Foot and Ankle Surgery
Please select from the following:
 Hallux Valgus
This condition is commonly called as bunion deformity. The big toe is deviated towards the outer side of the foot.
This can be associated with pain over the bunion and a wide fore foot.
X-rays are required to assess the degree of deformity and plan treatment.
Scarf Osteotomy
Scarf and Akin Osteotomy
Chevron Osteotomy
Treatment is required for pain and difficulty in wearing shoes.
Non-operative treatment includes wearing wide fitting footwear.
Operative treatment usually involves making cuts in the bone to straighten the big toe.
For mild deformity, I perform a modified Chevron osteotomy.
For severe deformity, I perform Scarf osteotomy with Akin osteotomy if necessary.
The cuts in the bone are fixed with screws so that there is no need for plaster of Paris. Rarely, if the bone quality is poor and the fixation is not adequate, you need plaster immobilisation. The bone heals in approximately six weeks.
Complications are rare and they include:
- Infection - would require antibiotics and rarely another operation.
- Nerve damage - resulting in numbness and painful scar, either temporary or permanent.
- Swelling of the foot - can take 3 to 6 months to settle.
- Blood cots (DVT) are very rare.
- Non-Union - Bone heals in 6 weeks. Rarely, it can take longer time to heal and if does not heal, you would require a second operation to stimulate healing.
Postoperative treatment
You will be x-rayed the next day and allowed to walk with a pair of crutches without putting any weight through the toes.
Follow - up in 2 weeks to check the wound and then in 6 weeks to x-ray the foot to assess bone healing.
You will be able to drive in 6 weeks provided the bone has healed and you have pain free movements in the foot.
Bunionette deformity
This is caused by prominence at the outer border of the foot due to deformity of the lesser metatarsal bone.
Treatment depends on the severity of the condition and includes:
- Non-Operative - wide fitting shoes
- Operative - Corrective osteotomy
Morton's Neuroma
This is a condition caused by thickening of a nerve between 2 toes. Patients present with pain, clicking and numbness of the toes. It is common to occur between the 2nd & 3rd and 3rd & 4th toes. Ultrasound scan is useful to confirm the diagnosis. Treatment includes
Insole
Surgical excision:
Surgery is required if pain does not resolve with insoles. I prefer to approach the neuroma through the top of the foot. Result of surgery is very good. You will be left with permanent numbness of the toes, which does not cause any disability.
Hallux Rigidus - Painful stiff big toe
This condition is caused by arthritis of the big toe joint, resulting in pain and stiffness of the joint.
The treatment option depends on the stage of the disease and includes:
- Cheilectomy - Removal of bone spur
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- Joint fusion
- Joint replacement
Plantar Fasciitis - Painful heel
This is one of the common causes for heel pain. This is caused by inflammation of a cord of tissue attached to the heel bone. Patients present with severe early morning pain in the heel. Treatment includes:
- Heel pads, stretching and night splint
- Steroid injection
- Rarely surgery to release the fascia from the heel bone.
Tibialis Posterior Tendon Disorder
This is one of the common causes for flat foot deformity in an adult. This is caused by inflammation of the tendon lining, resulting in complete rupture of the tendon in severe cases.
Clinical features:
- Pain and swelling on the inner side of ankle
- Flat foot
- Weakness of the tendon
- Too many toes (seen from behind)
Investigation:
Treatment:
- Depends on the stage of the stage.
- Splint and drugs
- Synovectomy and tendon release
- Tendon transfer with heel bone osteotomy.
- Joint fusion
Ankle Instability
Instability is usually caused by complete rupture of the outer ligament of the ankle joint.
Incomplete damage (one slip of the three) called sprain of the ankle is treated with RICE regime, which includes - Rest, Ice, Compression, and Elevation.
Severe cases involving damage to all 3 slips of the outer ligament can cause persisting pain, giving way and swelling. These patients would require surgery to reconstruct the ligament. Surgery involves either tightening the capsule and ligament or use one of the tendons to strengthen the ankle.
Footballer's ankle - Anterior impingement
This condition is caused by a bone spur in front of the ankle resulting in reduced ankle movement. This is common among football players and hence the name Footballer's ankle. Treatment is by arthroscopic resection of the bone spur. Rarely, the joint needs to be opened if the spur is very large
Ankle Arthritis
Arthritis results from damage to the joint cartilage, which can be caused by systemic disease like rheumatoid, trauma, infection and others.
Treatment depends on the stage of the disease and includes:
- Arthroscopy
- Joint fusion
- Joint Replacement
Arthroscopic surgery is useful in early stages of the arthritis. This operation reduces pain by removing loose debris inside the joint and washing out pain producing factors. This operation will not cure arthritis but will make it less painful.
Joint replacement:
Joint Replacement for ankle is done in increasing numbers recently. Short-term results are encouraging. Joint replacement abolishes pain and improves the range of movement to certain extent. Complications include infection, blood clots (DVT), fracture, loosening of the implant.
Joint fusion:
Some patients are not suitable for joint replacement. Fusing the joint abolishes pain at the expense of loss of movement.
Achilles Tendon Disorders
Rupture of the tendon causes severe pain in the calf muscle and difficulty in walking.
Diagnosis is by history, clinical examination and occasionally special test like ultrasound.
Simmond's test is positive - ankle does not move by squeezing the calf muscle.
Treatment can be non-operative or operative and depends on your level of activity and associated medical disorders.
Advantage of surgery is lower rate of re-rupture and improved strength of the tendon.
Disadvantage includes infection, nerve damage, delayed wound healing.
Achilles tendinopathy and paratendinopathy:
This condition refers to thickening of the Achilles tendon and tendon sheath respectively. Treatment varies from rest, physiotherapy, and surgery
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Surgeons
Chinnakonda Arvind
Foot & Ankle Surgeon
More Info
Mr. Chinnakonda Arvind, FRCS (Tr. & Orth.)
Knee and Foot & Ankle surgeon
Secretary: Mary Wilkins
Tel: 0118 902 8060
Fax: 0118 902 8153
Email mary.wilkins@ramseyhealth.co.uk
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