The hallux valgus or bunion is a bony deformity at the base of the big toe on the inside of the foot. It occurs when the big toe is pushed inward towards the rest of the toes, forcing the joint at the base of the foot outwards, causing the appearance of a bony lump or protrusion on the inside of the foot.
The main symptoms are a bulging bump in the area around the joint between the big toe and the rest of the foot, and the associated pain and inflammation, which usually get worse when walking. As the bunion grows, it will become more inflamed and uncomfortable. Other symptoms include:
Possible causes of bunions are:
To prevent bunions it is vital to pay attention to the development of our feet. When there are calluses or corns on the inside of the big toe or if you notice it is starting to point inwards, it is advisable to take some kind of measure to prevent it from getting worse. It may be impossible to prevent bunions, but the best way to lower your chances is to choose the right footwear:
Bunions are often manageable conditions, and non-surgical treatments to deal with the symptoms should always be tried before surgery. These include:
Surgey, called bunionectomy, is only indicated in severe cases where walking becomes highly difficult. Through this procedure, the surgeon can realign your toe and remove the bony protuberance and swollen tissue. However, full recovery can take weeks, or even months, and even then bunions can recur. For this reason, it is important to only wear appropriate shoes and take care of your feet after surgery.
The Achilles tendon, also known as the calcaneal tendon, is the tendon that connects the calf muscle on the back of the leg to the heel bone. It is a tough band of fibrous tissue that allows the calf muscle to move the foot and is essential for walking, running and jumping. It is the strongest and largest tendon in the body, allowing it to withstand the tension caused by movement and to bear the weight of the rest of the body. In spite of this strength, the constant high tensions it endures and its limited blood supply mean that it can suffer from several injuries and conditions.
There are several ways to test for Achilles tendon issues:
Orthopaedic surgeons, particularly those specialising in foot and ankle problems deal with all sorts of conditions affecting the Achilles tendon.
Arthritis is a disease that causes inflammation of the membrane that covers the joints. There are more than 100 different types of arthritis, but the most common are:
The symptoms of arthritis can be:
This pathology can be a consequence of:
Joint damage can be prevented with timely and adequate diagnosis and treatment. Also, if someone has a family history it is important to talk with the doctor, even if s/he does not have any symptoms. It is also recommended to avoid repetitive and excessive movements to prevent osteoarthritis.
The treatment aims to alleviate the symptoms and prevent the disease from getting worse. The treatment can be covered by several aspects:
Ankle arthroscopy is a minimally-invasive surgical technique that lets you view and work directly inside the joint, without opening, thanks to a tiny camera. Only small incisions or cuts in the skin of about one centimetre are made. Ankle arthroscopy is applied in cases of joint cleaning and removal of loose bodies, or other treatments, such as osteochondritis. After the intervention, it is recommended a week of rest and applying ice to prevent swelling. The patient may also need rehabilitation therapy with physiotherapists.
Morton’s neuroma (also known as Morton’s metatarsalgia or interdigital neuroma) is a painful condition of the foot caused by one of the nerves between the toes becoming irritated and the tissue around it becoming thickened. It most commonly affects the nerve between the third and fourth toes, but can also affect the nerve between the second and third toes.
The pain caused by Morton’s neuroma is often said to feel like you are standing a pebble in your shoe, but the pain can be sharp, and the toes may also sting or experience numbness.
There are no outward symptoms of Morton’s neuroma; instead it manifests as painful or uncomfortable sensations in the ball of the foot and the toes, including:
It is recommended that you see a doctor if the symptoms last more than a few days.
It is not fully understood what causes the nerves in the foot to become irritated and subsequently thickened, but it is this irritation and thickening that causes the pain associated with Morton’s neuroma. It is thought that the cause is some sort of damage to the nerve, either by over-compressing or over-stretching it.
Some risk factors include:
It is unclear if these factors are direct causes of Morton’s neuroma, or simply things that exacerbate it.
Treatment for Morton’s neuroma depends on the individual case; the doctor will discuss options with the patient based on the severity and how long the patient has had the condition.
Non-surgical options to reduce pressure on the foot or offer pain relief include:
Not all patients respond to these methods, in which case, surgery may be advised. This may involve removing tissue around the nerve to create more space and reduce pressure, or removing part of the nerve itself.
Many orthopaedic surgeons, especially those that specialise in foot and ankle problems will treat Morton’s neuroma. There are also special foot doctors called podiatrists, who have expertise in this area.
Plantar fasciitis is the inflammation of the plantar fascia by overloading or stretching. The plantar fascia is a thick ligament in the sole of the foot which connects the heel with the toes. This inflammation causes pain as you walk about, usually first thing in the morning, which flares up when standing after sitting for a long period.
Non-surgical treatments reduce pain in almost all cases. It may take several months before symptoms improve. Some people require surgery to reduce the pain.
Generally, this condition causes pain and rigidity in the lower part of the heel.
The pain is usually accompanied by the following symptoms in the lower part of the heel:
To diagnose plantar fasciitis, the patient’sclinical history is evaluated and a physical examination is performed. The examination determines which stage the plantar fasciitis is at. Next, the specialist performs a gait analysis and evaluates whether the inflammation of the plantar fascia is related to the way the patient walks. An X-ray scan or MRI scan might be performed to rule out bone problems and potential pinched nerves.
