The Achilles tendon is the largest tendon in your body. It connects the upper calf muscles to the back of the heel bone. When the Achilles tendon degenerates and becomes inflamed, it is called Achilles tendinosis. If you have Achilles tendinosis, your tendon can swell and become painful. This condition is common in athletes, runners, and people who have calf tightness. Achilles tendinosis may occur in the middle of the tendon (known as midsubstance Achilles tendinosis) or at the point where the tendon connects to the heel bone (known as insertional Achilles tendinosis).

For midsubstance Achilles tendinosis, surgery focuses on removing the diseased portion of the tendon. If most of the tendon is damaged, your foot and ankle orthopaedic surgeon often will use the tendon that goes to the big toe to support the Achilles tendon after repair. Other procedures may include lengthening the Achilles tendon or calf muscles if they are too tight.

The goal of Achilles tendon repair is to reconnect the calf muscles with the heel bone to restore push-off strength. Regaining Achilles tendon function after an injury is critical for walking.

The goal of ankle arthrodesis (also known as ankle fusion) is to relieve pain and maintain or improve function for patients with ankle arthritis. Ankle arthritis is degeneration of the cartilage that covers the ends of the bones that form the ankle joint. These bones are the tibia, the fibula, and the talus. Pain typically is made worse with movement of the arthritic ankle. In ankle arthrodesis the ankle bones are fused into one bone. This eliminates the joint motion and reduces pain coming from the arthritic joint. 

Ankle arthroscopy is a minimally invasive surgical procedure that orthopaedic surgeons use to treat problems in the ankle joint. Ankle arthroscopy uses a thin fiber-optic camera (arthroscope) that can magnify and transmit images of the ankle to a video screen. Ankle arthroscopies can reduce ankle pain and improve overall function.

Arthroscopy can be used to diagnose and treat different disorders of the ankle joint. The list of problems that can sometimes be treated with this technology is constantly evolving and includes:

Ankle arthritis: Ankle fusion is a treatment option for many patients with end-stage ankle arthritis. Ankle arthroscopy offers a minimally invasive way to perform ankle fusion. Results can be equal to or better than open techniques.

Ankle fractures: Ankle arthroscopy may be used along with open techniques of fracture repair. This can help to ensure normal alignment of bone and cartilage. It also may be used during ankle fracture repair to look for cartilage injuries inside the ankle.

Ankle instability: Ligaments of the ankle can become stretched out, which can lead to a feeling that the ankle gives way. These ligaments can be tightened with surgery. Arthroscopic techniques may be an option for treating moderate instability.

An ankle cheilectomy is a surgery that removes a bone spur from the talus or tibia, which are the lower and upper bones of the ankle joint. 

The goal of an ankle cheilectomy is to relieve ankle pain caused by bone impingement or pinching at the front of the ankle. While this may be a sign of early ankle arthritis, an ankle cheilectomy is a joint preserving option that may help with pain and function and buy time before additional treatment is needed.

The ankle is made up of three bones:

• the tibia (shin bone), which forms the inside, front, and back of the ankle
• the fibula, which forms the outside of the ankle
• the talus, a small bone that sits between the tibia and fibula and the heel bone

The ends of these bones are called malleoli. The tibia has a medial (inside) malleoli and a posterior malleoli. The fibula forms the lateral (outside) malleoli. 

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.

Osteochondral lesions of the talus (OLTs) are ankle joint injuries involving damage to the joint surface (cartilage) and/or underlying ankle bone (talus). A normal, healthy ankle joint is made up of smooth cartilage supported by strong bone underneath. Sometimes an ankle injury leads to damaged, rough areas of cartilage and bone underneath. Foot and ankle orthopaedic specialists call this type of injury an OLT. Since the ankle joint moves while walking, the rough spots may cause pain, swelling, stiffness, and decreased motion. It is kind of like having a pothole in the joint surface.

Bulk allograft transplantation takes bone and cartilage from a human cadaver and places it into the damaged talus. This surgery is reserved for severe cases of OLT that have either failed previous surgical treatment or involve a very large part of the talus. These types of OLTs may not respond to lesser surgeries.

