1. Hallux valgus (Bunion)
What is it?
A bunion is a joint deformity affecting the big toe joint. The big toe bends outward towards the second toe and the joint becomes prominent and painful. 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, footwear fitting 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 footwear can help along with pads and insoles to help foot function and protect the prominent joint. Surgery can offer a permanent solution, which involves breaking the bone around the joint and fixing it in a new position with tiny 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 970 patients at 6 months post op 94.7% were better off 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 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. Surgery involves either cleaning up the joint, sometimes with small implants to replace damaged cartilage. 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 224 patients divided equally either having the joint cleaned up or fusion 83% was better with clean up and 90.2% with fusion.
3. Hammertoe
What is it?
A deformity of the small toes, often the 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 is painful.
What causes it?
Hammertoes often develop 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 chiropody care. Surgery usually involves. Fusion 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 641 patients, 92.4% were better following surgery
4. Mortons Neuroma
What is it?
A swollen nerve, 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 knuckle 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 and insoles as a first line, along with steroid injections to reduce inflammation and alcohol injections to shrink the nerve can help. Surgery involves cutting out the swollen nerve, and takes around 3 weeks to recover from.
How successful is surgery?
In an audit of 129 patients 86% were better following surgery
5. Plantar fasciitis
What is it?
Inflammation of the ligament in the heel. 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 can be seen on X-rays, but this in itself 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. Add on treatments include steroid injections, night splints, shock wave therapy 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.
About Mr Antony Wilkinson
Mr Antony Wilkinson MSc, FPodA, FCPodS is a Consultant Podiatric Surgeon working at Park Hill Hospital in Doncaster.
Mr Wilkinson has Diploma in Podiatric Medicine. (D.Pod.M), Part 1 Primary Fellowship of the Podiatry Association (M.Pod.A), Advanced cardiac life support provider, Part 2 Fellowship of the Podiatry Association (F.Pod.A), Advanced cardiac life support Instructor.
Read more about Mr Wilkinson's qualifications, background and clinical interests.
About Ramsay Health Care UK Podiatric Services
Ramsay is a leading provider of podiatric surgery in the UK.
Please contact us if you would like to discuss any podiatric surgery procedure in more detail.