The causes of plantar fasciitis is when the tension on the tissue becomes too great, causing inflammation. It is more likely to occur in people who:
This can be difficult to prevent, however, maintaining a healthy weight can help reduce the chances of this developing. However, if you frequently do exercises such as running, dancing, or aerobics, plantar fasciitis can develop. In addition, checking that the ankle, Achilles tendon and calf muscles are flexible may help to prevent plantar fasciitis. It may also be helpful to stretch the plantar fascia in the morning before you get out of bed and to perform physical activities in moderation.
There are different treatments for this condition but the first option considered is conservative treatments, including rest, applying ice to the painful area and stretching over several months. Massaging and stretching the fascia, can help to provide symptoms relief.
Other, more novel techniques are infiltration of growth factors, intratissue percutaneous electrolysis (EPI) and shock waves, which have all been demonstrated to be highly effective treatments in the acute phase.
Moreover, more and more tools are becoming available for the manufacturing of very precise individualised shoe insoles. One such technique uses a laser to obtain a virtual 3D mould of the patient’s foot.
In very specific cases in which none of the above treatments have worked, plantar fascia surgery should be performed. During this surgery, the tendon is partially or totally released or, if a heal spur is present, the heel spur is reduced.
An orthopaedic specialist can help to treat plantar fasciitis.
Mr Paul Hamilton is a top orthopaedic consultant based in Surrey and South London. He specialises in adult foot and ankle surgery and trauma surgery, including forefoot reconstruction, arthroscopy and arthroplasty, and is an expert in treating sport injuries, Morton's neuroma, arthritis and bunions. After qualifying from St Bartholomew's and the Royal London Medical School, he completed three medical fellowships in the UK and a travelling fellowship to Boston, USA, giving him extensive specialist training. In addition to his private and NHS practices, Mr Hamilton is actively involved in research, and has published and presented his work in orthopaedics around the world.
Ankle arthrodesis is an operation performed to correct a deformity or unhealed injuries as a result of arthritis, or to relieve pain in the ankle. Arthrodesis fuses the two bones that form the joint together.
The Achilles tendon, also known as the calcaneal tendon, is the tendon that connects the calf muscle on the back of the leg to the heel bone. It is a tough band of fibrous tissue that allows the calf muscle to move the foot and is essential for walking, running and jumping. It is the strongest and largest tendon in the body, allowing it to withstand the tension caused by movement and to bear the weight of the rest of the body. In spite of this strength, the constant high tensions it endures and its limited blood supply mean that it can suffer from several injuries and conditions.
There are several ways to test for Achilles tendon issues:
Orthopaedic surgeons, particularly those specialising in foot and ankle problems deal with all sorts of conditions affecting the Achilles tendon.
Ankle arthroscopy is a minimally-invasive surgical technique that lets you view and work directly inside the joint, without opening, thanks to a tiny camera. Only small incisions or cuts in the skin of about one centimetre are made. Ankle arthroscopy is applied in cases of joint cleaning and removal of loose bodies, or other treatments, such as osteochondritis. After the intervention, it is recommended a week of rest and applying ice to prevent swelling. The patient may also need rehabilitation therapy with physiotherapists.
There are number of tendons in the ankle including the finger and ankle extenders in the front and the Achilles tendon and flexor of the big toe in the back. Tendons attach the muscles to the bones in your body and help you to move, as well as acting as an important shock absorber.
Tendons can be injured in a number of ways. Tendonitis involves an inflammation of the tendon.
Most cases of tendonitis are resolved within a few weeks providing you give the injured tendon adequate rest. It is not common to need to seek further treatment after this time.
The main symptoms associated with ankle tendonitis are:
However, if you experienced a “pop” when you injured your ankle, you may have ruptured the tendon – in which case, it’s important to see a doctor right way.
Ankle tendonitis is often caused by overuse of the tendon. This can occur because you play a particular sport or your job involves manual labour. In other cases, tendonitis can occur as part of the ageing process, which makes them more prone to stress.
You can help prevent ankle tendonitis by taking appropriate measures when you exercise, such as warming up beforehand and taking regular breaks.
Ankle tendonitis can be diagnosed with a medical examination and asking about your symptoms. However, it likely that you will not need to see a GP as most cases of tendonitis can be treated at home.
If you see the GP because your symptoms haven’t improved after a few months, they may recommend further examinations such as an X-ray or MRI in order to investigate whether the pain is the result of a different condition.
You can usually treat tendonitis at home. For the first few days after the injury, try to rest it as much as possible, apply ice, and keep the ankle elevated. Afterwards, you should be able to start moving the joint. To reduce pain and swelling you can visit your local pharmacy for painkillers and anti-inflammatory medication.
If the symptoms don’t improve after a few weeks, your doctor might recommend physical therapy, extracorporeal shockwave therapy, or steroid injections to tackle the inflammation. In severe cases, you may be offered surgery to repair the tendon.
Arthritis is a disease that causes inflammation of the membrane that covers the joints. There are more than 100 different types of arthritis, but the most common are:
The symptoms of arthritis can be:
This pathology can be a consequence of:
Joint damage can be prevented with timely and adequate diagnosis and treatment. Also, if someone has a family history it is important to talk with the doctor, even if s/he does not have any symptoms. It is also recommended to avoid repetitive and excessive movements to prevent osteoarthritis.
