Ankle & Foot
Bunion Surgery
Achilles Tendon Repair
What is a bunion?
A bunion, also known as hallux valgus, is bony prominence at the base of the big toe, which often results in pain, redness and rubbing in footwear. The 1st metatarsal bone abnormally angles outward towards the other foot from its joint in the midfoot. A bunion can change the shape of your foot, make it difficult for you to find shoes that fit correctly and worsen the symptoms if left untreated.
What are the causes of bunions? Although it is not clearly understood why bunions occur, possible causes include:
- Family history and genetics- Arthritis (inflammation of the joints) including rheumatoid arthritis, psoriatic arthritis and gout- Neuromuscular conditions such as cerebral palsy (affects movement and coordination)- Connective tissue disorders such as Marfan's syndrome (affects the connective tissues)- Tight fitting shoes that are too tight, narrow or high heeled. Signs and symptoms of bunions The main indication of a bunion is the pointing of the big toe towards the other toes of the foot. Other signs and symptoms include:
- Pain and swelling over the big toe that increases while wearing shoes- Swelling with red, sore and calloused skin at the base of the big toe- An inward turning of the big toe pushes the second toe out of place- A bony bump at the base of the big toe- Sore skin over the bony bump- Difficulty walking and wearing shoes Diagnosis of bunions The diagnosis of a bunion by an orthopaedic surgeon includes taking a medical history and performing a physical examination to assess the extent of misalignment and damage to the soft tissues. Your surgeon will usually order weight-bearing X-rays (i.e. taken while standing) to access the severity of the bunion and deformity of the toe joints.
Treatment of bunionsConservative treatment for bunions
Your GP may have already initially recommended conservative treatment measures with the goal of reducing or eliminating your foot pain.
Such measures can include:
- Medications for relieving pain and inflammation- Wearing surgical shoes with a wide and high toe box, avoiding tight, pointed or high-heeled shoes.- Use of orthotics to realign the bones of your foot and ease the pain.- Padding of bunions- Ice applications several times a day Conservative treatment measures can help relieve the discomfort of a bunion, however, these measures will not prevent the bunion from becoming worse.
Surgery for bunions Surgery is the only means of correcting a bunion. Surgery is also recommended when conservative measures fail to treat the symptoms of bunion.
There are many surgical options to treat a bunion. The common goal is to realign the bones in the foot, correct the deformity, and relieve pain and discomfort. The surgery is performed as a day procedure, under the effect of a light general anaesthetic and a regional nerve block. When you wake up, you will not be in pain and will be able to walk on your foot straight away.
Osteotomy is a common type of bunion surgery that involves the surgical cutting and realignment of the bones around your big toe. Your surgeon selects the appropriate surgical procedure based on the type of bunion and its severity.
There are 3 main types of osteotomies used by foot and ankle surgeons; namely akin osteotomy, chevron osteotomy, and scarf osteotomy.
Akin Osteotomy Akin osteotomy corrects the sideways deviation of the big toe. In this procedure, your surgeon makes a small cut in the proximal phalanx (base of the big toe) and removes a wedge of bone to straighten the big toe. The bony fragments are then stabilised using a screw or staples. This procedure is often used in conjunction with the other procedures below.
Chevron osteotomy A chevron osteotomy is usually recommended for mild to moderate bunion deformities. During this procedure, your surgeon will make an incision over your big toe. The joint capsule is opened and the bunion is removed using a surgical saw. A
V-shaped cut is made on your big toe and the metatarsal bones are shifted to bring your toe into its normal anatomical position. The bunion is then shaved and the soft tissues are realigned to correct the position. Akin osteotomy may be performed if necessary. The mobility of your big toe is examined, and the capsule and wound are re-approximated with sutures. Screws or pins are used to hold the bones in their new position until healing.
This procedure can also be performed minimally invasively with keyhole style incisions.
Arthrodesis: Involves fusing the two bones that form the big toe joint. This procedure is used for severe bunions and when arthritis has set in. The movement of your big toe is reduced following this procedure but pain and deformity are very well controlled.
Scarf Osteotomy Scarf osteotomy is usually recommended for moderate to severe bunion deformities.
Your surgeon will make an incision along your big toe and open the joint capsule to expose the bump. The bump on your big toe is then removed using a bone saw. Your first metatarsal bone is then cut in a Z shape and realigned to correct the deformity. Your surgeon will fix the cut bone with pins or screws. The joint capsule and surgical wounds are then re-approximated using dissolvable sutures keeping your toe in a straight position. This is a very powerful corrective procedure with excellent long term results.
