Hallux valgus is a painful condition which affects the forefoot. It is a deformity that is caused by the medial deviation of the great toe metatarsal and lateral deviation of the proximal phalanx. The prominence of the bone in this area is often referred to as a bunion.
Hallux valgus is commonly associated with a strong family history, inflammatory conditions such as rheumatoid arthritis and high heels shoe wear. It is more common in the female sex, but can occur in both men and women.
Apart from the displeasing appearance, hallux valgus is often associated with pain, usually as a result of rubbing against shoe wear. It can also be associated with painful arthritis of the joint.
If you have symptoms of hallux valgus you should first see your General Practitioner. Nonoperative management usually involves modification of shoe where to include a wider toe box, calf stretches to reduce the pressure on the forefoot, and analgesics such as anti-inflammatories or Panadol if required. Surgical management involves correction of the deformity with soft tissue releases and bone osteotomy. If the deformity is severe, or there is underlying arthritis a fusion procedure may be indicated.
Hallux rigidus is a painful condition which affects the forefoot. It is caused by arthritis of the metatarsophalangeal joint of the great toe.
Hallux rigidus can be associated with a traumatic injury or inflammatory conditions such as rheumatoid arthritis or gout. However hallux rigidus most commonly occurs without an underlying cause.
If you have symptoms of hallux rigidus you should first see your general practitioner. Nonoperative management usually involves modification of shoe wear to include a rigid sole, calf stretches to reduce pressure on the forefoot, and analgesics such as anti-inflammatories or Panadol if required. Surgical management involves fusion of the metatarsophalangeal joint of the great toe. Joint replacement procedures can be performed on a select group of patients who meet the appropriate indications. However in general, the results of joint replacement procedures have been shown to be highly unpredictable.
Lisfranc injury is a very serious and highly unstable injury of the midfoot. It is usually associated with a high-energy mechanism such as in athletes, high-speed motor vehicle accidents and crush injuries. It is a very uncommon condition, left untreated the implications are very serious.
The midfoot is made up of a series of complex articulations between the bases of the metatarsals and the remaining bones of the midfoot. Disruption of these ligaments or fractures of the bones around these joints can result in instability of the midfoot. These injuries have a high risk for collapse of the arch across the midfoot and the development of post-traumatic arthritis.
Initial treatment involves immobilisation and soft tissue management. Over the first 1 to 2 weeks swelling is controlled by a combination of strict elevation, application of ice and limited mobility. Once the swelling is adequately controlled and the soft tissues have settled, surgery is usually performed. Surgery involves stabilisation of the midfoot with plates, screws and wires. Often further surgery is required to remove the plates, screws and wires once the ligaments and fractures have healed. Patients usually take six months to completely recover from this injury.
Arthritis can occur in all joints of the foot including the midfoot. The midfoot is a complex series of joints across the 11 bones in this region. Arthritis in this area can develop as a result of trauma, infection, inflammatory conditions such as rheumatoid arthritis, or there may be no identifiable cause.
Arthritic joints have lost their cartilaginous lubrication, and the contact between two rough surfaces causes inflammation and pain. Arthritic joints are also very stiff. The foot is made up of a number of complex articulations such that stiffness in one joint often results in secondary effects in other bones or joints. Pain can be activity related such as with long walks, but can also occur at rest. Arthritis commonly has a fluctuating course and you may notice there are times when the pain is significantly better and there are other times when the pain is significantly worse.
If you develop symptoms of midfoot arthritis you should first see a general practitioner. Nonoperative management involves orthotics, activity modification and anti-inflammatory medications. Surgical management for this condition involves fusion procedures across the affected joints.
Arthritis can occur in all joints of the foot including the hindfoot. The hindfoot is comprised of three main articulations: the subtalar joint, the talonavicular joint and the calcaneocuboid joint. Arthritis in this area can develop as a result of trauma, primary osteoarthritis, inflammatory conditions such as rheumatoid arthritis and hindfoot deformities such as adult acquired flatfoot.