The treatment aims to alleviate the symptoms and prevent the disease from getting worse. The treatment can be covered by several aspects:
The hallux valgus or bunion is a bony deformity at the base of the big toe on the inside of the foot. It occurs when the big toe is pushed inward towards the rest of the toes, forcing the joint at the base of the foot outwards, causing the appearance of a bony lump or protrusion on the inside of the foot.
The main symptoms are a bulging bump in the area around the joint between the big toe and the rest of the foot, and the associated pain and inflammation, which usually get worse when walking. As the bunion grows, it will become more inflamed and uncomfortable. Other symptoms include:
Possible causes of bunions are:
To prevent bunions it is vital to pay attention to the development of our feet. When there are calluses or corns on the inside of the big toe or if you notice it is starting to point inwards, it is advisable to take some kind of measure to prevent it from getting worse. It may be impossible to prevent bunions, but the best way to lower your chances is to choose the right footwear:
Bunions are often manageable conditions, and non-surgical treatments to deal with the symptoms should always be tried before surgery. These include:
Surgey, called bunionectomy, is only indicated in severe cases where walking becomes highly difficult. Through this procedure, the surgeon can realign your toe and remove the bony protuberance and swollen tissue. However, full recovery can take weeks, or even months, and even then bunions can recur. For this reason, it is important to only wear appropriate shoes and take care of your feet after surgery.
Cavus foot (sometimes known as Pes cavus) is a type of foot deformity. In cavus foot, the arch of the foot is higher than normal and can’t flatten. Sometimes, the toes might be curled up and the heel drawn in. Cavus foot usually affects both feet.
What distinguishes cavus foot from other foot deformities involving a high arch is that the front part of the foot is drawn downwards, so the foot tends to rest on the outer side.
Cavus foot can be straightened through surgery (see the part on treatment below), but this is only considered if it’s causing severe symptoms.
Some people don’t experience any problems other than finding it a little more difficult to buy shoes that fit.
Other people with the condition experience foot pain, particularly around the ankle or on the ball of the foot. The foot as a whole can ache if you’re on your feet for long periods of time because cavus feet tend to be stiffer than normal and cannot take pressure as well.
Cavus foot can also cause some people to sprain heir ankle more easily, or experience numbness as a result of their skin rubbing on shoes.
A diagnosis is usually made with a clinical examination and follow-up tests.
In the examination, the doctor ask about your symptoms, including any pain you experience – in your foot as well as in other parts of the body. Next the doctor will examine your foot and the way you stand to determine the kind of deformity you have. Finally, they will ask about your family history, as cavus foot is often an inherited condition.
The doctor is likely to order further tests to rule out or confirm other possible causes of the condition. This can include neurological tests, or scans of your spine if a tumour is suspected.
Most people with the cavus foot have a neurological disorder, which could be static (symptoms stay the same) or progressive (symptoms worsen over time).
Static neurological disorders that cause cavus foot include stroke, polio, cerebral palsy, spinal injury, and peroneal nerve injury.
Progressive neurological disorders that can cause cavus foot include a spinal tumour, brain tumour, spinal cyst, muscular dystrophy, Friedreich’s ataxia, and Charcot-Marie-Tooth syndrome.
One in five cases of cavus foot have no obvious cause.
For most people cavus foot doesn’t involve serious enough symptoms to treat with surgery, and the best thing to do is simply to make sure you take care of your feet. For some people foot pain can be improved by wearing special insoles or foot braces. Others have found physiotherapy helpful in improving their ankle muscles for greater stability. If you play sport, it’s important to make sure there is plenty of shock-absorbency in your shoes.
Surgery for cavus foot can include a range of procedures, including:
The aim of surgery is to put your foot in a neutral position, reducing pain and improving your mobility and balance.
Foot surgery is a major operation – expect to have your foot in a cast for about six weeks, with full recovery taking up to twelve months. This is why it is generally only recommended in patients where symptoms are severe or expected to get worse.
Diabetic foot is a set of complications of vascular and nervous conditions that affects patients with chronic diabetes. The effect of irregular blood sugar levels on the vascular system may lead to arterial blockages that impede blood supply to the feet and in severe cases can cause gangrene. On a neurological level, the effect can be on a motor skill or sensory level. The sensation for the patient is the feeling of wearing a tight or excessive cold or heat sock, and the loss of muscle mass at foot level. Both causes, vascular and neurological, can result in of neuropathic diabetic foot ulcers, which can often be complicated by infection. A diabetic foot is often very delicate and vulnerable to discomfort when wearing shoes, although in many patients the symptoms are painless.
The arch, or instep, of the foot is the part in the middle of the foot that is usually raised off the ground. Flat feet are when the arches of the feet are very low or non-existent, in some cases lying completely flat against the ground. They may occur due to weakness in the tendons in that area. It is a common condition, especially in children, whose arches may develop as they grows up. There are two types: rigid flat foot, which has no arch under any circumstances; and flexible flat foot (the most common type), in which the foot flattens when pressed on the ground, but when raising it, the arch reappears.
Before two years of age, flat feet are impossible to detect, because until then the feet have a layer of fat and soft tissue on the sole. The insteps form in most children between the ages of 3 and 5. After this age, the key symptom is the flat appearance of the foot, without an arch.