Risks and complications As with any surgery, bunion surgery involves certain risks and complications. They include:
- Infection- Recurrence of the bunion- Nerve damage- Unresolved pain and swelling- Joint stiffness or restricted movement- Delayed healing or healing in the wrong position In rare cases, a second surgery may be necessary to correct the problems.
Post-operative care Patients should follow all instructions given by the surgeon following the surgery. These include:
- Keep your dressings dry and leave them in place until your next outpatient appointment.- Minimize walking where possible.- Elevate the foot to minimize swelling as much as possible for the first 6 weeks.- You will have to wear specially designed post-operative shoes to protect the wounds and assist in walking- You may not be able to wear regular shoes for 6 weeks
What are the causes of bunions? Although it is not clearly understood why bunions occur, possible causes include:
- Family history and genetics- Arthritis (inflammation of the joints) including rheumatoid arthritis, psoriatic arthritis and gout- Neuromuscular conditions such as cerebral palsy (affects movement and coordination)- Connective tissue disorders such as Marfan's syndrome (affects the connective tissues)- Tight fitting shoes that are too tight, narrow or high heeled. Signs and symptoms of bunions The main indication of a bunion is the pointing of the big toe towards the other toes of the foot. Other signs and symptoms include:
- Pain and swelling over the big toe that increases while wearing shoes- Swelling with red, sore and calloused skin at the base of the big toe- An inward turning of the big toe pushes the second toe out of place- A bony bump at the base of the big toe- Sore skin over the bony bump- Difficulty walking and wearing shoes Diagnosis of bunions The diagnosis of a bunion by an orthopaedic surgeon includes taking a medical history and performing a physical examination to assess the extent of misalignment and damage to the soft tissues. Your surgeon will usually order weight-bearing X-rays (i.e. taken while standing) to access the severity of the bunion and deformity of the toe joints.
Treatment of bunionsConservative treatment for bunions
Your GP may have already initially recommended conservative treatment measures with the goal of reducing or eliminating your foot pain.
Such measures can include:
- Medications for relieving pain and inflammation- Wearing surgical shoes with a wide and high toe box, avoiding tight, pointed or high-heeled shoes.- Use of orthotics to realign the bones of your foot and ease the pain.- Padding of bunions- Ice applications several times a day Conservative treatment measures can help relieve the discomfort of a bunion, however, these measures will not prevent the bunion from becoming worse.
Surgery for bunions Surgery is the only means of correcting a bunion. Surgery is also recommended when conservative measures fail to treat the symptoms of bunion.
There are many surgical options to treat a bunion. The common goal is to realign the bones in the foot, correct the deformity, and relieve pain and discomfort. The surgery is performed as a day procedure, under the effect of a light general anaesthetic and a regional nerve block. When you wake up, you will not be in pain and will be able to walk on your foot straight away.
Osteotomy is a common type of bunion surgery that involves the surgical cutting and realignment of the bones around your big toe. Your surgeon selects the appropriate surgical procedure based on the type of bunion and its severity.
There are 3 main types of osteotomies used by foot and ankle surgeons; namely akin osteotomy, chevron osteotomy, and scarf osteotomy.
Akin Osteotomy Akin osteotomy corrects the sideways deviation of the big toe. In this procedure, your surgeon makes a small cut in the proximal phalanx (base of the big toe) and removes a wedge of bone to straighten the big toe. The bony fragments are then stabilised using a screw or staples. This procedure is often used in conjunction with the other procedures below.
Chevron osteotomy A chevron osteotomy is usually recommended for mild to moderate bunion deformities. During this procedure, your surgeon will make an incision over your big toe. The joint capsule is opened and the bunion is removed using a surgical saw. A
V-shaped cut is made on your big toe and the metatarsal bones are shifted to bring your toe into its normal anatomical position. The bunion is then shaved and the soft tissues are realigned to correct the position. Akin osteotomy may be performed if necessary. The mobility of your big toe is examined, and the capsule and wound are re-approximated with sutures. Screws or pins are used to hold the bones in their new position until healing.
This procedure can also be performed minimally invasively with keyhole style incisions.
