Ankle Fractures

What is an Ankle Fracture?

An ankle fracture is when bones in the ankle, specifically the tibia and fibula, break partially or completely. In an ankle fracture, the tibia and fibula are broken close to the foot. These are called the distal ends of the bone. The fibula is located on the outside of the leg, and the tibia is located on the inside of the leg.

Ankle fractures can be minor avulsion injuries, where shards of bone break off, or they can be injuries where the entire distal end of either the tibia or fibula is shattered. Ankle fractures often present with tendon and ligament damage.

Causes of an Ankle Fracture

Any kind of fall can lead to an ankle fracture. Most ankle fractures occur from a fall that twists the ankle in or out. These fractures can also be caused by extreme pressure on the joint, such as jumping or falling from a height or twisting the ankle side to side. Over-extending the joint may also result in fracture.

Symptoms of an Ankle Fracture

The most common symptoms of an ankle fracture are:

  • Pain at the site of the injury, between the foot and the knee
  • Swelling, tenderness
  • Inability to move the joint, or stiffness when doing so
  • Unable to walk
  • Blisters may appear on the skin over an ankle fracture
  • Bruising
  • Bone punctured through skin

When bone appears through the skin it is a very serious injury, called an open ankle fracture. This injury should be treated immediately by an Emergency Room doctor to prevent other issues.

Treatments and Prognosis

If you suspect you have fractured your ankle, you should visit a doctor as soon as possible. It can often be difficult to tell if you have a severe sprain or an ankle fracture, but a doctor will X-ray your ankle to find out for sure.

Treatments vary from elevation and icing to different types of casts to even surgery. It is less common to need surgery, but usually the alignment of the ankle will be restored by placing metal pins in an ankle to keep it in place and allow it to heal.

Most often a patient’s foot is set in a hard cast, then over time they move to a fracture boot. This allows the bones to heal by keeping them immobilized. The prognosis for most ankle injuries is good, and most patients are asked to follow up with physical therapy.

Arthritis of the Foot and Ankle

Arthritis of the foot and ankle encompasses more than 100 different conditions; all cause inflammation, pain and stiffness in the joints. Arthritis can’t be cured but treatment can help slow the progression of the disease and make you more comfortable.

Anatomy and Arthritis

The foot and ankle include 31 bones and more than 30 joints. In most joints, the ends of the bones are covered in cartilage, which helps them move smoothly. Joints are surrounded by a thin lining that secretes synovial fluid for joint lubrication. Arthritis can damage the cartilage and thicken the synovial fluid, making joints stiff and painful.

Common Types of Arthritis

Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common arthritic conditions in the foot and ankle.
~ Osteoarthritis results from wear and tear (degeneration). Older people and those who are obese are at higher risk for this kind of arthritis.
~ Rheumatoid arthritis is an autoimmune disease – the immune system attacks its own tissues. It is more common in women and genetic factors may play a part.
~ Post-traumatic arthritis, as the name implies, occurs after a joint injury such as a dislocation or fracture.

Symptoms and Diagnosis

In most cases, symptoms develop gradually. Pain with motion or that becomes worse with vigorous activity are common. The joint may feel tender when pressure is applied or be red, warm or swollen. Pain and stiffness are typically worse first thing in the morning or after you’ve been sitting or resting for a while. You may have difficulty walking because of the symptoms. Doctors diagnose symptoms by evaluating your symptoms and performing a physical examination, including a gait analysis. In some cases, you may need blood tests or X-rays.


Initially, treatment of foot and ankle arthritis is non-surgical. Medications, changes in activity patterns, or a support like a brace are typical treatments. Physical therapy can help maintain motion and increase strength and flexibility. If your condition continues to get worse, you may need surgery. If you have pain in the foot or ankle, please contact Carolina Hand and Sports Medicine.

Buttonhole Deformity

What Is Buttonhole Deformity?
Buttonhole deformity is a condition caused by damage to the tendons of the finger. It is painful and makes using the hand difficult, and if it goes untreated it can cause permanent damage. However, it is usually not difficult for a physician to correct, so it should be treated as soon as possible.

Symptoms of Buttonhole Deformity
In cases of buttonhole deformity, the finger loses the ability to straighten at the middle joint. The fingertip also bends backward at the last joint, producing a hooked appearance. There will usually be pain and swelling on the upper side of the finger’s middle joint as well.