Arthritic joints have lost their cartilaginous lubrication and the contact between two rough surfaces causes inflammation and pain. Pain can be activity related such as with long walks, but can also occur at rest. Arthritic joints are also very stiff. The foot is made up of a number of complex articulations such that stiffness in one joint often results in secondary effects in other bones or joints. Arthritis commonly has a fluctuating course and you may notice there are times when the pain is significantly better and there are other times when the pain is significantly worse.
If you develop symptoms of hindfoot arthritis you should first see your general practitioner. Treatment involves shoe where modification and orthotics, activity modification and anti-inflammatory medications. Surgery involves fusion procedures across the affected joints as well as osteotomy of adjacent bones if required.
Plantar fasciitis is a painful and all too common condition that typically affects men and women in middle age. The plantar fascia is a thick band of tissue that runs along the sole of your foot. It inserts into the medial half of the heel. This is where pain is often most severe. Often there is no underlying cause and it can often affect both feet at the same time.
If you have signs of plantar fasciitis you should first consult your general practitioner. Plantar fasciitis is usually self-limiting (which means it should get better on its own), however it can take up to 18 months.
Xrays will often show a “heel spur,” this is a common finding and is not the cause of the plantar fasciitis.
The best treatment is non-operative. Our treatment protocol includes:
1. Daily calf stretches
2. Heel cushion inserts
3. Non-steroidal anti-inflammatory medications
4. Rolling a bottle of frozen water along the sole of your foot for 10 minutes each night
5. Night splint with the ankle in dorsiflexion
If this non-operative treatment is conducted daily for 10 weeks, we have found that over 90% of patients have improved significantly.
Surgery is an option for recalcitrant cases of plantar fasciitis but is highly unpredictable and is therefore only used in severe cases that fail to improve with non-operative measures.
Arthritis can occur in all joints of the foot and ankle including the ankle joint. The ankle joint is formed between the tibia and talus bones, there is also lateral support from the fibula. Arthritis in this joint is uncommon but can occur as a result of rheumatoid arthritis, primary osteoarthritis or prior trauma to the ankle.
Arthritic joints have lost their cartilaginous lubrication and the contact between two rough surfaces causes inflammation and pain. Pain can be activity related such as with long walks, but can also occur at rest. Arthritic joints are also very stiff. The foot is made up of a number of complex articulations such that stiffness in one joint often results in secondary effects in other bones or joints. Arthritis commonly has a fluctuating course and you may notice there are times when the pain is significantly better and there are other times when the pain is significantly worse.
If you have symptoms of ankle arthritis you should first consult your general practitioner. Non-operative treatment involves non steroidal anti-inflammatory medication, well supported shoe wear or a boot and in some cases an injection of local anaesthetic and corticosteroid medications.
Ultimately, if surgery is required it will involve either fusion or replacement procedures. Ankle fusion is the gold standard and has shown excellent results for many years. Ankle replacements are a controversial topic. Over the past 20 years there have been high failure rates with ankle replacement implants. Some newer implants are showing better survival, however this operation is only an option for a select group of patients.
Ankle instability is a very common problem affecting men and women. It is associated with high level activity (most commonly sports such as soccer and netball) and therefore typically affects patients between the ages of 10 and 40. It can also occur in patients with a predisposition to ligamentous laxity (loose joints). It is often referred to as an ankle sprain or dislocation.
Ankle instability occurs as a result of the failure of the lateral ligaments that stabilise the ankle. These three ligaments namely the Anterior talo-fibular ligament, the Calcaneofibular ligament and the Posterior talo-fibular ligaments can be stretched or torn as the ankle inverts (rolls inwards).
Treatment is divided into immediate, short term and long term. Immediate treatment involves immediate application of a bandage, application of ice, rest and elevation. You should first consult your general practitioner, or if the symptoms are very severe your local emergency department. In many cases an xray will be required to exclude associated fractures. Short term management will involve application of an immobilisation boot and rest, usually for up to 2 weeks. Long term management will involve physiotherapy focusing on range of motion, strengthening and proprioception.