Arthrodesis: Involves fusing the two bones that form the big toe joint. This procedure is used for severe bunions and when arthritis has set in. The movement of your big toe is reduced following this procedure but pain and deformity are very well controlled.
Scarf Osteotomy Scarf osteotomy is usually recommended for moderate to severe bunion deformities.
Your surgeon will make an incision along your big toe and open the joint capsule to expose the bump. The bump on your big toe is then removed using a bone saw. Your first metatarsal bone is then cut in a Z shape and realigned to correct the deformity. Your surgeon will fix the cut bone with pins or screws. The joint capsule and surgical wounds are then re-approximated using dissolvable sutures keeping your toe in a straight position. This is a very powerful corrective procedure with excellent long term results.
Risks and complications As with any surgery, bunion surgery involves certain risks and complications. They include:
- Infection- Recurrence of the bunion- Nerve damage- Unresolved pain and swelling- Joint stiffness or restricted movement- Delayed healing or healing in the wrong position In rare cases, a second surgery may be necessary to correct the problems.
Post-operative care Patients should follow all instructions given by the surgeon following the surgery. These include:
- Keep your dressings dry and leave them in place until your next outpatient appointment.- Minimize walking where possible.- Elevate the foot to minimize swelling as much as possible for the first 6 weeks.- You will have to wear specially designed post-operative shoes to protect the wounds and assist in walking- You may not be able to wear regular shoes for 6 weeks
What is the Achilles tendon?
The Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to the heel bone. It is used when you walk, run and jump.
What causes the Achilles tendon to tear? The Achilles tendon ruptures most often in athletes participating in sports that involve running, pivoting and jumping. Recreational sports that may cause Achilles rupture include tennis, football, basketball and gymnastics.
Symptoms of Achilles tendon tear When the Achilles tendon ruptures, you will experience severe pain in the back of your leg above your heel, swelling, stiffness, and difficulty to stand on tiptoe and push the leg when walking. A popping or snapping sound may be heard when the injury occurs.
Diagnosis of Achilles tendon tear Your doctor diagnoses the rupture based on symptoms, history of the injury and physical examination. Your doctor may also feel a gap or depression in the tendon, just above heel bone. Your doctor will gently squeeze the calf muscles. If the Achilles tendon is intact, there will be flexion movement of the foot, if it is ruptured, there will be no movement observed.
Treatment of Achilles tendon tear Achilles tendon rupture is treated using a non-surgical method or surgical method.
Non-surgical treatment for Achilles tendon tear Non-surgical treatment involves wearing a cast or special brace which lifts your heel, allowing the tendon to heal.
Surgical repair of Achilles tendon tear Surgical procedure involves opening the skin and suturing the torn tendon together. Surgery helps to decrease the recurrence of the Achilles tendon in comparison to the non-surgical treatment. With either treatment, physical therapy is recommended to improve the strength and flexibility of leg muscles and the Achilles tendon.
Prevention of Achilles tendon tear To help prevent an Achilles tendon injury, it is a good practice to perform stretching and warm-up exercises before participating in any exercises or sports activities. Gradually increase the intensity and length of time of activity. Muscle conditioning may help to strengthen the muscles in the body.
What causes the Achilles tendon to tear? The Achilles tendon ruptures most often in athletes participating in sports that involve running, pivoting and jumping. Recreational sports that may cause Achilles rupture include tennis, football, basketball and gymnastics.
Symptoms of Achilles tendon tear When the Achilles tendon ruptures, you will experience severe pain in the back of your leg above your heel, swelling, stiffness, and difficulty to stand on tiptoe and push the leg when walking. A popping or snapping sound may be heard when the injury occurs.
Diagnosis of Achilles tendon tear Your doctor diagnoses the rupture based on symptoms, history of the injury and physical examination. Your doctor may also feel a gap or depression in the tendon, just above heel bone. Your doctor will gently squeeze the calf muscles. If the Achilles tendon is intact, there will be flexion movement of the foot, if it is ruptured, there will be no movement observed.
Treatment of Achilles tendon tear Achilles tendon rupture is treated using a non-surgical method or surgical method.
Non-surgical treatment for Achilles tendon tear Non-surgical treatment involves wearing a cast or special brace which lifts your heel, allowing the tendon to heal.
Surgical repair of Achilles tendon tear Surgical procedure involves opening the skin and suturing the torn tendon together. Surgery helps to decrease the recurrence of the Achilles tendon in comparison to the non-surgical treatment. With either treatment, physical therapy is recommended to improve the strength and flexibility of leg muscles and the Achilles tendon.
