Foot Surgery Hand Surgery Wrist Surgery |
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The Clinic's Foot Services Offered |
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| Hallux Rigidus Hallux rigidus is arthritis of the main joint of the big toe in the ball of the foot. It is a wearing out of the joint surfaces. It is called "hallux rigidus" because its main feature is stiffness ("rigidus") of the big toe ("hallux"). In most people there is no definite cause - it just develops. Probably the main reason why this joint is particularly subject to wearing out is that it is under tremendous stress in walking. With each step, a force equal to twice your body weight passes through this very small joint.
Tibialis Posterior Insufficiency - Flat Feet In many people, that is just the shape the foot is. It may run in the family, and both feet are usually much the same and reasonably supple. Rarely, the flat foot shape is due to something wrong with the way the foot formed in the womb; a joint may be malformed or two or more bones may be fused together. These feet are stiff and flat and the problem is usually obvious in childhood. In other people, the foot tends to roll in too much on standing or walking. This may be due to lax ligaments in the heel (subtalar) joint or at the base of the big toe which allow more than the normal amount of rolling in of the foot. As rolling in of the foot is known as "pronation" these people are said to have an "over-pronated foot". Due to the rolling in of the middle of the foot, the heel usually points outwards more than normal, as does the front of the foot. These people often have lax joints in other parts of their body too. This is the usual reason why children have no arch in their feet: children tend to have looser joints than adults. As they get older their joints tighten up and, in most children, an arch appears. The best way to tell if a person has mobile over-pronated feet is to stand on tip-toe, or to push the big toe up as far as it will go. If this causes the arch to appear, the foot is flexible and probably basically normal.
Plantar Fascitis - Heel Pain Pain in the heel can be caused by many things. The commonest cause is plantar fascitis (which will be discussed more in the next section). Other causes include:
Lesser Toe Surgery The small toes are important in walking, especially when pushing off with the foot towards the next step. They share the pressure with the big toe and the ball of the foot. Most deformities of the lesser toes are the result of a muscular imbalance within the foot which causes the lesser toes to deform. The toes become deformed when the pressures on the toes are stronger than the joints can resist. The joints may be weak because they have been damaged by injury or arthritis. The muscles that control them may become unbalanced, so that one set pulls harder than others and causes the toe to bend. In some people the tissues in the lower part of the joint at the base of the toe become weak, allowing the base of the toe to drift upwards. The main problem with deformed toes is that they tend to rub on your shoes, either on the top of the toe, the tip of the toe, or both. This rubbing may simply be uncomfortable, or the skin may be rubbed raw. Bent toes may also rub on one another. If your toes are interfering with your daily activities and the problem is not helped by simple measures such as buying shoes which have enough room in the toe area, avoiding high heels and using small pads on the top or end of the toe to improve discomfort, surgery may be a consideration. The aim of surgery would be to reduce pain and improve your foot function correcting any toe deformities at the same time. There are several small surgical procedures which can be utilized depending on the exact nature of your problem.
Midfoot/Lisfranc Fractures Lisfranc injuries occur at the midfoot, where a cluster of small bones form an arch on top of the foot between the ankle and the toes. From this cluster, five long bones (metatarsals) extend to the toes. The second metatarsal also extends down into the row of small bones and acts as a stabilizing force. The bones are held in place by connective tissues (ligaments) that stretch both across and down the foot. However, there is no connective tissue holding the first metatarsal to the second metatarsal. A twisting fall can break or shift (dislocate) these bones out of place. Lisfranc fracture-dislocations are often mistaken for sprains. The top of the foot may be swollen and painful. There may be some bruising. If the injury is severe, you may not be able to put any weight on the foot. Lisfranc injuries are often difficult to see on x-rays. If the initial x-ray does not show an injury, further tests may be required. This may include weight bearing xrays, CT Scan or MRI Scan (magnetic resonance image). Treatment of a Lisfranc injury depends on the severity of the injury. If the bones have not been forced out of position, you will probably have to wear a cast/ boot and refrain from putting weight on the foot for about six weeks. Sometimes, operative treatment is needed to stabilize the bones and hold them in place until healing is complete. You will then be required to wear a cast/ boot. It is important that you refrain from activities until advised otherwise by your surgeon. If you return to activities too quickly, you may easily suffer another injury.
Sesamoid Problems Sesamoids are like pulleys. They provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. The sesamoids in the forefoot also assist with weightbearing and help elevate the bones of the great toe. Like other bones, sesamoids can break (fracture). Additionally, the tendons surrounding the sesamoids can become irritated or inflamed. This is called sesamoiditis and is a form of tendonitis. In most patients, pain is focused under the great toe on the ball of the foot. With sesamoiditis, pain may develop gradually. With a fracture, pain will be immediate. There may be swelling and bruising present and you may experience difficulity and pain in bending and straightening the great toe. Treatment for sesamoiditis is generally non operative. However, if conservative measures fail, you surgeon may recommend surgery to remove the sesamoid bone.
Mortons Neuroma A neuroma is a benign tumour of a nerve. Morton's Neuroma is not actually a tumour, but a thickening of the tissue that surrounds the digital nerve leading to the toes. It occurs as the nerve passes under the ligament connecting the toe bones (metatarsals) in the forefoot. Morton's Neuroma most frequently develops between the third and fourth toes, usually in response to irritation, trauma or excessive pressure. The incidence of Morton's Neuroma is 8 to 10 times greater in women than in men. Normally, there are no outward signs, such as a lump, because this is not really a tumour. Patients complain of burning pain in the ball of the foot that may radiate into the toes. The pain generally intensifies with activity or wearing shoes. Night pain is rare. There may also be numbness or an unpleasant feeling in the toes. Runners may feel pain as they push off from the starting block. High-heeled shoes, which put the foot in a similar position to the push-off, can also aggravate the condition. Tight, narrow shoes also aggravate this condition by compressing the toe bones and pinching the nerve. Treatment for Morton's Neuroma can be non operative. If conservative treatment does not relieve your symptoms your surgeon may discuss surgical treatment options with you. Surgery can resect a small portion of the nerve or release the tissue around the nerve.
Source: British Orthopaedic Foot & Ankle Society; OrthoGate Project |
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