Generally, flat feet do not cause pain when walking or making any movement, but some patients may experience pain in the feet, ankles, or even higher up in the legs, hips and lower back. This pain may get worse when moving around, and swelling can occur around the ankles.
There are several possible causes of flat feet. In babies and toddlers, flat feet are normal, as the arch hasn’t formed yet. Even older children may have flexible flat feet, where the arch only appears when the child is not putting pressure on the sole of the foot, e.g. when sitting. As this is due to the fact that the arch is still developing, most children with flexible flat feet will grow out of them. In other cases, flat feet may be caused by the following:
Most of the causes of flat feet are impossible to prevent. However, you can minimise your chances of developing flat feet in adulthood by taking care of your feet. Some steps you can take include:
Most cases of flat feet do not cause the patient any problems, in which case, no treatment is necessary. In cases where flat feet cause pain, the following treatments may be advised by the patient’s doctor:
If more conservative treatments fail, or if there is an underlying condition, there are surgical options. If bones are abnormally shaped or joined together, surgery may involve straightening and separating them; if the problem is in the connective tissue, surgery may involve lengthening or repairing this tissue.
Foot arthrodesis (foot fusion surgerry) is a surgical technique consisting of the artificial fusion of bones forming the joint, which become immobile after the surgery.
Foot arthrodesis surgery is performed under local anaesthesia as an outpatient procedure.
The goal of the intervention is to relieve pain or to reduce any deformity caused by:
Two different techniques are used in foot arthrodesis:
Open foot arthrodesis: A large incision is made and the joint is visualised directly.
Arthroscopic foot arthrodesis: Small incisions are made in the skin and a thin arthroscope is passed through. The arthroscope has a small camera and is connected to a monitor allowing the doctor to view every stage of the operation. Other thin instruments for performing the surgery are passed through the incisions into the joint. There are many ways to attach the two bones together so that they do not move in relation to each other:
Preparation involves exhaustive cleaning of the metatarsal bone and the base of phalanx until the subchondral bone appears.
The joints will take four months to fuse completely. Subsequently, you will require rehabilitation therapy with a physiotherapist. Post-operative pain is fully controlled with tablets. During this period, post-operative therapies, follow-up X-rays and rehabilitation exercises are done. Post-operative footwear must be worn for 6-8 weeks, until the bones fuse. Subsequently, you will wear trainers for a similar duration.
Arthroplasty or replacement of the joint is an alternative way to improve the affected joint and to relieve pain.
A foot fracture is a break in any of the bones of the foot (tarsus, metatarsals and phalanges). The injury occurs by direct trauma or excessive load on the bone. The foot fracture causes pain, swelling, numbness of the fingers or toes, decreased range of motion, inability to walk comfortably, and a lump or visible deformity over the fracture zone. Depending on the severity of the fracture, the patient could undergo surgery or have a splint or cast. The metatarsal bones and phalanges can be fixed in a period ranging from three to six weeks, but the tarsal bones take longer to heal, usually six to ten weeks.
A fractured ankle is a break in one of the ankle bones (tibia, fibula and talus). These fractures may be partial (partially cracked bone), complete (perforated in two parts and bone) or may occur on one or both sides of the ankle. The injury may be caused by a fall or trauma. Symptoms may include pain and swelling in the injured ankle, unable to move or inability to bear weight. And, if the fracture is severe, you may notice that the parts of the fractured bone show through the skin. In the latter case, the injury may require surgery, including the use of metal pins, screws or plates to hold the bones in place while the fracture heals. If the ankle fracture is treated without surgery, it is likely that the patient must wear a cast for at least six weeks. Most people need at least a period of between six and ten weeks to fully recover from a broken ankle.
A ganglion cyst is a benign but painful growth, usually on the hand or wrist. The pain often comes on at night, or after constant use of the hand.
Ganglion cysts can vary in size, growing up to three centimetres wide. While the position of the cyst doesn’t tend to change, the size may fluctuate over time, and some go away entirely without treatment.
As previously mentioned, ganglion cysts sometimes go away on their own. If the cyst persists, treatment may be recommended to reduce the size or attempt to remove it completely. Unfortunately if the cyst is removed there is still a chance that it will come back, and you may need further treatment.
Cysts usually form a visible nodule, although in some cases if the cysts are small they may not be noticeable.
Many of them have no symptoms, but if they do press on a nerve, it can cause pain, tingling and muscle weakness.
Usually a ganglion cyst can be diagnosed by your GP with a physical examination. They may use a syringe to draw out fluid from the cyst. In some cases, they might refer you for an ultrasound or MRI to look at the inside of the lump and rule out other potential causes.
The cause of ganglion cysts is unknown. They have been found to be more common in young people between the ages of 15 and 40 and to develop more in women. It is also more likely to be developed by people who use and overload the wrist. People who have arthritis may develop them more easily.
At the moment it is not clear how to prevent ganglion cysts. The best thing to do is to see you doctor early on if you notice anything unusual.
For many people, treatment will not be necessary especially if there is no associated pain. The main job of the GP will be to reassure you that the lump is not caused by anything more serious.
