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Treating Foot and Ankle Injuries
Dr. Chelsea Mathews discusses common foot injuries and how to optimize your foot health.
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Learn more about Chelsea Mathews, MD
Chelsea Mathews, MD
Chelsea Mathews, MD is an active participant and instructor of the Perry Initiative, an organization committed to inspiring young women to be leaders in the fields of orthopaedic surgery and engineering through outreach programs targeting women in high school and medical school and providing them with hands-on exposure and mentoring support to pursue careers in these fields.Learn more about Chelsea Mathews, MD
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Treating Foot and Ankle Injuries
Evo Terra: We abuse the heck out of our feet. By the time we reach our 80th birthday, those of us who were able bodied will have taken some 216 million steps. It's no wonder foot injuries are common. I know this firsthand as I'm broken my ankle twice, doing the most common of activities. So today we're discussing healthy feet with Dr. Chelsea Matthews, an orthopedic surgeon at UAMS. This is UAMS Health Talk the podcast by the University of Arkansas for Medical Sciences. I'm Evo Terra. Dr. Matthews, what types of foot injuries do you commonly see at UAMS?
Dr. Matthews: The most common injuries I see are typically ankle fractures, tendonitis, and Achilles tendon ruptures with the occasional fracture in the foot or the mid foot area, commonly called a list frank injury.
Host: Is there something special about those injuries where you're at or this is just the most common injuries for everyone everywhere?
Dr. Matthews: So, you do tend to be the most common injuries for anyone anywhere and that's because they can be related to sports. They can be related to motor vehicle accidents or simply stepping off a curb or twisting your ankle in the wrong way.
Host: Yeah, I've definitely been there now. I'm fortunate enough not to have had to require surgery for this, but I know that I'm, you know, obviously in a good place, some people have it so bad that they require their entire ankle to be replaced. So what would require someone to actually get a full on ankle replacement instead of just having surgery?
Dr. Matthews: A lot of the injuries that we treat surgically are because the foot or the ankle is unstable. And so it won't support the weight of the body and that's how we make our decision. But in order to need an ankle replacement, you really need to have in-stage arthritis, meaning bone on bone, and that your cartilage has completely worn away from the two main bones, which are the tibia and the tailless. And those two bones can either be in regular alignment or they can be out of alignment due to injury or arthritis or some other preceding condition. And that would warrant you to have an ankle replacement, which is made up of metal and plastic parts to take away those arthritic and painful bony edges.
Host: Sounds like a pretty major procedure, like taking off someone's foot. Or am I going too far?
Dr. Matthews: That's a little bit too far. We keep the foot attached, but we take away the bony edges at the end of the tibia, which is your big shinbone. And at the top of the tailless, which is the bone that kind of rotates underneath the shin. And we replaced those with some metal components that ingrown or attach themselves into your bone. And then there's a little plastic spacer that acts as your new cartilage or your new joint that the ankle moves around on.
Host: Am I right in assuming that our feet take a significant amount of abuse, because those of us who are able bodied are walking on them day after day. When you look at the bone structure as a lay person, you're thinking, how could that last for 80 plus years?
Dr. Matthews: Absolutely the feet take a tremendous load and, on the shape, or the morphology of your foot, whether you have a flat foot or a high arched foot can absolutely change the way that your foot wears out over time. And whether you have arthritic changes or tendon changes, and whether your foot holds up for 80 years or not. So everyone is a little bit different in that way, but the things that we can do to prevent footwear or foot pathology are having good shoes, keeping our weight in check and keeping a healthy weight and just the normal things that we do to protect our joints, good nutrition, good hydration, being active, keeping mobile, those sorts of things.
Host: Let's focus on the shoes for a moment. When I was a significantly younger person, I was diagnosed as, and this is probably not the appropriate term these days, but in the seventies it was pigeon toed. And so I had these lovely plastic inserts that my mother forced me to wear all the time. Yeah, that was a lot of fun. So before we talk about shoes, let's talk about devices like that. Do we still do that? Do we still have corrective inserts we put in children's shoes today?
Dr. Matthews: We do have some corrective inserts, not so much for children, as much as for adults. We know that children with foot deformities, whether they be large and exaggerated or very small, it's probably a harmless condition. So kids with flexible flatfoot, although their mothers often get very concerned, there's nothing wrong with them. It's a healthy foot. It's a rigid deformities that we worry about. And so in those cases, either surgery or casting or bracing can be used to correct that. But I like to think of it as that we were born with the feet that we're given, and they're only a problem if they hurt or cause dysfunction.
