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The 5 most common foot and ankle conditions and treatments

1. Hallux valgus (Bunion)

What is it?
A bunion is a joint deformity affecting the big toe joint. The big toe is forced towards the other toes and the big toe joint becomes prominent and painful. A hard, bony lump forms on the joint, causing pain, inflammation and swelling. It is a very common condition affecting both sexes although more prevalent in females.

What causes it?
It is believed to be hereditary. As the deformity develops, shoe fit becomes more of a problem, leading to irritation and pain. The deformity can start in childhood and progresses, as you get older.

What is the treatment?
Good fitting shoes or footwear can help along with padding and sometimes insoles may help foot function and protect the prominent joint. Surgery can offer a permanent solution, which involves cutting the bone around the joint and fixing it in a new position with small screws. Recovery generally takes around 6 weeks, although modern techniques mean there is no need for a plaster cast.

How successful is surgery?
In an audit of 500 patients at 6 months post op 92.5% were satisfied  or more than satisfied following surgery.


2. Hallux rigidus (Osteoarthritis of the big toe)

What is it?
A joint deformity of the big toe, caused by wear and tear. Usually there is reduced range and quality of  joint motion and a bony lump over joint. The joint becomes painful and the lump irritates on shoes.

What causes it?
Often trauma can be involved e.g. stubbing the toe. Changes then occur in the joint over time.

What is the treatment?
Stiff soled shoes and insoles can often help. Injections of steroid or natural lubricants can help but may have short-lived effects. Most commonly performed surgery: debridement, cheilectomy or fusion.

Surgery involves either “cleaning up” the joint (debridement), sometimes with small implants to replace damaged cartilage Cartiva™. In later stages fusion of the big toe joint can provide permanent relief. Recovery is similar to bunion surgery

How successful is surgery?
In an audit of 100 patients divided equally either having the joint cleaned up or fusion 86% was better with clean up and 93.3% with fusion.


3. Hammer, Mallet and Claw  toe deformity

What are they?
A deformity of the lesser ( 2,3,4,5)  toes, often the 2nd (one next to the big toe). The middle joint becomes abnormally bent and causes pressure on the shoe. Corns and calluses then develop over the joint, which may be  painful.

What causes it?
Hammertoes often develop in association with bunions. As the big toe bends inwards, the pressure shifts to the second toe causing damage to ligaments and buckling of the joints.

What is the treatment?
Shoes with a deeper toe box can help along with pads and palliative podiatric care. Surgery usually involves fusion of the deformed joint either with a small implant or surgical pin, which is removed after 4 weeks. Recovery takes between 3 and 6 weeks, depending on the type of surgery.

How successful is surgery?
In an audit of 100 patients, 90% were improved following surgery


4. Morton’s Neuroma (peri-neural fibroma)

What is it?
A swollen nerve, in the 3-4 intermetatarsal space which develops in the ball of the foot. Usually causing shooting and burning pain up into the toes.
 

What causes it?
Often pinching and pressure from the joints in the “ball” of the foot lead to thickening of the nerve. Pain then starts to develop which can come and go, often affected by the type of foot wear, with tighter closed in shoes increasing the problem. Often patients feel they need to remove the shoe and massage the foot to relieve pain. Numbness can develop over time along with a feeling of "rumpled up socks" under the toes.
 

What is the treatment?
Wider shoes as a first line, occasionally with steroid injections to reduce inflammation can help. Surgery involves removing the swollen portion of nerve. This surgery takes around 3-4 weeks to recover from.


How successful is surgery?
In an audit of 120 patients 89% were improved following surgery


5. Plantar fasciitis

What is it?
Inflammation of the ligament in the heel. It is a degenerative condition. It gradually develops with patients complaining of pain after rising from bed or from sitting. The pain can improve after 5 or 10 minutes, and return after periods of standing and walking. Often bony spurs develop which may be seen on X-rays, but this is not the cause of the pain.

What causes it?
Injury to the heel, which may be innocuous, is often the cause. Shoes with harder heels can aggravate the problem. Sometimes, especially if it affects both heels it can be associated with inflammatory arthritis. The plantar fascia ligament becomes thicker and less stretch leading to micro tears and thickening with inflammation.

What is the treatment?
Treatment should focus on stretching tight foot and leg muscles, along with ice and insoles. Lifestyle changes and weight loss may help. Add on treatments include steroid injections, night splints, and in rare cases surgery to release the ligament. Supportive softer heeled shoes or trainers can help. The condition can resolve naturally in 18 months, but treatment speeds up the process.
 


Mr Jason Nandlal consults at The Chelmsford on Wednesday mornings from 8am. Mr Nandlal qualified in 1985, becoming a surgical fellow in 1999. He has been a Consultant Podiatric Surgeon at The Chelmsford Private Day Surgery Hospital since 2007 and has also worked in the NHS in Essex since 2003. Mr Nandlal has undertaken over 9000 foot and ankle surical cases in his career. 

Mr Nandlal has attained Fellowship in Podiatric Surgery, an MSc in Podiatric Surgery and is an independent prescriber for medicines. He is also a Fellow of the Royal Society of Medicine and an Associate of the American College of Foot and Ankle Surgeons (ACFAS).

To book an appointment with Mr Nandlal, please call our helpful team on 01245 253760 or e-mail info@thechelmsford.co.uk

Date: 12/04/2017
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