However, if the cyst is causing you pain the GP may recommend treatment. The two main forms of treatment for ganglion cysts are:
Surgery is a more complex treatment and may involve putting your hand in a splint for several days afterwards. However, it tends to result in fewer recurrences of the cyst compared to aspiration.
A heel spur is a calcium deposit in the heel produced as a result of excessive and continuous stretching of the plantar fascia, a ligament that connects the heel to the foot. It causes the heel bone to protrude very slightly. Some heel spurs are very small and difficult to pick up on an X-ray.
If it is not treated in time, the disease can become chronic, resulting in a very painful and difficult to cure condition.
Often you can have a heel spur without symptoms. When symptoms do occur, the most common are pain and swelling in the area around the heel, and difficulty with putting your weight on your heel. The pain is usually felt on the inside on the heel and gets worse when you are active.
Diagnosis of a heel spur usually requires an X-ray examination to get a better view of the heel bone.
A heel spur is usually the result of:
Even if you have a genetic condition that affects the structure of your foot, it is possible to prevent heel spurs by taking appropriate steps. You may require orthotic insoles or adapted shoes to properly support your foot.
All people can help avoid heel spurs by avoiding poorly-fitting shoes, and taking extra care to wear suitable footwear when doing sports. Finally, maintaining a healthy weight is important.
Conservative treatment usually involves:
In the vast majority of people these treatments will improve symptoms. In some patients, however, surgery may be necessary to correct the spur and relieve pain caused by inflammation of the plantar fascia.
Podiatrists specialise in the examination, assessment, and treatment of foot problems. If you see your GP about a foot problem and they are unable to make a diagnosis themselves they are likely to refer you to a podiatrist. In the UK podiatrists are also known as chiropodists.
Depending on the treatment recommended, you may also see a physiotherapist or orthopaedic surgeon.
Metatarsals are five long bones in the foot, found between the bones of the toes and the tarsal bones. Each metatarsal is attached to one of your toes. They are positioned side by side in the shape of an arch, which gives the foot its arch. They are important for maintaining balance when standing and walking.
The two most common conditions which can affect the metatarsals are:
Metatarsalgia – an injury which affects the sole of the foot near the beginning of the toes, in severe pain, limping and even being unable to walk. This is a very common problem, affecting women and sportspeople in particular, with the metatarsal of the second finger being the most affected.
Fifth metatarsal fracture – the fifth metatarsal is a bone located on the outer edge of the foot. It is of clinical importance because many fractures occur in this bone. Its fracture is very frequent in the sports field, especially in those sports that require jumping and changes in rhythm and direction (such as football and basketball). Fracture can occur because of prolonged exercise or because of a sudden movement.
Treatment for metatarsalgia depends on the cause. Some basic things you can do to aid the healing process are wearing suitable footwear, losing weight, or using custom insoles to reduce pressure on the injured area.
Conservative treatment to eliminate pain is recommended with physical therapy, with exercises such as:
Pharmacological therapy is recommended in the most acute phases of pain with the presence of inflammation. Hyaluronic acid injections are sometimes additionally performed to relieve pain and reduce inflammation.
Surgical treatment may be advisable in the case of metatarsalgia caused by a deformity of the foot to try to restore the ideal biomechanics of the forefoot:
Stress fracture of a metatarsal usually responds well to conservative treatment. Immobilisation with a cast or splint and crutches are usually applied to avoid loading the affected foot. It is also recommended to apply ice during the first 48 hours after the fracture to combat inflammation and pain.
Surgical treatment is indicated only in cases of comminuted fracture, complete fracture with displacement of the bone fragment or in cases where, after a period of immobilisation, the fracture has not been properly healed.
Podiatrists specialise in the examination, assessment, and treatment of foot problems. If you see your GP about a foot problem and they are unable to make a diagnosis themselves they are likely to refer you to a podiatrist. In the UK podiatrists are also known as chiropodists.
Depending on the treatment recommended, you may also see a physiotherapist or orthopaedic surgeon.
Minimally invasive or percutaneous surgery for bunions is a novel technique for treating bunions. It is performed under local anaesthesia.
Minimally invasive surgery for bunions is an alternative to open surgery which has several advantages:
Minimally invasive surgery for bunions is generally indicated for those cases in which attempts to treat the pain with conservative medical treatments (anti-inflammatory agents, splints, corrective footwear) have been unsuccessful, with pain persisting or increasing, making it difficult to walk.
Conservative medical treatments are not effective in severe cases; this is why it is important to consult with an orthopaedic specialist when the first symptoms appear.
This type of surgery involves making small skin incisions, around 2mm in length, then introducing through them the small instruments with which the bunion is eliminated.
The intervention is straightforward and takes 10-15 minutes. It is a procedure that only requires local anaesthesia. The patient can return home on the same day.
After the procedure, orthopaedic footwear, a special shoe, will be worn. You are then allowed to place weight on the foot.
Osteotomy via open surgery : In cases with greater deformity, open surgery is performed, during which the bone is cut and screws are placed to ensure that the correction is permanent. This surgery is also performed under local anaesthesia on an outpatient basis.
Morton’s neuroma (also known as Morton’s metatarsalgia or interdigital neuroma) is a painful condition of the foot caused by one of the nerves between the toes becoming irritated and the tissue around it becoming thickened. It most commonly affects the nerve between the third and fourth toes, but can also affect the nerve between the second and third toes.
