Foot and Ankle Disorders

A bunion is a bony prominence on the inner aspect of the base of the big toe. Bunions are extremely common in the United Kingdom. The cause of bunions remains uncertain although they seem to be more common in families where bunions are prevalent and there is some evidence to suggest that wearing narrow shoes may also be a cause. A large number of patients with bunions do not require surgical treatment. It is only when they become painful and when conservative treatment is unsuccessful that surgery should be considered.

Bunions normally coexist with hallux valgus; a condition characterised by the big toe drifting off towards the second toe. Provided that there is no arthritis in the big toe joint, surgical treatment for bunions involves removing the bony prominence and also correcting the associated hallux valgus deformity by cutting and realigning the bone; an operation known as an osteotomy.

There are three different type of osteotomies ; the chevron, the scarf and the basal osteotomies to treat the spectrum of bunion deformities which all have good results in the scientific literature. The type of osteotomy recommended is dependent on how severe the deformity is.

More information on bunion surgery can be found here.

These are common deformities that often present with the affected toe being painful and rubbing on shoes or the neighbouring toe. Surgical correction is indicated if conservative measures fail. The correction recommended depends on the nature of the deformity which may be of two types; flexable or fixed.

For a flexable deformity, when the toe can be easily corrected, a soft tissue procedure is recommended. The soft tissue procedure performed depends on the position of the toe but would involve either a tenotomy (tendon release), a tendon lengthening, a capsulotomy (soft tissue joint release), or tendon transfer (reattaching one tendon to another).

For a fixed deformity, when the toe cannot be corrected, a bony correction is required. This involves removal of the stiff joint affected and stabilisation with a wire which is removed after 4-6 weeks.

Plantar fasciitis is a common orthopaedic complaint and cause of heel pain. Your plantar fascia ligaments stretch from your heel to your toes. They support the arch of your foot and act as shock-absorbers. These ligaments get a lot of daily wear and are subject to substantial pressure. They may become inflamed and cause heel pain and stiffness.

Heel pain typically presents at the base of your heel and is worse in the morning and after prolonged standing, sitting or intense activity. Plantar fasciitis pain can be caused by obesity, pregnancy, ill-fitting shoes, activities that place a lot of stress on your heel bone such as running and jumping, flat-footed or high arches and wearing shoes with poor arch support or stiff soles, being middle-aged or older and spending a lot of time on your feet.

Your heel pain is normally self-limiting but may take 18 months to resolve. Conservative treatment involves pain killers, heel pads and physiotherapy. Night splints, steroid injections and ultrasound therapy may also be helpful. Surgical treatment involves the release of the plantar fascia for chronic pain, although this is rarely necessary.

There are many different types of arthritis that may affect joints; osteoarthritis and rheumatoid arthritis are the two commonest seen in the foot and ankle. Osteoarthritis refers to a degenerative loss of cartilage that normally lines the joint. It is seen as patients get older or may be a result of a previous injury that has disrupted the joint.

Rheumatoid arthritis is an inflammatory condition that causes destruction of bone and cartilage. Both conditions commonly present with pain, swelling and reduced mobility. If the pain is severe and does not respond to conservative measures, then surgery is considered. The options of surgical intervention for arthritis of the foot and ankle include:

A steroid/local anaesthetic injection is a routine treatment to relieve painful foot and ankle conditions. It is used as part of a detailed treatment plan alongside physiotherapy exercises and orthoses. 

The injection is a mixture of a local anaesthetic and a steroid and is often administered using ultrasound guidance. The local anaesthetic is used to numb the treatment area and minimise discomfort during the procedure. The steroid helps relieve the pain and inflammation symptoms of a damaged foot or ankle. It is frequently used for soft tissue inflammation in rheumatoid disease and big toe joint osteoarthritis. 

Corticosteroid foot and ankle injections are carried out for diagnostic or therapeutic purposes. Diagnostically they are particularly useful when the source of your pain is not clear and to help your surgeon to confirm the exact structure in your foot or ankle that is causing pain. Therapeutically, they are used to ease your pain and to improve your function and mobility, to help you return to normal activities and hobbies or to start physiotherapy. These injections do not treat the underlying cause of the problem.

