A metatarsal osteotomy is an operation for bunions – hallux valgus (bunions). Surgery for a bunion may be advised if simple measures, such as well-fitting shoes, simple painkillers and padding do not relieve the pain of the bunion. It may also be performed if the big toe is so deformed that it is pressing on or overlapping the second toe.
Treatment: Surgery: Bunion(s) removal
A cut is made on the side of the bunion. The big toe joint is opened and the bony lump is removed. The first metatarsal is cut through, re-positioned and may be fixed with a screw. Sometimes a second cut is made between the first and
second toes to free up the tight tissues on this side of the toe. The soft tissues over the bunion are tightened to correct the deformity. This surgery is usually done as a day case under a general anaesthetic.
I do not usually put on a plaster after a metatarsal osteotomy. I will put dressings and a bandage on your foot and you can walk on the heel in a protective sandal with a stiff sole. After 2 weeks, the stitches are removed and a firm bandage is used to hold the great toe in the corrected position for a further 4 weeks.
A bunionette is a deformity similar to a bunion but on the outer side of the foot It produces similar problems often with footwear.
The treatment for this is generally an oblique distal metatarsal osteotomy. An incision is made on the top of the outer side of the foot. The 5th metatarsal is cut through obliquely so that the bone can slide into a better position. The foot is placed in a bandage for about 3 weeks. No plaster is necessary. The bandage and stiches are removed in 3 weeks and you are generally able to walk almost immediately.
These quite often as a result of wearing tight shoes or secondary to bunions, where the joint of the toes become fixed in a painful deformed position with overlying corns.
Treatment is by taking out the relevant joint, straightening the toe and holding this position by means of a pin which is left protruding through the tip of the toe. You are generally able to walk on it straight away. The stitches are removed in 2 weeks. The protruding pin is removed at 6 weeks following surgery.
Hallux rigidus (big toe arthritis)
You can take simple pain killers for the pain if it bad and interfering with your life.
Because the joint is usually most painful when the toe is bent upwards during walking, it sometimes helps to stiffen the sole of your shoe so that it does not bend while walking. Orthotics can help with this.
Treatment: Hallux rigidus
If the toe remains very painful in early arthritis, an injection of steroid and local anaesthetic can be done. This reduces the inflammation inside the joint. The injection can usually be given in the outpatient clinic, although sometimes you may have to come into hospital as a day patient. The toe may be painful for a few days after the injection and any improvement has usually occurred by a week.
If symptoms persist then surgery is sometimes required. I do a silastic arthroplasty where an artificial joint is inserted into the toe. This is done under a general anaesthetic as a day case.
A Morton’s neuroma is swelling and inflammation of a nerve that lies between two metatarsal bones of your foot. It causes pain in the ball of your foot and possibly your toes. Women find that high heeled shoes make their symptoms worse.
It can sometimes be treated with simple measures such as comfortable shoes, weight loss, insoles and simple analgesia. If these measures do not work an ultrasound scan may be requested and an injection or sometimes two can be tried.
If symptoms persist then I would suggest that the morton’s neuroma be surgically removed.
Treatment: Morton’s neuroma
A cut is made on the sole of the foot between the metatarsal bones. The nerve is identified and a short section is removed. The skin is then stitched up and the foot dressed with a firm bandage.
After your dressings have been removed you can start gently exercising your foot and walking further each day. Most people are reasonably comfortable in 3 weeks and can get back to most of their previous activities within 3 months. As the trapped nerve has been excised, the sides of the 2 toes it supplied may be permanently numb. Occasionally people find this slightly strange but usually they become accustomed to it.
The foot tends to swell up after surgery. Swelling is part of your body’s natural response to any injury and surgery is no exception. In addition, your foot is at the bottom of your body so fluid tends to collect in its tissues and cause swelling. People vary in how quickly this swelling disappears after an operation and 6 months is not all that unusual. Elevation of the limb will help. Provided you are not having undue pain or inflammation there is probably nothing to worry about and you can must give it time to settle. The wounds usually heal quickly, but occasionally these can become infected and need antibiotics. As the trapped nerve has been excised, the sides of the 2 toes it supplied may be permanently numb. Occasionally people find this slightly strange but usually they become accustomed to it.