The pain caused by Morton’s neuroma is often said to feel like you are standing a pebble in your shoe, but the pain can be sharp, and the toes may also sting or experience numbness.
There are no outward symptoms of Morton’s neuroma; instead it manifests as painful or uncomfortable sensations in the ball of the foot and the toes, including:
It is recommended that you see a doctor if the symptoms last more than a few days.
It is not fully understood what causes the nerves in the foot to become irritated and subsequently thickened, but it is this irritation and thickening that causes the pain associated with Morton’s neuroma. It is thought that the cause is some sort of damage to the nerve, either by over-compressing or over-stretching it.
Some risk factors include:
It is unclear if these factors are direct causes of Morton’s neuroma, or simply things that exacerbate it.
Treatment for Morton’s neuroma depends on the individual case; the doctor will discuss options with the patient based on the severity and how long the patient has had the condition.
Non-surgical options to reduce pressure on the foot or offer pain relief include:
Not all patients respond to these methods, in which case, surgery may be advised. This may involve removing tissue around the nerve to create more space and reduce pressure, or removing part of the nerve itself.
Many orthopaedic surgeons, especially those that specialise in foot and ankle problems will treat Morton’s neuroma. There are also special foot doctors called podiatrists, who have expertise in this area.
Orthopaedic surgery is the field of surgery responsible for diagnosing and treating a wide range of conditions of the musculoskeletal system, as well as for reducing the symptoms of any conditions affecting it. These conditions can affect the bones, cartilaginous structures or the joints.
Some of the conditions treated by orthopaedic surgery include:
Emergency or trauma surgery can be regarded as a sub-specialisation of orthopaedic surgery. This type of surgery treats people who’ve suffered a traumatic injury (thus, an acute trauma). A few examples of traumatic injuries include:
If you have one of the above-mentioned conditions, you should see an orthopaedic specialist, who will determine whether or not you need surgery. Should the orthopaedic specialist also be a surgeon, he or she will be the one performing the surgery (if needed).
Osteoarthritis is a degenerative disease that affects the joints and cartilage. As cartilage breaks down and pain sets in, the bone reacts by growing on either side of the cartilage and becoming deformed.
Ankle arthritis is a degenerative joint disease involving wear and tear of the cartilage that covers the bone. If these tissues wear, they won’t be able to cushion the weight that the ankle carries.
Ankle arthritis is not a common disease, and usually appears due to a foot or leg fracture. The opposite is true for hip or knee arthritis, which are much more common.
A patient with ankle arthritis will normally feel:
Over time the ability to walk begins to decrease. In severe cases the person is unable to walk more than a few metres, if at all.
In order to correctly diagnose ankle arthritis the patients’ medical history must be taken into account, including any trauma that the ankle may have suffered.
The doctor will then examine:
X-rays are normally taken, as they enable the doctor to look at the joints and bones in the foot. Sometimes further imaging tests are done, such as an MRI or CT scan. They allow a better view of the ankle and surrounding joints.
The main causes of arthritis in the ankle are:
Some recommendations to prevent ankle arthritis include:
Conservative treatment of ankle arthritis includes:
In severe cases where you are experiencing a lot of pain or the join is badly damaged, you might be offered surgery. Surgery can either involve fusion of the ankle bones, or an ankle replacement. Both kinds of surgery can now be carried out using minimally-invasive techniques, resulting in reduced postoperative pain and a faster recovery.
If you have arthritis it is likely you will see a rheumatologist for conservative treatment. Ankle surgery involves referral to an orthopaedic surgeon.
An osteotomy is a surgical procedure, carried out using general anaesthesia, that repairs damaged joints by cutting and reshaping the bones.
An osteotomy can be performed on the following joints:
An osteotomy will fix problems experienced in different bones and joints.
Due to the complexity of an osteotomy, a hospital stay will be required. General anaesthesia is used, meaning you are asleep during the operation. The surgeons makes an incision over the area of bone that is being remodelled. Using a special surgical saw, a section of bone will be removed. The cut edges of bone are then secured together with metal hardware or special bone grafts. For a bone graft, a wedge of bone is usually taken from the pelvis, and it is secured with metal hardware.
Before surgery you won’t be able to eat or drink and certain medications will have to be stopped. You will receive special instructions from your specialist.
You can expect to stay in hospital for a couple of nights. Depending on the type of osteotomy performed, crutches are likely to be needed for a couple of months. Full rehabilitation can take up to 6 months. In most cases, physical therapy exercises will be needed to help restore strength, stability and movement to the bones.
An osteotomy is often an alternative to larger surgical procedures, such as hip and knee replacements which are serious operations with very lengthy recovery times, and often revision surgeries too. Discussing your treatment options with your specialist is essential in making a treatment decision.
Percutaneous foot surgery, also known as minimal incision surgery, is a novel surgical technique to treat foot pathologies affecting the bones or soft tissues. Local anaesthesia is used in practically all cases, leading to a very significant reduction in anaesthesia-related complications.
The most common pathologies treated using percutaneous foot surgery are bunions and metatarsalgia (pain in the bottom of the toes).