Prevention of Achilles tendon tear To help prevent an Achilles tendon injury, it is a good practice to perform stretching and warm-up exercises before participating in any exercises or sports activities. Gradually increase the intensity and length of time of activity. Muscle conditioning may help to strengthen the muscles in the body.
Cheilectomy
Ankle Ligament Reconstruction
Minimally Invasive Cheilectomy of the 1st MTPJ
What is minimally invasive cheilectomy?
Cheilectomy is a procedure to remove excessive bone from the first metatarsophalangeal joint (MTPJ). The MPT joints are the junctions between the metatarsal bones (long bones in the foot) and the proximal bones (bone in toes). The first MTPJ refers to the joint in the big toe of the foot. This surgery is intended to treat pain and stiffness and to increase the motion in the joint of the big toe. It may be performed in a minimally invasive manner through a very small incision.
Indications for minimally invasive cheilectomy Cheilectomy is designed to treat early arthritis and hallux rigidus. The surgery is performed to treat pain, stiffness and limited range of motion in the joint of the big toe which is caused due to arthritis.
Pre-operative care before minimally invasive cheilectomy Before surgery, the details of your medical history will be collected. Your doctor might recommend you to undergo an X-ray examination. If necessary, you might also be advised to get a CT-scan done.
Surgical procedure for minimally invasive cheilectomy The surgery is carried out as a day-case procedure (no overnight stay in the hospital) and under general anaesthesia. A single 2cm incision or small keyhole incision is made on the top of the big toe. The excessive bone or build-up of bone at the joint, which blocks the normal movement of the toe, is excised and the skin is sutured with dissolvable stitches. In rare cases, the surgeon might recommend an additional surgery where 2 keyholes are made at the base of the big toe to align the joint. The procedure will be carried out under live X-ray guidance (fluoroscopy) and the surgeon may insert screws for stabilization of the alignment.
Post-operative care after minimally invasive cheilectomy At the end of the operation, local anaesthesia is injected in the ankle to provide post-operative pain relief for almost 10 hours. Your foot will be dressed with a bandage that will be removed after 7 days. You will be asked to keep your foot in an elevated position and take anti-inflammatory medications to minimize swelling. A surgical shoe is worn for 1 week initially after surgery to avoid infection. The physiotherapists will guide you with mobilisation exercises to reduce muscle tightness after which you will be able to walk gradually and resume daily activities. You will be advised not to drive a vehicle for 3 weeks and not to wear high heels for 6-8 weeks.
Risks and complications of minimally invasive cheilectomy Risks associated with cheilectomy are:
- Infection- Swelling- Slow wound healing- Nerve damage- Deep vein thrombosis Around 80% of the people who have undergone cheilectomy have found it to be effective and safe.
Indications for minimally invasive cheilectomy Cheilectomy is designed to treat early arthritis and hallux rigidus. The surgery is performed to treat pain, stiffness and limited range of motion in the joint of the big toe which is caused due to arthritis.
Pre-operative care before minimally invasive cheilectomy Before surgery, the details of your medical history will be collected. Your doctor might recommend you to undergo an X-ray examination. If necessary, you might also be advised to get a CT-scan done.
Surgical procedure for minimally invasive cheilectomy The surgery is carried out as a day-case procedure (no overnight stay in the hospital) and under general anaesthesia. A single 2cm incision or small keyhole incision is made on the top of the big toe. The excessive bone or build-up of bone at the joint, which blocks the normal movement of the toe, is excised and the skin is sutured with dissolvable stitches. In rare cases, the surgeon might recommend an additional surgery where 2 keyholes are made at the base of the big toe to align the joint. The procedure will be carried out under live X-ray guidance (fluoroscopy) and the surgeon may insert screws for stabilization of the alignment.
Post-operative care after minimally invasive cheilectomy At the end of the operation, local anaesthesia is injected in the ankle to provide post-operative pain relief for almost 10 hours. Your foot will be dressed with a bandage that will be removed after 7 days. You will be asked to keep your foot in an elevated position and take anti-inflammatory medications to minimize swelling. A surgical shoe is worn for 1 week initially after surgery to avoid infection. The physiotherapists will guide you with mobilisation exercises to reduce muscle tightness after which you will be able to walk gradually and resume daily activities. You will be advised not to drive a vehicle for 3 weeks and not to wear high heels for 6-8 weeks.
