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Mr Jason Nandlal, Consultant Podiatric Surgeon, has been working in the NHS in Essex since 2003 and has been consulting at The Chelmsford since 2007 and has performed over 9000 foot and ankle surgical cases in his career. Mr Nandlal, has highlighted the top 5 most common podiatric conditions and the associated frequently asked questions.
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.
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.
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.
In an audit of 500 patients at 6 months post op 92.5% were satisfied or more than satisfied following surgery.
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.
Often trauma can be involved e.g. stubbing the toe. Changes then occur in the joint over time.
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
In an audit of 100 patients divided equally either having the joint cleaned up or fusion 86% were better with clean up and 93.3% with a fusion.
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.
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.
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.
In an audit of 100 patients, 90% were improved following surgery
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.
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.
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.
In an audit of 120 patients 89% were improved following surgery
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.
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.
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.