Some other conditions frequently treated using percutaneous surgery are:
In other conditions, there is often a choice between open (“classic”) surgery or percutaneous (“minimally invasive”) surgery:
Percutaneous foot surgery is performed through small incisions, minimising harm to nearby tissues. Interventions are performed under X-ray guidance.
If the decision is made to perform percutaneous surgery, you will then normally undergo a presurgical blood analysis and X-ray.
After the operation, you will have to wear special shoes, which are wide and have a rigid sole, to reduce the load on the operated foot.
The first follow-up visit is usually at one week, to remove stitches. You will be taught how to change the surgical bandage. You will then have to change the bandage yourself every day after cleaning yourself for 2-3 weeks. You will also have to wear the post-surgical shoe during this period. From one month onwards, you can begin to wear normal shoes.
Percutaneous foot surgery is a treatment for treating foot pathologies that is minimally-invasive and avoids the potential complications and lengthy recovery period of traditional open surgery.
Plantar fasciitis is the inflammation of the plantar fascia by overloading or stretching. The plantar fascia is a thick ligament in the sole of the foot which connects the heel with the toes. This inflammation causes pain as you walk about, usually first thing in the morning, which flares up when standing after sitting for a long period.
Non-surgical treatments reduce pain in almost all cases. It may take several months before symptoms improve. Some people require surgery to reduce the pain.
Generally, this condition causes pain and rigidity in the lower part of the heel.
The pain is usually accompanied by the following symptoms in the lower part of the heel:
To diagnose plantar fasciitis, the patient’sclinical history is evaluated and a physical examination is performed. The examination determines which stage the plantar fasciitis is at. Next, the specialist performs a gait analysis and evaluates whether the inflammation of the plantar fascia is related to the way the patient walks. An X-ray scan or MRI scan might be performed to rule out bone problems and potential pinched nerves.
The causes of plantar fasciitis is when the tension on the tissue becomes too great, causing inflammation. It is more likely to occur in people who:
This can be difficult to prevent, however, maintaining a healthy weight can help reduce the chances of this developing. However, if you frequently do exercises such as running, dancing, or aerobics, plantar fasciitis can develop. In addition, checking that the ankle, Achilles tendon and calf muscles are flexible may help to prevent plantar fasciitis. It may also be helpful to stretch the plantar fascia in the morning before you get out of bed and to perform physical activities in moderation.
There are different treatments for this condition but the first option considered is conservative treatments, including rest, applying ice to the painful area and stretching over several months. Massaging and stretching the fascia, can help to provide symptoms relief.
Other, more novel techniques are infiltration of growth factors, intratissue percutaneous electrolysis (EPI) and shock waves, which have all been demonstrated to be highly effective treatments in the acute phase.
Moreover, more and more tools are becoming available for the manufacturing of very precise individualised shoe insoles. One such technique uses a laser to obtain a virtual 3D mould of the patient’s foot.
In very specific cases in which none of the above treatments have worked, plantar fascia surgery should be performed. During this surgery, the tendon is partially or totally released or, if a heal spur is present, the heel spur is reduced.
An orthopaedic specialist can help to treat plantar fasciitis.
Shockwaves have a therapeutic effect and cause the regeneration of injured or diseased tissues. Shockwaves are acoustic waves which have high power mechanical and biological effects. Such treatments are primarily used for treatment of diseases which require tissue regeneration.
If a person sustains an injury during exercise, sports participation or any type of physical activity, depending on the severity of the injury, they may be advised by a sports medicine specialist to see an orthopaedic surgeon for treatment. Surgery is normally the last resort for amateur sportsmen and is more common amongst professional athletes. Surgery is likely if a person has sustained a serious injury or as a result of persistent symptoms that were not successful following the use of other treatments prior to the operation.
Sports surgery can repair damaged soft tissue, realign bones and joints. However, not all injuries require surgery. A sports medicine doctor may treat the following injuries sustained through physical activity:
The most common sports injuries are strains and sprains, which is when the ligaments have been stretched past their limits and have resulted in a tear.
Many sports injuries are treated using keyhole surgery. This involves the surgeon making a small incision and using a tiny camera to guide them during the procedure. This type of surgery is most common with knee injuries and is known as arthroscopy.
Even though it is recommended to exercise regularly as an important part of maintaining overall health, precautions should be taken to minimise the risk of injuries. Sports injuries occur from overtraining, lack of conditioning and poor technique. The following tips can be used as a preventative for sports injuries:
Recovery from an operation for a sports injury depends on the severity and the individual case. Most injuries require a long rest period following surgery on an affected joint, muscle or soft tissue. Physiotherapy is used to rebuild strength and to increase the range of movement around the joint or muscle. It will also help to condition the injury to make it more resistant to any future complications.
Competitive and non-competitive sports injuries are injuries that occur in athletic activities or whilst exercising. Whilst some of these happen by chance, others are facilitated by inadequate practice or poor execution in terms of technique, as well as by not using sports equipment correctly.
Sports injuries mainly consist of muscle injuries or joint and ligament injuries:
The outlook of a sports injury greatly depends on what caused it and its severity. Imaging tests (ultrasound, MRI scan) can rule out structural injuries and help to assess the severity of the injury itself. Furthermore, based on the results, the specialist can estimate how long it will take for you to recover and get back to sports, as well as your risk of getting injured again.
