bones in the back of the foot (tarsal bones). Similar to Accessory Navicular Syndrome, this connection doesn’t often cause issues until adolescence. Tarsal coalitions can lead to pain, stiffness, and severe flatfoot. Treatment may include removing the connection (bar) or fusing the joints.
An ankle fracture occurs when one or more of the ankle bones break. Fractures range in severity from minor breaks to severe breaks that require you to remain non-weight bearing for an extended period of time. Broken ankle bones may also cause ligament damage, which further destabilizes the joint.
Ankle fractures can happen to anyone, no matter the age or activity level. The injury could come from sports, falls, car accidents, sudden twists or rotations, and more. Especially with older people, activity level can impact the probability of ankle fractures.
Tendon tears may come from trauma or repetitive motions that add pressure to the ankle. The severity of the tear plays a huge role in the treatment options. Some may benefit from bracing and injections, while others may have to undergo surgery.
Many older patients suffer from chronic inflammation at the insertion of their achilles, which can make maneuvering through daily tasks difficult. For these patients, Dr. Kneidel performs a tendon transfer and reconstructs the achilles with a tendon that flexes the big toe.
Other conditions Dr. Kneidel treats include:
- Lisfranc injury
- Forefoot conditions
- Other sports-related injuries
If you believe you have a foot or ankle injury or condition, it’s best to avoid self-diagnosing. For the most effective treatments, you should visit an orthopedic foot and ankle physician who can assess, diagnose, and treat your condition before it worsens.
Chronic ankle sprains and treatment at APEX Orthopedics
Chronic ankle sprains are the most common condition Dr. Kneidel treats in his practice. Ankle sprains are a tear of one or two ligaments, and the severity lies on a broad spectrum. For instance, you could have a partial tear or a complete tear. About 95% of the time, people recover from ankle sprains and return to their normal activities. However, there are times when a person may have neglected proper treatment or failed to rehab the joint. When that happens, the joint isn’t protected enough to allow the ligaments to repair themselves, leading to instability and chronic sprains.
Conservative treatments are always an option (especially if the sprain is recent and non-recurring) for orthopedic foot and ankle patients. For the most part, conservative measures center around lace-up ankle bracing and physical therapy to strengthen the peroneal tendons. On the other hand, if you keep spraining your ankle due to major instability, then surgery is often the best bet. In fact, many patients who come to Dr. Kneidel for chronic ankle sprains have already exhausted conservative measures, and surgery has become their last step.
As an ankle sprain doctor, Dr. Kneidel often performs a Brostrom ligament reconstruction to repair chronic ankle sprains. During surgery, he starts with an arthroscopy where he guides a small camera (arthroscope) into the joint to clean up scar tissue. After, he makes a small incision (about 2 to 3 inches) over the ligaments at the lateral ankle. From there he repairs the two ligaments:
- Anterior TaloFibular Ligament (ATFL): The ATFL is the most commonly injured ligament after a sprain and is important for stabilizing the ankle to prevent inversion.
- CalcaneoFibular Ligament (CFL): The CFL is also important for preventing inversion, particularly during dorsiflexion (pointing the toes upward).
Typically, repairing the ligaments includes sutures, then reinforcing those sutures with a covering over the tendons at your ankle. In some cases, Dr. Kneidel may add more reinforcements via an internal brace—a suture attached to two screws stretching from the talus (ankle bone directly under the shin bone) to the fibula (smaller leg bone lateral to the shin bone). He may use an internal brace for obese patients or patients with general ligamentous laxity (loose ligaments).
Ligament reconstruction recovery:
The surgery itself only takes about 30 to 45 minutes, but recovery may take several months. Directly following surgery, Dr. Kneidel will put you in a cast, and you will have to remain non-weight bearing for six weeks.
Read next: How should I get around after surgery if I can’t walk? →
You will go into the office to change your cast several times after surgery. After the first two weeks, you will have your first follow-up visit. This gives Dr. Kneidel a chance to assess the wound and provide a more comfortable cast. During your second visit, he completely takes off your cast, re-examines the wound, removes the staples, and reapplies the cast. After six weeks, most patients are free from the cast, able to walk with a brace, and can begin physical therapy.
At APEX Orthopedics, there is a specific protocol we ask patients to take to their therapists. For most, physical therapy lasts for around three months, though sessions for athletes may be slightly more aggressive to return to play.
People who may not be candidates for surgery:
Dr. Kneidel takes special care in understanding a person’s health history to determine candidacy. If a diabetic patient doesn’t have good sensations in the leg, reconstructive surgery typically is not the best idea; there is a greater risk for complications. Smokers are also patients who could face wound complications, and sometimes they don’t heal as well as non-smokers.
It’s important to realize your foot and ankle lie at the end of your body far from the heart. That means you need to have good circulation in the area for your body to heal properly.
Get to know Dr. Kneidel at APEX Orthopedics & Sports Medicine
Dr. Kneidel is our only physician who focuses on orthopedic foot and ankle diagnoses and treatments. In 2002, he gained a fellowship in foot and ankle at the American Sports Medicine Institute, and since then he has grown his practice to serve young children, adolescents, and adults. With his dedication to his patients and passion for foot and ankle complexities, he offers the best treatments for his patients’ needs.
APEX’s private practice model ensures Dr. Kneidel can provide his patients with the most value that doesn’t involve hidden fees or outlandish pricing.
The core of his success lies in proper diagnosis. An appointment with Dr. Kneidel includes the highest quality technology to pinpoint a patient’s underlying musculoskeletal conditions. From there, he can better understand which foot and ankle treatment will work best for you.
For a thorough evaluation with Dr. Kneidel, call us at 913-642-0200 or schedule an appointment today.