Foot & Ankle

The Montefiore Approach

The Division of Foot and Ankle Surgery at Montefiore brings together a tremendous breadth of experience and expertise for the diagnosis and management of a wide range of foot and ankle conditions.

As an academic medical center, we are committed to the treatment and study of foot and ankle conditions. We are constantly striving to develop novel and cutting-edge techniques for the advancement of care within our own health system and beyond.

  • Our Patient-Centered Care

    The experience of our patients and their loved ones—not simply their ailments—demands our full attention. Your dedicated care team will be there to discuss your condition, answer questions, assess treatment options, and develop a treatment strategy that is best for you.

  • Our Expertise

    Though widely common, disorders of the foot and ankle represent some of the most disruptive musculoskeletal complaints. At Montefiore, we believe that optimal outcomes are achieved through accurate diagnosis, appropriate and timely treatment, and intelligent patient-specific management.

    Using a collaborative multidisciplinary approach, we bring together podiatric surgeons, vascular surgeons, and plastic surgeons with experts from non-operative specialties, including physical medicine and rehabilitation, physical and occupational therapy, rheumatology, musculoskeletal radiology, and pain management to provide comprehensive and well-considered care.

    Our board-certified, fellowship-trained surgeons are actively invested in the training of medical students and orthopaedic surgery residents.

  • Our Dedication to Research

    Our status as an academic medical center puts us at the forefront of our field. Together with our Albert Einstein College of Medicine, one of the highest NIH-funded institutions in the country, we are continually conducting research with the goal of discovering better treatment options for our patients. We routinely present our research findings and publish our study results in peer-reviewed publications.

Conditions We Treat

Montefiore treats a vast spectrum of conditions, a selection of which you will find listed below. In addition to these, we have experience treating many other conditions. Please contact us today to schedule a consultation so that we can review and discuss your specific healthcare needs.

Some Common Conditions

  • Foot and ankle fractures
  • Arthritis of the ankle and midfoot
  • Conditions requiring total ankle replacement
  • Conditions requiring arthrodesis
  • Ankle injuries
  • Chronic ankle pain/instability
  • Achilles tendon disorders, rupture, and tendinitis
  • Heel pain/plantar fasciitis
  • Flatfoot
  • Spring ligament injury
  • Tarsal coalition
  • Tendon dysfunctions and injuries
  • High-arched foot
  • Diabetic foot conditions
  • Bunions
  • Arthritis of the big toe joint
  • Sesamoiditis
  • Neuroma
  • Claw, hammer, and mallet toes
  • Avascular necrosis
  • Lapidus Arthrodesis
  • Dislocated Toe Joints

Our Treatments

The majority of conditions affecting the foot and ankle can be treated with non-surgical intervention like bracing, casting, injections, orthotics, or physical therapy. In some instances, however, surgery represents the most effective solution. Our team offers patients a wide spectrum of techniques designed to decrease pain, improve function, minimize surgical discomfort, and shorten recovery time. For those seeking further information, we have included a few examples of common procedures that we perform at Montefiore.

Highlighted Treatments

  • Achilles Tendon Repair

    A ruptured Achilles tendon can be a severe and debilitating injury. It most commonly occurs in adults, often individuals in their middle age. The injury may happen during sporting activities, but it can also occur with a significant misstep during everyday life. Patients often experience a sudden pop in the back of their ankle and feel as though they were hit in this region. Significant swelling happens as a result, and a patient loses the ability to forcefully push off on their toes.

    Partial ruptures of the Achilles tendon can often be treated conservatively without surgery. Complete ruptures are commonly, though not always, treated with surgery. The benefits of surgical treatment include a decreased risk of re-rupture and a shorter recovery time. Patient-specific considerations, such as a history of smoking, diabetes, desired activity level, and age, are important in making the most appropriate treatment decision for each patient.

    Surgical treatment involves a single small incision on the back of the ankle at the site of the rupture, directly over the Achilles tendon. This incision may be particularly small if a percutaneous technique is utilized. The incision may be large if the patient has a previous Achilles tendon condition. The tendon ends are then sewn together.

    After surgery, once the incisions are healed, ankle motion is encouraged as soon as possible. This helps decrease scarring and maximize strength and function. Weight bearing is allowed in a boot at around four weeks. The patient can return to a regular shoe at 10 to 12 weeks. A wedge is often utilized in the shoe to help protect the Achilles tendon during recovery. Continued improvement and increased strength may be expected for up to a year.

  • Ankle Fractures

    Ankle fractures are an extremely common injury that may occur following both low mechanisms of injury (i.e. slipping on ice) or major trauma (i.e. falling from a height, or a motor vehicle accident). Certain ankle fracture patterns maintain the overall stability of the ankle joint, while others are significantly unstable and require surgery to realign the bones and the joint appropriately. Many of these injuries also cause substantial soft tissue damage and, in some scenarios, injury to the cartilage lining the joint. These additional injuries can have tremendous impact on outcomes if not treated appropriately from the outset.

    The major problems following an ankle fracture are stiffness, chronic pain, and arthritis of the ankle joint, particularly following inappropriate realignment of the bones and the joint surface. Even a few millimeters of malalignment of the joint can lead to arthritis and subsequent disability. When surgery is necessary, rigid plates and screws are used to fix the inside and outside of the ankle joint to provide maximal stability to the bones and joint.