With appropriate treatment the risk of recurrence is low. However, if there is multiple recurrence despite non-operative treatment, surgery will be required. Surgery involves reconstruction of the three lateral ligaments.
Rupture of the Achilles tendon is a common and very serious condition. The Achilles tendon is the confluence of the main muscles that make up your calf, namely the Gastrocnemius and Soleus muscles. These are very powerful muscles that are used with each step. Therefore the Achilles tendon is a large and strong tendon.
Achilles tendon ruptures can occur in association with high paced sports such as soccer or netball. Rupture can also occur if there is pre-existing achilles tendonitis or injection with corticosteroids.
Patients typically have a sensation of being “shot in the leg” at the time of rupture. It is a sudden and very severe pain. If you have these symptoms you should be assisted to see your general practitioner or present to the local emergency department.
Treatment has evolved over the years. In the past surgery was the mainstay of treatment, however non-operative treatment is now showing equivalent results in certain groups of patients.
Non-operative treatment involves a short period of immobilisation followed by commencement of range of motion exercises and gradual weight bearing in a CAM Boot.
Surgery may be indicated depending on the nature or location of the rupture.
The Achilles tendon is the confluence of the main muscles that make up your calf, namely the Gastrocnemius and Soleus muscles. These are very powerful muscles that are used with each step. Therefore the Achilles tendon is a large and strong tendon. This large tendon can become inflamed after years of overuse.
Achilles tendonitis is a very painful chronic condition. It is often located in the substance of the Achilles tendon or where the Achilles tendon inserts into the calcaneus (heel bone). It can occur with activity and can occur at rest. You may notice nodules or bumps in the substance of the Achilles tendon or prominences of bone at the insertion into the calcaneus.
If you have symptoms of Achilles tendonitis you should first consult your general practitioner. Non-operative treatment will involve:
1. CAM Boot for walking
2. Night Boot with the ankle in dorsiflexion
3. Calf stretches
4. Non-steroidal anti-inflammatory medications
5. Rest
In cases that do not improve with non-operative management, surgery will be required. This will involve excision and debridement of scarred and fibrotic tissue or bone. Depending on the severity of the tendonitis it may also involve reattachment of the Achilles tendon once all the diseased tissue has been removed.
Flatfoot is a very common condition and isolated flatfoot is often normal and no reason for concern. Approximately 30% of people are born with a flatfoot (diminished arch of the foot). If there is no associated pain or stiffness then often no treatment is required for the duration of the patient’s life.
Some patients with flatfoot can develop foot pain or stiffness and another group of patients are born with an arch which collapses during their life. These groups of patients often require treatment and should be seen as two separate groups.
Those patients who are born with a flatfoot but develop pain or stiffness, can have causes which include congenital conditions such as tarsal coalition or accessory navicular bones. The pain and stiffness can also be due to the development of arthritis in the joints of the foot.
There are many causes for the collapse of the midfoot arch (development of a flatfoot), these include, failure of the Posterior Tibial Tendon and inflammatory condition such as rheumatoid arthritis.
There are over 25 bones in the foot and as many joints and tendons. Most of these structures are involved in flatfoot deformity. Therefore the treatment of a painful flatfoot needs to be carefully considered after all appropriate investigations.
High arches are a subjective term. Many patients are born with relatively high arches which can be normal for them. Other patients may develop high arches during their lifetime. In and of itself, high arches are not unusual and if the patients are aymptomatic, often no treatment is required.
High arches can be associated with pain, stiffness or weakness. In serious cases the cause can be neurological. This includes Charcot Marie Tooth Syndrome and disorders of the nerves, muscles or spinal cord.
If you have symptoms including pain stiffness or weakness, or are concerned by a worsening deformity of the arch you should first consult your general practitioner.
A careful diagnosis is important in these instances. Treatment will often be lifelong and should be tailored to the individual patient and their underlying diagnosis.