The Achilles tendon is a tendon which runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the “heel cord”, the Achilles tendon facilitates walking by helping to raise the heel off the ground.
Achilles Tendonitis also known as Achilles Tendonosis are common disorders that occur in the tendon.
The symptoms associated with Achilles tendonitis include pain, stiffness, and tenderness around the tendon. When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged. Achilles tendonitis is usually caused by a sudden increase of a repetitive activity involving the Achilles tendon which puts too much stress on the tendon too quickly, leading to injury. Due to this ongoing stress on the tendon, the body is unable to repair the injured tissue.
Treatment: Non surgical:
• Oral medications. Non steroidal anti-inflammatory drugs
(NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation in the early stage of the condition.
• Physiotherapy. This may involve hands on treatment or
immobilisation. This may involve the use of a cast or removable walking boot to reduce forces through the Achilles tendon and promote healing.
• Ice may be necessary to reduce swelling. Apply a bag of
ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
If non-surgical approaches fail to restore the tendon to its normal condition, surgery may be necessary.
This may involve decompression (dividing the sheath around the tendon). Occasionally, exploration of the tendon itself and curettage (scraping out) of the degenerate portion of the tendon may be necessary.
This is done under a general anaesthetic as a day case and normally you would be able to return to work within 3 – 4 weeks.
Osteotomy of the knee
Osteotomy of the knee is generally reserved for young, active patients, who want to delay the time until knee replacement. When done in the right patients, knee osteotomies are usually successful at decreasing pain. This surgery tends to last about 8 to 10 years, and after that time, many patients will require total knee replacement. Because the bone is cut, it needs time to heal. The total healing time is at least 8 weeks, and can take longer. Most patients need physiotherapy to regain their knee motion.
The function of the heel in walking is to absorb the shock of your foot striking the ground as it is put down and to start springing you forward on the next step. It contains a strong bone (the ‘calcaneum’). Under the bone are a large number of small pockets of fat in strong elastic linings, which absorb much of the shock (‘fat pads’). The heel is attached to the front of the foot by a number of strong ligaments which run between the front part of the calcaneum and various other parts of the foot.
The strongest ligament is the ‘plantar fascia’, which attaches the heel to the toes and helps to balance the various parts of the foot as you walk. It therefore takes a lot of stress as you walk. In some people the plantar fascia becomes painful and inflamed. This usually happens where it is attached to the heel bone, although sometimes it happens in the mid-part of the foot. This condition is called plantar fasciitis. This condition is usually due simply to constant stress, and is therefore commoner in people who spend all day on their feet or are overweight.
An x-ray will confirm whether you have a bone spur. The bone spur you have is a symptom but not the cause of your problem. Near the plantar fascia attachment the fascia has torn and become inflamed. Near, but not at the tear, some extra bone may form producing a small ‘spur’. Heel spurs are more common in people with plantar fasciitis, but they can be found in people with no heel pain. The heel spur is caused by the same process as the heel pain, but the spur is not itself the cause of the pain and the spur itself does not need surgery.
First line of treatment would be to avoid the things that cause heel pain to start: Avoid getting overweight, minimise the shock to your feet from constant pounding on hard surfaces. Reduce the shocks on your heel by choosing footwear with some padding or shock-absorbing material in the heel. If you have high-arched feet or flat feet, a moulded insole in your shoe may reduce the stresses on your feet. If you have an injury to your ankle or foot, make sure you exercise afterwards to get back as much movement as possible to reduce the stresses on your foot and your heel in particular. If you start to get heel pain, doing the above things may enable the natural healing process to get underway and the pain to improve.