The symptoms of a sports injury depend on how big and how severe the injury is. They usually are:
Sports injuries, especially muscular ones, can be diagnosed with a physical examination.
The following tests may be prescribed to get further insight on where the injury is and how severe it is:
As an example, the main risk factors for a football injury are:
The main preventive measures are:
Treatment largely depends on how severe the injury is. It usually consists of physical therapy, surgery, applying ice packs, taking painkillers or anti-inflammatory medications and bed rest.
You should see a specialist in sports medicine, but you may also be treated by physiotherapists and orthopaedic surgeons, depending on your treatment plan and injury.
Sports medicine is a branch of medicine that focuses on the prevention, diagnosis, and treatment of sports-related injuries.
Sports injuries can happen suddenly, due to overtraining, not training properly, poor technique, wearing inappropriate clothing, and a lack of fitness, among other causes.
The treatments used allow the person to go back to their normal training routine as soon as possible and in the best conditions.
Sports traumatology focuses on athletes specifically and injuries arising in sport, considering the athlete's needs, whereas traditional traumatology treats general locomotive system injuries.
This kind of specialist has in depth knowledge of different types of sports and understands the different situations that the athlete may have. They not only have physical, medical, physiological knowledge of the human body, but they are also able to treat different sports injuries (due to training, seasonal changes, competition expectations, among others), as well as other reasons for injuries.
The most common injuries are:
The right treatment in sports medicine will always be based on each player’s medical history, which should include family and personal history, injury history, surgical history, and orthopaedic issues.
The information gathered in a sports admission exam will be included, this will assess postural information, the skeletal muscle, joints, ligaments, and physical fitness, risk factors will also be included for any potential injuries according to the sport.
Some of the treatments within this speciality include:
Ultrasound-guided galvanic electrolysis technique, commonly known as USGET, is an innovative medical and physiotherapy technique that enables accurate treatment of injured tendons, muscles, or ligaments, successfully treating sports injuries such as:
Platelet Rich Plasma (PRP) is a highly effective treatment to stimulate scarring, regeneration, and healing damaged tissues, such as:
Hyaluronic acid: Hyaluronic acid injections can reduce pain and revive joint function thanks to the treatment’s lubricant, mechanical, and biochemical effect. The most common areas to treat are:
A sprained ankle is an injury of the ankle ligaments caused by twisting or being stretched beyond their limit of movement.
There are three types of sprained ankle, classified by severity:
Generally, the majority of sprained ankles are mild injuries, however, some cases can be more serious, requiring longer recoveries and sometimes surgery.
The most relevant signs and symptoms of this injury are:
The diagnosis is essentially clinical and is based on the review of the patient’s history and a physical examination, via evaluating manoeuvres, such as the anterior drawer test, the forced inversion test, the forced external rotation test and the squeeze test. An X-ray may be very helpful in ruling out associated bone fractures or complete ligament tears.
A sprain may be caused by a direct impact on the ankle or following a fall or tripping over.
It is impossible to prevent a sprained ankle, but we can adopt several measures to reduce the probability of ankle sprains:
Generally, surgery is not necessary in the treatment of ankle injuries, given that the majority of ankle sprains are mild injuries that heal with minimal treatment. Some cases may be more serious, but will never require surgery.
Generally, treatment for ankle sprains consists of:
Anti-inflammatory medications provide pain relief and reduce swelling.
The right specialist for treating an ankle sprain is a specialist in orthopaedics.
Tendinopathy is an umbrella term for diseases of the tendons. Tendons are fibrous cords of tissue that hold muscles to bone, and in order to do their job, they must be strong and flexible. Despite this, they can be injured due to overuse.
Tendinopathy broadly refers to three varieties of tendon injury, and is often confused with, or used synonymously with them. They are:
All of these conditions increase the risk of a more serious tendon tear, or rupture.
The common symptom of all types of tendinopathy is pain in or around the tendon, most commonly in the place where it attaches to the bone. Other symptoms depend on the type of tendinopathy – for example, tendonitis is characterised by inflammation, including heat, swelling and redness, while tendinosis is a chronic ache, pain or stiffness without much, if any inflammation.
The pain is usually worse during and after activity, and the area around the joint can be stiffer the following day.
There are tendons in many parts of our bodies, and tendinopathy can occur in any of them. It most commonly strikes in tendons such as those in the arms, shoulder, hands, and the Achilles tendon (in the heel).
It is thought that the biggest factor in most tendinopathies is overuse, although there are many theories regarding other possible factors, such as thermal damage and load-induced ischemia. Both sudden bursts of exertion leading to injury and repetitive movements are thought to be the main causes of tendonitis, and obesity is thought to be a risk factor.
In the case of calcific tendonitis, calcium deposits in the tendon are the cause of the inflammation, but why they build up in the first place is not fully understood.
While it is impossible to prevent with 100% certainty, the best way to prevent tendinopathy is to look after your muscles and tendons by not over-exerting yourself, but keeping them strong and flexible by doing exercise. Warming up before exercise and cooling down afterwards by stretching your muscles is also recommended.
The treatment may depend on the kind of tendinopathy, but in most mild cases the RICE therapy is advised:
Painkillers may be prescribed to deal with the pain – particularly NSAIDs if there is inflammation.
In more severe cases, shockwave therapy or even surgery may be necessary.
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