Host: That's exactly what I was thinking when I was six. I just couldn't quite say it that way, but that was really what I was thinking about. Okay. So back to shoes, I know that we do have shoes. What kind of shoes would you recommend for all of us to optimize our, the healthy feet that we have? And I guess more importantly, are there certain shoes we should avoid?
Dr. Matthews: So, I think women are probably the biggest culprit of this and it's the narrow toe box or the pointy toe shoes that can crowd the forefoot and lead to sores, callous, pain. They can lead to deformity of the toes, especially if they're crunched into a tiny little shoe, obviously high heels, the higher, the heel, the more pressure going on the forefoot or that ball of your foot, the big MTP joint bear . So that increases the load through a portion of the foot. That's not meant to weight bear all of the weight. For men, it's less of an issue, but a stiff shoe or even a narrow dress shoe can cause pain and can cause crowding of the forefoot, which is uncomfortable at first and then leads to deformity down the road.
Host: What about sandals? Sandals okay too wear?
Dr. Matthews: Sandals are okay. In the right setting. So if you're in a setting, obviously where you're on a construction site or a site where there may be sharp objects, you should protect your feet because there are tendons on the top that can be cut or lacerated and that can change your toe function.
Host: Yeah. That wouldn't be a bad idea to be wearing sandals if you're in the middle construction site, obviously it makes sense. So I think I'll wrap this up with what advice do you find yourself giving over and over again to your patients?
Dr. Matthews: The first is to wear comfortable shoes, wear shoes that are wide enough and big enough for your foot so that it's not painful every time you put them on or every time you take a step. Although they might not look as cool, you will be glad you did down the road. The second thing is to stretch your calves. And the reason for that is that the calf’s puts a tremendous amount of stress and pressure on the ankle and the foot as it gets tight or contracted. And so it acts like a lever and can really pull on the foot in a way that it shouldn't. So keeping your calves flexible, protects your foot and also makes it feel better as it's allowed to transfer weight appropriately.
Host: Dr. Matthews, thanks for talking to us today about healthy feet.
Dr. Matthews: Absolutely. I'm happy to.
Host: Again, that was Dr. Chelsea Matthews, an orthopedic surgeon at UAMS. For more information on healthy feet, visit UAMShealth.com. Thank you for listening to this episode of UAMS Health Talk, the podcast by the University of Arkansas for Medical Sciences. I am Evo Terra. If you found this episode helpful, please share it on all your social channels and be sure to check our entire library of past episodes, which you can find at UAMShealth.com.
Treating Foot and Ankle Injuries
Evo Terra: We abuse the heck out of our feet. By the time we reach our 80th birthday, those of us who were able bodied will have taken some 216 million steps. It's no wonder foot injuries are common. I know this firsthand as I'm broken my ankle twice, doing the most common of activities. So today we're discussing healthy feet with Dr. Chelsea Matthews, an orthopedic surgeon at UAMS. This is UAMS Health Talk the podcast by the University of Arkansas for Medical Sciences. I'm Evo Terra. Dr. Matthews, what types of foot injuries do you commonly see at UAMS?
Dr. Matthews: The most common injuries I see are typically ankle fractures, tendonitis, and Achilles tendon ruptures with the occasional fracture in the foot or the mid foot area, commonly called a list frank injury.
Host: Is there something special about those injuries where you're at or this is just the most common injuries for everyone everywhere?
Dr. Matthews: So, you do tend to be the most common injuries for anyone anywhere and that's because they can be related to sports. They can be related to motor vehicle accidents or simply stepping off a curb or twisting your ankle in the wrong way.
Host: Yeah, I've definitely been there now. I'm fortunate enough not to have had to require surgery for this, but I know that I'm, you know, obviously in a good place, some people have it so bad that they require their entire ankle to be replaced. So what would require someone to actually get a full on ankle replacement instead of just having surgery?
Dr. Matthews: A lot of the injuries that we treat surgically are because the foot or the ankle is unstable. And so it won't support the weight of the body and that's how we make our decision. But in order to need an ankle replacement, you really need to have in-stage arthritis, meaning bone on bone, and that your cartilage has completely worn away from the two main bones, which are the tibia and the tailless. And those two bones can either be in regular alignment or they can be out of alignment due to injury or arthritis or some other preceding condition. And that would warrant you to have an ankle replacement, which is made up of metal and plastic parts to take away those arthritic and painful bony edges.
Host: Sounds like a pretty major procedure, like taking off someone's foot. Or am I going too far?