Risks and complications of minimally invasive cheilectomy Risks associated with cheilectomy are:
- Infection- Swelling- Slow wound healing- Nerve damage- Deep vein thrombosis Around 80% of the people who have undergone cheilectomy have found it to be effective and safe.
How are ankle ligaments injured?
A sprain is stretching or tearing of a ligament. Ligaments connect adjacent bones in a joint and provide stability to the joint.
An ankle sprain is a common injury and occurs when you fall or suddenly twist the ankle joint or when you land your foot in an awkward position after a jump. It most commonly occurs when you participate in sports or when you jump or run on a surface that is irregular.
Symptoms of ankle ligament injury Ankle sprains can cause pain, swelling, tenderness, bruising, and stiffness, numbness in the toes, and inability to walk or bear weight on the ankle accompanied by persistent discomfort.
Inadequate healing of a sprained ligament or incomplete rehabilitation of the affected ligament can result in instability of the ankle.
Diagnosis of ankle ligament injury A complete medical history, including a history of any previous ankle injuries, and a physical examination is essential for an accurate diagnosis of the condition. An X-ray may be ordered to confirm the diagnosis.
Conservative treatment of ankle ligament injury Acute injuries can be managed with conservative treatment measures such as RICE method (rest, ice, compression and elevation), medications, bracing, and physical therapy.
Surgical treatment of ankle ligament injury Surgical intervention to reconstruct the injured ligament may be considered in patients with a high degree of instability and in those who have failed to respond to non-surgical treatments.
Procedure for ankle ligament reconstruction Ankle ligament reconstruction may be performed arthroscopically under general anaesthesia. Your surgeon will make small incisions in your ankle. A tiny camera and a few special instruments are inserted through the incisions to repair and strengthen the ligaments. Stretched or torn ligaments will be shortened and stitched as needed. Sometimes, a weakened ligament is reconstructed with a section of tendon-derived from the foot and around the ankle.
Recovery after ankle ligament reconstruction The recovery time after ankle ligament reconstruction depends on the extent of an injury and the procedure performed. For the first few weeks after surgery, you will be instructed to use crutches or a wheelchair and avoid bearing any weight on the constructed ankle joint.
Risks and complications associated with ankle ligament reconstruction Specific complications of ankle ligament reconstruction include infection, nerve damage, ankle joint stiffness, and recurrent instability.
An ankle sprain is a common injury and occurs when you fall or suddenly twist the ankle joint or when you land your foot in an awkward position after a jump. It most commonly occurs when you participate in sports or when you jump or run on a surface that is irregular.
Symptoms of ankle ligament injury Ankle sprains can cause pain, swelling, tenderness, bruising, and stiffness, numbness in the toes, and inability to walk or bear weight on the ankle accompanied by persistent discomfort.
Inadequate healing of a sprained ligament or incomplete rehabilitation of the affected ligament can result in instability of the ankle.
Diagnosis of ankle ligament injury A complete medical history, including a history of any previous ankle injuries, and a physical examination is essential for an accurate diagnosis of the condition. An X-ray may be ordered to confirm the diagnosis.
Conservative treatment of ankle ligament injury Acute injuries can be managed with conservative treatment measures such as RICE method (rest, ice, compression and elevation), medications, bracing, and physical therapy.
Surgical treatment of ankle ligament injury Surgical intervention to reconstruct the injured ligament may be considered in patients with a high degree of instability and in those who have failed to respond to non-surgical treatments.
Procedure for ankle ligament reconstruction Ankle ligament reconstruction may be performed arthroscopically under general anaesthesia. Your surgeon will make small incisions in your ankle. A tiny camera and a few special instruments are inserted through the incisions to repair and strengthen the ligaments. Stretched or torn ligaments will be shortened and stitched as needed. Sometimes, a weakened ligament is reconstructed with a section of tendon-derived from the foot and around the ankle.
Recovery after ankle ligament reconstruction The recovery time after ankle ligament reconstruction depends on the extent of an injury and the procedure performed. For the first few weeks after surgery, you will be instructed to use crutches or a wheelchair and avoid bearing any weight on the constructed ankle joint.
Risks and complications associated with ankle ligament reconstruction Specific complications of ankle ligament reconstruction include infection, nerve damage, ankle joint stiffness, and recurrent instability.