Cheilectomy is a surgical operation to remove a bony lump on your big toe joint. It is usually performed to reduce pain and stiffness caused by osteoarthritis of your big toe, called hallux rigidus. 

This successful procedure is performed either because the bony lump is pressing painfully on your shoes or to treat early arthritis of your big toe and improve the range of movement of your toe.

Cheilectomy is usually performed under general anaesthetic as a day case procedure. Your surgeon makes a cut on the side of your big toe and removes the bony prominence around the toe. A cheilectomy may be done using keyhole surgery. Sometimes your surgeon will recommend an osteotomy as well to realign your big toe so that it is more comfortable to walk.

Arthroscopy with debridement is a type of keyhole surgery used to treat ankle problems, typically ankle arthritis. It involves your surgeon making small incisions and the use of a tiny camera to see inside your ankle joint. They can then perform any necessary treatment that may include removing the damaged cartilage, bone or other debris. 

Ankle arthroscopy can be used to help diagnose your ankle problem by providing clear images of your ankle and foot joints and structures or a small biopsy sample can be taken. Arthroscopy with debridement is performed if an ankle injury does not settle or if you have osteoarthritis that is causing pain. It can remove the diseased parts of your ankle joint, along with any bone spurs or loose fragments of bone. It can also repair damaged tissue and cartilage tears following a sprain or injury.

As the surgery is minimally invasive your recovery should be shorter than with open surgery.

An ankle fusion, also known as ankle arthrodesis, is carried out to “fuse” or stiffen your ankle joint. It may be recommended if you have long-term and disabling ankle pain that has not improved using non-surgical treatments such as physiotherapy or steroid injections.

The aim of ankle fusion surgery is to reduce or remove this pain. The main causes of ankle pain are ankle arthritis due to osteoarthritis or rheumatoid arthritis, ankle injury, ankle instability or a severe deformity of the rear part of your foot such as flat foot, high arched foot or club foot.

Ankle fusion surgery will remove damaged joint surfaces and then permanently fuse your ankle joint using special metal screws. The fusion is usually performed by keyhole surgery.

Foot and ankle trauma include sprains, strains and fractures.  RICE (Rest, Ice, Compression and Elevation) is an effective treatment technique for mild strains, sprains and fractures where the bone has not moved out of place.

More serious ankle fractures, also called a broken ankle, usually require surgery to repair the fracture and any damaged ligaments, tendons and muscles. The most common ankle fractures are those to the tibia and fibula where they join your foot. A fractured ankle causes pain and swelling.

Ankle fracture surgery typically aims to put your ankle joint back into its correct place if it has displaced or become misaligned, to remove an infection if present, stabilise the bones to heal and stimulate bone growth with a bone graft. Special hardware may be used including plates, screws or pins. Ankle fracture surgery can also decrease your risk of developing arthritis of the ankle.

Foot and ankle sports injuries are common. They occur when playing sports or whilst exercising and are often caused by accidents, inadequate training and insufficient stretching or warm-up exercises. It is important to see a doctor or physiotherapist for major injuries. You should not return to the sport until you are fully recovered as this can result in re-injury and long-term disability.
Our expert teams are able to advise and treat athletes with sporting injuries from all sports and ability levels. We treat patients who enjoy keeping fit through to those who are Premiership Rugby players.  

The most common sports injuries are sprains and strains, fractures and dislocations. We treat chronic ankle sprains and instability, Achilles tendon ruptures, Achilles Tendonitis and Tendinosis, Plantar Fasciitis (Painful Heel), chondral/osteochondral defects of the ankle, midfoot sprains, ankle and stress fractures, sesamoid injuries, Lisfranc injuries, Freiberg’s disease and nerve entrapment syndromes.

Treatment for these conditions may include orthotics, braces, physiotherapy, steroid injections and foot and ankle surgery. The aim of treatment is to get you back to normal activity and sport as soon as possible. If surgery is required, we use minimally invasive arthroscopy when possible.