    After surgery, the ankle is often immobilized in a splint until the incisions have healed. Thereafter, early motion of the ankle is encouraged to avoid stiffness. Patients generally need to avoid all weight bearing for the first two weeks. At two to six weeks, weight bearing is gradually allowed in a protected walking boot and, eventually, patients are transitioned into a regular shoe. Activity is slowly increased over time. During the recovery, physical therapy, low-impact strengthening, and aquatic exercise are encouraged and initiated as soon as possible. Continued improvement is seen for up to six to 12 months.

  • Triple Arthrodesis

    When arthritis affects the bones of the hindfoot (the talus, navicular, calcaneus, and cuboid bones), patients may require a surgical procedure that removes the arthritic joint surfaces and fuses the hindfoot bones together. By fusing these bones and creating one solid bone mass, stability can be improved, deformity can be corrected, and pain relief can be realized.

    A triple arthrodesis (fusion of the hindfoot bones) may be a reasonable consideration in a number of instances, including severe dysfunction of the tendons, inflammatory arthritis, arthritis resulting from prior fractures of the hindfoot, and other conditions. Hindfoot arthritis sometimes needs to be addressed together with ankle arthritis; however, this is not always the case and the ankle joint should be carefully assessed in a patient-specific manner.

    The bones of the hindfoot work together to provide the side-to-side motion of the foot. After this procedure, there is limitation of side-to-side motion, but up-and-down motion of the ankle and foot is preserved. Walking on flat, even surfaces usually can be performed without difficulty; however, walking on uneven surfaces, such as rocky trails or a beach, may be difficult.

    Triple arthrodesis is generally performed by making incisions on the inside and outside of the ankle and foot, preparing the joint surfaces for fusion and placement of screws, plates, staples, or other orthopaedic devices to stabilize the bones while they are healing.

    After surgery, patients are casted for approximately six weeks, after which they can weight bear in a CAM boot walker for six weeks. Thereafter, patients can usually return to wearing a regular shoe. Aggressive physical therapy is needed to strengthen the foot and ankle.

  • Hallux Rigidus

    Hallux rigidus is arthritis that develops at the metatarsophalangeal joint (MTP joint), which is the base of the great toe. Despite being a small joint, arthritis in this area can be very uncomfortable and can greatly impact activity tolerance, shoe wear, and quality of life. While there are some conservative options for mild hallux rigidus, more symptomatic patients may benefit from surgery.

    Surgical options for hallux rigidus depend upon the degree of arthritis within the joint. A cheilectomy is usually recommended when damage is mild or moderate. Working through an incision at the top of the foot, the bone spurs and a portion of the foot bone are removed, giving the toe more room to bend. The toe and the operative site may remain swollen for several months after the operation, and a wooden-soled sandal must be worn for two weeks after the surgery. Most patients experience long-term relief; however, the underlying arthritis in the joint is not removed, so some pain may persist and additional surgery might be needed in the future.

    When damage to the cartilage is severe, arthrodesis is recommended. Working through an incision at the top of the foot, the damaged cartilage is removed. Pins, screws, or a plate are then used to fuse the joint in a permanent position. This type of surgery means that the toe cannot be bent at all across this specific joint. Nonetheless, it is the most reliable method in which to reduce pain. During recovery, patients can walk immediately but are required to use a rigid wooden-soled shoe for the first six weeks after surgery.

    Indicated in very select scenarios, arthroplasty is a surgical procedure in which the normal joint surface is removed and replaced. Interpositional arthroplasty, in which a soft tissue graft is placed between the damaged surfaces of the joints, works as a cushion for the big toe joint and is an alternative to metal implants. Appropriate for select individuals, this procedure may relieve pain and preserve joint motion.

  • Morton’s Neuroma

    Morton’s neuroma is one cause of metatarsalgia, which is pain in the ball of the foot due to inflammation of a nerve in the foot. This tumor-like inflammation is an enlargement of the nerve, not a malignancy, and is caused by entrapment of the nerve under the metatarsal heads due to repeated injury. The nerve becomes trapped under the metatarsal heads when standing and walking. This most often occurs as the result of high heels and thin, hard soles, but can occur from any standing or walking situation. It usually occurs between the third and fourth toes.

    The symptoms of Morton’s neuroma are pain and numbness in a specific spot in the ball of the foot, sometimes radiating into the toes. The pain, which may feel like a marble or a stone under the foot, can be severe enough to prompt a patient to remove his or her shoe. Moving around can cause a sharp snap and pain to be felt. The examining physician can sometimes feel this by squeezing and pressing on the foot. Testing with a pin may reveal some numbness.

    Initial treatment includes shoe modification. A soft shoe with an extra wide toe box should such be worn. A metatarsal pad can also help improve symptoms. A cortisone injection around the nerve may help reduce the swelling and inflammation and may also help localize the problem.

    If conservative treatment does not relieve symptoms, surgery may be considered. Surgery involves removing a small portion of the nerve, releasing the tissue and ligaments overlying the nerve.

    This outpatient procedure can be performed under local anesthetic and involves a recovery period of approximately two weeks. During this time, a rigid orthopedic shoe is worn. Transition to a regular shoe occurs as soon as swelling allows. Since the nerve is removed, patients will experience numbness in the toes and in the ball of the foot afterward. This is not usually a substantial problem and becomes less noticeable with time. Persisting pain may be due to irritation at the cut end of the nerve, which is termed a stump neuroma. This can require additional surgery for those who do not get relief from the first surgery. Scarring and contractures around the toes may also occur and require surgery.