Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Hills, Michigan.
Quick Answer
Most foot and ankle problems respond to conservative care — proper footwear, supportive inserts, activity modification, and targeted stretching — within 4-8 weeks. Persistent pain beyond that window, or any symptom that prevents walking, warrants a podiatric evaluation to rule out fracture, tendon tear, or systemic cause.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Total ankle replacement (TAR) — replacing the damaged tibiotalar joint surfaces with metal and polyethylene implant components — has emerged as a viable motion-preserving alternative to ankle arthrodesis for end-stage ankle arthritis in appropriately selected patients. Third-generation TAR designs have dramatically improved survivorship compared to first and second-generation implants, and 10-year data now supports TAR as a durable option for the right patient.
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Current Implant Designs
Third-generation TAR systems use a three-component design with a tibial component (titanium or cobalt-chrome), a mobile or fixed polyethylene bearing, and a talar component — designed with uncemented hydroxyapatite-coated surfaces for biological fixation. The most widely used systems in the United States include the INBONE II, Salto Talaris, STAR (Scandinavian Total Ankle Replacement — the only FDA-approved mobile bearing system in the US), and INFINITY total ankle systems. Design differences (mobile vs fixed bearing, flat vs anatomic talar geometry) affect kinematics and failure patterns but have not produced clearly superior clinical outcomes across all patient populations in direct comparative studies.
Patient Selection and Outcomes
Optimal TAR candidates: patients with end-stage ankle arthritis, preserved hindfoot alignment, adequate bone stock, a sedentary to moderately active lifestyle, BMI <35, and age typically >55 years. Relative contraindications include: severe deformity requiring concurrent reconstruction, avascular necrosis of the talus, active or recent infection, significant peripheral vascular disease, and unrealistic patient expectations regarding impact activity. Third-generation TAR 10-year survivorship: approximately 80–90% in appropriately selected patients in specialized centers — comparable to total hip and knee replacement. Revision options after TAR failure include component revision (when bone stock is preserved) or conversion to ankle arthrodesis (using the residual bone stock with tricortical iliac crest or femoral head allograft). Dr. Biernacki at Balance Foot & Ankle evaluates end-stage ankle arthritis and discusses both total ankle replacement and ankle arthrodesis in detail during surgical consultation. Call (810) 206-1402 at our Bloomfield Hills or Howell office.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Frequently Asked Questions
How do I know if I sprained or broke my ankle?
Both cause pain, swelling, and difficulty walking. Key differences: fractures often cause more immediate severe pain, tenderness directly over bone (not just ligament), and inability to bear any weight. X-rays and the Ottawa Ankle Rules help determine if imaging is needed.
How long does an ankle sprain take to heal?
Grade I (mild): 1–2 weeks. Grade II (moderate): 3–6 weeks. Grade III (complete tear): 2–3 months. Chronic instability from improperly treated sprains can persist and may require surgery.
What is the best treatment for a sprained ankle?
RICE protocol (Rest, Ice, Compression, Elevation) for the first 48–72 hours, followed by protected weight-bearing as tolerated. Physical therapy rehabilitation is critical for high-grade sprains to restore strength and proprioception and prevent chronic instability.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
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Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Same-week appointments available at both locations.
Book Your AppointmentMost Common Mistake We See
The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Unable to bear weight
- Severe swelling with skin colour change
- Fever with foot pain (possible infection)
- Diabetes plus any new foot symptom
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)