You have a number of tendons that run through your ankle and attach lower leg muscles to your foot and ankle bones. The Achilles, peroneal and posterior tibialis tendons are those most commonly affected.

Our foot and ankle experts treat injuries and disorders of the Achilles, peroneal and posterior tibialis tendons. These include tendinitis (an acute, inflammatory injury caused by sudden, sharp movements or repetitive movements), tendon tears or ruptures (partial or complete, caused by an injury or increased pressure on the tendon from sports or a fall), tendinosis (a degenerating tendon that results from untreated tendonitis or repetitive trauma)  and subluxation (dislocation caused by damage to the tissues that stabilise your tendon). 

We used the latest diagnostic techniques including foot and ankle x-rays, ultrasound and MRI to identify your foot and ankle condition. Your surgeon will advise on the best treatment for your tendon disorder. Physiotherapy, steroid injections, braces, splint and casts are recommended treatments. Arthroscopic surgery or open surgery may be used to treat tendon disorders if they do not respond to nonsurgical treatment and you are experiencing pain.

This structure is very important in walking and by providing the power to ‘toe off’. The tendon may become inflamed(tendinitis), tear(complete or partial) or become degenerative. Conservative treatment for Achilles tendon problems includes immobilisation in a plaster(for acute ruptures not for surgery), physiotherapy (tendinitis), orthotics and ultrasoundtherapy. Surgical treatment is indicated as a primary treatment in most active patients for conditions such as acute Achilles tendon rupture where there is a lower re-rupture rate for surgery or in conditions when conservative treatment has failed. Achilles Tendon Reconstruction is indicated for complete/partial tears and for severe tendon degeneration. It may be primary (direct suture of the tendon ends) or secondary (using tendon lengthening/transfer techniques) for delayed rupture when the tendon ends retract. Achilles tendon decompression is considered for tendinitis resistant to conservative measures.

Peroneal tendon injuries occur most often if you participate in sports with repetitive or excessive ankle motion. If you have a higher arch, you have an increased risk of peroneal tendon injuries. Injuries include peroneal tendonitis, tears and subluxation.

The peroneal tendons lift your foot up and out during walking. Symptoms of peroneal tendon problems can include pain in the outside of your foot, swelling at the back of your ankle and instability of your ankle when bearing weight. For peroneal subluxation, you might feel a sharp pain around the outside of your ankle, a snapping sensation and a feeling that your tendon is moving over your bone.

Early treatment of peroneal tendon disorders is important to assess the problem and prevent further damage. Surgical treatment involves repair and restoration of the normal shape of the tendon for tears, and repair of the supporting tendon sheath and deepening of the normal bony grove for dislocations.

Your tibialis posterior tendon is an important structure in walking that pushes your foot down and gives support to your inner foot arch. Tendon dysfunction is one of the most common problems of the foot and ankle. It happens when your posterior tibial tendon becomes inflamed or torn due to a fall or overuse, and is more common in women.

People experience pain behind the inner aspect of the ankle especially when walking and instability and a lack of support for the foot arch which can lead to a flat foot. 

Most tibialis posterior tendon disorders may be successfully treated conservatively with medial arch support insoles and physiotherapy. Surgery is indicated for severe forms which have not improved with conservative treatment. Surgery involves reconstruction with a tendon transfer or in advanced cases, partly fusing (stiffening) the foot.

Morton’s Neuroma is a common cause of forefoot pain and tingling, typically affecting the second and third toes. It is due to a swelling on the nerve in the sole of the foot.

At Ramsay our highly qualified podiatrists, physiotherapists and foot and ankle surgeons are experienced and trained to diagnose and effectively treat Morton’s Neuroma using a range of conservative and surgical treatment techniques if required.

Conservative treatment involves the use of an insole that offloads this area. Physiotherapy may help minimise nerve compression. An ultrasound-guided steroid injection is often helpful. Surgical excision of the neuroma is recommended for cases resistant to conservative treatment.