Dr. Matthews: That's a little bit too far. We keep the foot attached, but we take away the bony edges at the end of the tibia, which is your big shinbone. And at the top of the tailless, which is the bone that kind of rotates underneath the shin. And we replaced those with some metal components that ingrown or attach themselves into your bone. And then there's a little plastic spacer that acts as your new cartilage or your new joint that the ankle moves around on.
Host: Am I right in assuming that our feet take a significant amount of abuse, because those of us who are able bodied are walking on them day after day. When you look at the bone structure as a lay person, you're thinking, how could that last for 80 plus years?
Dr. Matthews: Absolutely the feet take a tremendous load and, on the shape, or the morphology of your foot, whether you have a flat foot or a high arched foot can absolutely change the way that your foot wears out over time. And whether you have arthritic changes or tendon changes, and whether your foot holds up for 80 years or not. So everyone is a little bit different in that way, but the things that we can do to prevent footwear or foot pathology are having good shoes, keeping our weight in check and keeping a healthy weight and just the normal things that we do to protect our joints, good nutrition, good hydration, being active, keeping mobile, those sorts of things.
Host: Let's focus on the shoes for a moment. When I was a significantly younger person, I was diagnosed as, and this is probably not the appropriate term these days, but in the seventies it was pigeon toed. And so I had these lovely plastic inserts that my mother forced me to wear all the time. Yeah, that was a lot of fun. So before we talk about shoes, let's talk about devices like that. Do we still do that? Do we still have corrective inserts we put in children's shoes today?
Dr. Matthews: We do have some corrective inserts, not so much for children, as much as for adults. We know that children with foot deformities, whether they be large and exaggerated or very small, it's probably a harmless condition. So kids with flexible flatfoot, although their mothers often get very concerned, there's nothing wrong with them. It's a healthy foot. It's a rigid deformities that we worry about. And so in those cases, either surgery or casting or bracing can be used to correct that. But I like to think of it as that we were born with the feet that we're given, and they're only a problem if they hurt or cause dysfunction.
Host: That's exactly what I was thinking when I was six. I just couldn't quite say it that way, but that was really what I was thinking about. Okay. So back to shoes, I know that we do have shoes. What kind of shoes would you recommend for all of us to optimize our, the healthy feet that we have? And I guess more importantly, are there certain shoes we should avoid?
Dr. Matthews: So, I think women are probably the biggest culprit of this and it's the narrow toe box or the pointy toe shoes that can crowd the forefoot and lead to sores, callous, pain. They can lead to deformity of the toes, especially if they're crunched into a tiny little shoe, obviously high heels, the higher, the heel, the more pressure going on the forefoot or that ball of your foot, the big MTP joint bear . So that increases the load through a portion of the foot. That's not meant to weight bear all of the weight. For men, it's less of an issue, but a stiff shoe or even a narrow dress shoe can cause pain and can cause crowding of the forefoot, which is uncomfortable at first and then leads to deformity down the road.
Host: What about sandals? Sandals okay too wear?
Dr. Matthews: Sandals are okay. In the right setting. So if you're in a setting, obviously where you're on a construction site or a site where there may be sharp objects, you should protect your feet because there are tendons on the top that can be cut or lacerated and that can change your toe function.
Host: Yeah. That wouldn't be a bad idea to be wearing sandals if you're in the middle construction site, obviously it makes sense. So I think I'll wrap this up with what advice do you find yourself giving over and over again to your patients?
Dr. Matthews: The first is to wear comfortable shoes, wear shoes that are wide enough and big enough for your foot so that it's not painful every time you put them on or every time you take a step. Although they might not look as cool, you will be glad you did down the road. The second thing is to stretch your calves. And the reason for that is that the calf’s puts a tremendous amount of stress and pressure on the ankle and the foot as it gets tight or contracted. And so it acts like a lever and can really pull on the foot in a way that it shouldn't. So keeping your calves flexible, protects your foot and also makes it feel better as it's allowed to transfer weight appropriately.
Host: Dr. Matthews, thanks for talking to us today about healthy feet.
Dr. Matthews: Absolutely. I'm happy to.
Host: Again, that was Dr. Chelsea Matthews, an orthopedic surgeon at UAMS. For more information on healthy feet, visit UAMShealth.com. Thank you for listening to this episode of UAMS Health Talk, the podcast by the University of Arkansas for Medical Sciences. I am Evo Terra. If you found this episode helpful, please share it on all your social channels and be sure to check our entire library of past episodes, which you can find at UAMShealth.com.