Causes of Buttonhole Deformity
This condition is caused by damage to the tendon that runs across the top of the finger and attaches to the middle bone. This is the tendon responsible for straightening the finger. When this tendon is not working properly, the other tendons pull the finger back, producing the crooked shape of a buttonhole deformity.

The tendon can be injured by a blow to the top of the finger, or by jamming the finger against a hard surface. Cuts or burns to the top of the finger can also damage the tendon. Arthritis in the fingers can also make it difficult for the tendon to function properly.

Treatment of Buttonhole Deformity
Your physician will test your ability to move your finger to determine the cause of the deformity. He or she will probably also ask for X-rays to make sure there are no broken bones or other severe damage in the finger.

Once a buttonhole deformity has been confirmed, the doctor will likely apply a splint to the affected finger to keep it straight and allow the tendon to heal. This splint must be worn continuously for 3-6 weeks.

In serious cases, where the tendon is completely cut through or damaged from arthritis, surgery may be needed to repair it. In these cases, the finger may never quite regain full flexibility. The sooner the deformity is treated, however, the better the results will likely be.

For more information about buttonhole deformity and other disorders of the hand, or to schedule an examination or treatment, contact us at Carolina Hand.

Hammer Toe

Hammer toe is a treatable condition in which one or more toes become deformed and curl downward due to arthritis, a muscle imbalance, or ill-fitting shoes. Other causes include tightened ligaments in the foot, a high foot arch, or nerve damage. Over 200,000 cases of hammer toe occur in the U.S. each year. In some cases, newborn babies are born with this condition, but hammer toe usually develops over a long period of time.


A common visual symptom of hammer toe is the downward bending of the affected toe along with the inability to flex or wiggle the toe. There is also a certain amount of pain and discomfort associated with this condition when walking, putting on shoes, or moving the toe. A hard corn or callus may develop on top of the affected toe, which can cause further discomfort, and the toe joint can swell and turn bright red in color.


A doctor may conduct a medical exam including x-rays to see which type of hammer toe a person has and how much damage the toe has gone through. If a person can move their toe at the joint, then it’s a flexible hammer toe, which means the condition is in its early stages. If the toe cannot be moved at the joint, then the joint is not in alignment, which means the condition is in an advanced stage.


Flexible hammer toe is a mild form of this condition which is treatable with over-the-counter remedies like cushions, pads, insoles, pain medications, and muscle relaxants. Rigid hammer toe will require outpatient surgery to reposition and realign the toe and tendons. If one toe develops this condition and it’s left untreated, then the other toes are at risk of developing hammer toe, which is why it’s important to get hammer toe treated as soon as possible.

Shoulder Bursitis

Bursae are small sacs of fluid that cushion the spaces between the joints and the muscles, and bursitis is the name for the condition when these sacs become inflamed. Shoulder bursitis is one of the more common forms of the condition.

Shoulder bursitis is a risk for people who have jobs were they put constant strain on their shoulders. It can also be caused by a rheumatic condition and rarely from an infection. A person who has continuous episodes of shoulder bursitis may have calcifications in the bursae.

The symptoms of shoulder bursitis are pain when a person tries to do an overhead movement or puts any weight on their shoulder. The area is also tender, and the range of movement of the shoulder may be reduced. The arm that connects to the shoulder is weak or has a swelling on the outside.

A doctor can often diagnose shoulder bursitis by taking note of the patient’s symptoms and performing a physical exam, though imaging technologies such as X-rays and MRIs are also used.

Many instances of shoulder bursitis espond well to resting the shoulder and soothing it with ice compresses. Doctors prescribe NSAIDs for pain and cortisone injections to ease the swelling. If the condition doesn’t respond to these treatments, the doctor can remove the fluid in the bursa through needle aspiration. A physical therapist may recommend electrotherapy and massage to further ease the pain and inflammation.

Though shoulder bursitis caused by an infection is uncommon, it needs to be treated aggressively. The doctor examines the fluid to find to what type of pathogens are causing the infection, then prescribes antibiotics to combat them. In some cases, the antibiotics are delivered intravenously. The infected fluid must be drained, and if necessary, the bursa may be removed surgically. This does not often impair the functioning of the shoulder joint.

Call Carolina Hand and Sports Medicine for More Information About Shoulder Bursitis
Residents of the areas around Asheville and Valdese North Carolina who fear they might be suffering from shoulder bursitis should call our board-certified doctors for a consultation today. Reach us at 828-253-7521 or find us at our website