A bunionette deformity is an abnormal bony prominence, or bump, on the outer side at the base of the fifth toe (the "pinky toe") at the metatarsophalangeal joint (MTPJ). The bony prominence can start out small and painless but become larger and more painful over time. When bunionettes become larger, it usually is because of growth of the bony prominence, a curved shape to the fifth MTPJ, or splaying of the fifth metatarsal away from the fourth metatarsal. The condition is also known as a tailor's bunion.

The calcaneus, or heel bone, plays an important role in walking. A calcaneal osteotomy is a controlled break of the heel bone, performed by a foot and ankle orthopaedic surgeon, to correct deformity of the foot and ankle. 

The heel bone can be realigned to achieve a different orientation, which can correct many different deformities and functional limitations. For example, abnormally high or low arches are deformities that can be addressed with a calcaneal osteotomy. The ultimate goal of all osteotomies is to relieve pain, improve alignment and walking, and reduce the likelihood of arthritis. 

The calcaneus is the heel bone. Fractures or breaks of the calcaneus commonly occur after a fall from a height or car accident. Treatment of these fractures may require surgery.

The goal of heel fracture surgery is to restore the shape of the heel bone as close to normal as possible. Restoration of normal alignment and contour is considered the best way to restore function and minimize pain.  

A cavus foot has a high arch. The cavus can range from being slightly high to severely deformed, causing a patient to walk on the outside of the foot. Surgery sometimes is needed to realign the foot.

While the cause of a high-arched foot it often unknown, a cavus could be caused by nerve disease, clubfoot, or injury. Treatment ranges from changes in shoes to surgeries, depending on the amount of deformity and related problems.

The main goals of cavus foot surgery are to reduce pain, improve function, and prevent further damage or injuries.

A bunion (also known as hallux valgus) is a misalignment of the knuckle of the big toe. This misalignment causes the big toe to turn toward the smaller toes. It often creates a bump at the base of the big toe. Bunions are not always painful, but this deformity generally will increase over time.

A Chevron osteotomy is a common bunion correction surgery. The foot and ankle orthopaedic surgeon cuts the end of the long bone leading to the big toe (metatarsal) and rotates the end of the bone to straighten the big toe. This procedure may be performed in conjunction with soft tissue adjustments around the joint. This osteotomy is mostly performed for mild to moderate bunion deformity. This bunion correction surgery relieves pain by restoring normal straightness to the first toe joint.

Most bunions can be treated without an operation, but sometimes surgical procedures are needed to relieve pain and deformity. Unfortunately, in some cases bunion repairs fail and the pain or deformity returns. There are multiple factors that can contribute to this challenging scenario. Bunions can recur because of medical conditions or non-healing of the bone after surgery. In some cases, there are technical aspects that can be improved to achieve the desired result with additional surgery.

The goal of correcting a failed bunion repair, using a procedure called revision surgery, is to relieve pain and deformity of the first toe that remains after the initial surgery. Sometimes arthritis develops after bunion surgery. This may require a different procedure than the first. It is important to figure out why the first surgery failed to prevent another failure.

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.

The metatarsal bones are the long bones in the middle of the foot. Each metatarsal bone has a base, a shaft, a neck, and a head. The fifth metatarsal is the last bone at the outside of the foot, and most breaks of the fifth metatarsal occur at the base. 

The majority of fifth metatarsal fractures are treated without surgery. However, certain situations may require surgical treatment. Surgery can be performed to help the bone heal in a correct position and return the patient to full function. Surgery may reduce the time needed for immobilization and improve the chance of healing compared to non-surgical treatment.

A bunionette (also known as a tailor's bunion) is a painful bony prominence, or bump, on the outside of the fifth (little) toe. Over time, the bunionette may worsen as the fifth toe moves inward and the fifth metatarsal (the bone connected to it) moves outward. Rubbing between the bump and tight shoes may also cause a callus to grow over the fifth toe area. All bunionettes can cause pain and pressure on the outside of the foot, though often they do not cause symptoms.

An osteotomy is a surgically performed cut of the bone. A fifth metatarsal osteotomy refers to a cut in the head, neck, or shaft of the bone to make it straighter and the bony prominence smaller. This reduces rubbing on the outer side of the foot and decreases or eliminates the pain.