Tough joints

Talk about irony. Aron M. Green, M.D., orthopedic surgeon, had just finished his fellowship. “My first month on the job, I badly sprained my ankle running on an unfamiliar trail.”

Talk about irony. Aron M. Green, M.D., orthopedic surgeon, had just finished his fellowship in foot and ankle surgery at Allegheny General Hospital in Pennsylvania and began his work as a practicing surgeon at Monmouth Medical Center. “My first month on the job, I badly sprained my ankle running on an unfamiliar trail,” he says with a laugh. “It swelled to the size of a grapefruit. I knew they’d abuse me at work mercilessly.”

Dr. Green’s was one of more than 2,300 ankle sprains that take place each day in the U.S. While knee, hip and shoulder problems get more press, ankle and foot injuries are actually the most common problem orthopedists treat. It’s no wonder: Those other body parts are single joints between two bones, while the foot and ankle are a complicated structure containing 28 different bones and 35 distinct joints. 

 “They make up a very precise and specialized piece of anatomy,” Dr. Green says. “It has taken close to 30 million years of evolution to perfect the function of getting us from point A to point B.”

“And yet, the ankle is a much smaller weight-bearing joint than the hip or knee,” says Lance A. Markbreiter, M.D., who has been doing foot and ankle surgery at Monmouth for 16 years. “Its surface area is less than one-tenth that of the knee, but it must handle the same pressures and forces as the knee. That’s why it’s more prone to injury.”

Until recently, though, the ankle was something of a poor stepchild in orthopedic care. “Very few orthopedic surgeons specialize in the foot and ankle,” says Glenn Gabisan, M.D., orthopedic surgeon and assistant program director of foot and ankle surgery. “When I started here six years ago, there was only one other foot and ankle surgeon in Monmouth County. But that number has really jumped in the last five years.”

These specialists are now able to provide surgical treatments, many of them done arthroscopically, that were unheard of just a few years ago. “There is a lot of new research going on right now in ankle replacement, cartilage restoration and other techniques, especially to help younger patients,” Dr. Gabisan says. And as technologies such as stop-motion filming have given us a better understanding of how the foot and ankle function, says Dr. Green, “we are finally at a point where we can do the kinds of procedures we’ve done in the hip and knee for the past 40 years.”

There are four main causes of foot and ankle problems, says Dr. Markbreiter: (1) trauma damage caused by injury or accident, (2) issues such as bunions and neuromas (pinched nerves) that 30 develop from improper footwear, (3) congenital abnormalities like flat feet and (4) general wear-and-tear problems such as tendonitis.

Surgery, of course, is always the last option. The first line of defense can be as simple as changing footwear—“Spiked stiletto heels are not the best choice, if you ask foot specialists,” says Dr. Green—or using orthotic devices. Injections of anti-inflammatory medication, physical therapy and avoiding activities that may be causing the problem can also be effective treatments.

“But if conservative approaches fail, there are many surgical options available,” says Dr. Markbreiter. “Advances in arthroscopic cameras and fiber-optic monitors now allow us to see inside these small joints with great ease. Recovery is more pleasant and rapid, and patients can return to normal activity much more quickly.”

Joint-replacement surgery for the foot and ankle has also improved in the past decade, says Dr. Markbreiter, who performed Monmouth’s first ankle replacement in 1996. “There are now three different ankle replacement units approved in the U.S.” But they haven’t reached the point yet where they can be used in younger, active patients. “Replacement is usually done in an older population no longer involved in sports,” he says. “It allows for pain-free walking, but it’s still not right for the active person.”

Still, younger people and athletes can take advantage of arthroscopy for many foot and ankle problems, says Dr. Gabison. “We use it to remove scar tissue that impinges between the bones or loose cartilage that can cause pain or clicking, just as we do in the knee.”

All these advances put foot and ankle care miles ahead of where it was a decade ago, all three surgeons say. But prevention remains the best medicine. Even Dr. Green knows that. His ankle sprain healed without surgery, but he’s learned his lesson.

"No more running on trails for me," he says with a smile. "I'm sticking to flat roads."

For more information on the treatment of foot and ankle problems at Monmouth Medical Center, please call 888-SBHS-123 (888-724-7123)

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