Michael S. Vrana, M.D.
Orthopedic Surgeon
Overview
how the foot and ankle workYour foot and ankle carry your whole body weight on a framework of 26 bones and more than 30 joints, tied together by ligaments and powered by tendons that wrap around the ankle like cables on a pulley. The heel takes the first hit of every step, the arch spreads the load, and the ball of the foot pushes you off. Most foot and ankle pain comes from one of those load points: an overworked tendon, a sprained ligament, an irritated nerve, or a joint wearing out.
What we treat in the foot & ankle
The conditions below link to plain-language guides: what each problem is, how we diagnose it, and the treatment path from simple measures to surgery when it is needed.
Sprains & instability
Tendon
Achilles Tendinopathy
Painful degeneration of the Achilles tendon from overuse.
Achilles Ruptures
Complete tear of the Achilles tendon, often with a sudden pop on push-off.
Peroneal Tendon Tear
Tear or slipping of the tendons along the outer ankle.
Posterior Tibial Tendon Dysfunction
Failure of the tendon that supports the arch, leading to a flattening foot.
Forefoot & midfoot
Plantar Fasciitis
Heel pain from inflammation along the bottom of the foot, worst with the first steps.
Bunions (Hallux Valgus)
A bony bump and drift of the big toe.
Big-Toe Arthritis (Hallux Rigidus)
Arthritis and stiffening of the big-toe joint.
Hammer Toe
A chronically bent toe joint from imbalanced tendon pull.
Metatarsalgia
Pain under the ball of the foot from overload.
Morton's Neuroma
Painful nerve enlargement between the toes.
Plantar Plate Tear
Tear of the ligament under a lesser toe, causing pain and toe drift.
Sever's Disease
Heel growth-plate irritation in active children and adolescents.
Arthritis
Nerve
Stress fractures
Fractures
What Usually Causes Foot and Ankle Pain
the usual suspectsPlantar fasciitis
Heel pain with the first steps of the morning. The most common cause of heel pain, and it almost never needs surgery.
Ankle sprains
The ligaments on the outside of the ankle stretch or tear with a roll. Most heal well, but bad ones need a real rehab plan.
Achilles tendon problems
A sore, thickened tendon above the heel that complains at the start of a run and after sitting.
Bunions
The big toe drifts and a bump grows at its base. Shoes and time make it worse; surgery is for pain, not looks.
Morton's neuroma
A pinched nerve in the ball of the foot. Burning pain and the feeling of a pebble in your shoe.
Ankle arthritis
Worn cartilage in the ankle joint, often years after an old injury.
When to Come In
timing and warning signsMost foot and ankle soreness settles with a few days of rest, ice, and over-the-counter pain relievers. Come in sooner if you cannot take four steps on it, the ankle or foot looks deformed, the pain followed a pop in the back of your heel, numbness is spreading, or the area is red and hot along with a fever. Diabetics with a new foot wound or a hot, swollen foot should be seen promptly.
What Your Visit Looks Like
exam first, imaging secondYour visit starts with a conversation and a hands-on exam. Where it hurts, what shoes you live in, and what the foot does under load tell us most of the story. We take X-rays in the office the same day if we need them, standing when it matters. Most foot and ankle pain gets better without surgery: shoe changes, inserts, stretching, therapy, bracing, and sometimes an injection.
How We Treat Foot & Ankle Pain
non-operative first, surgery when it countsMost foot and ankle pain gets better without an operation. The usual path is shoe changes and inserts, stretching and strengthening, bracing for unstable ankles, and an injection in select problems. Plantar fasciitis, the most common heel pain, settles without surgery in the vast majority of people, though it takes patience.
Surgery enters the conversation for structural problems (a bunion that makes shoes unwearable, an unstable ankle that keeps giving way, a ruptured tendon, arthritis that has worn a joint out) or when a full course of non-operative care has not worked. When that is the right step, your OSI surgeon performs it. See the foot and ankle operations we perform or browse non-operative care.
