The human foot has 26 bones and a number of ligaments, tendons, muscles etc. The human foot is a vital part for locomotion. Often minor ailments of the foot will produce significant discomfort. If these ailments are treated early, surgery may not be required. Modern technology (arthroscopy and tendonoscopy, joint replacement) and traditional surgery can treat many foot problems effectively. Of course some conditions can easily be treated with the appropriate orthosis, injection, physiotherapy and footwear. It is always better to have a flexible foot with some deformities rather than a good looking rigid foot.
This refers to a painful forefoot (front part of the foot). This may be due to soft tissue problems (Morton’s Neuroma or rheumatoid disease) or bony pathology (stress fracture, arthritis, deformities etc).
Management of metatarsalgia – after a thorough clinical examination usually an X-ray will be required. Other investigations (ultrasound and MRI scan) may be necessary dependent upon the cause, it can be treated by using an appropriate orthotic or surgery.
There is a lump at the base of the big toe and the big toe begins to drift towards the other toes. In severe cases the second toe may over ride or under ride the big toe. The female population is more affected by this and they often find it difficult to obtain appropriate shoes.
Management of hallux valgus – as this condition is often pain free, it can be treated with appropriate shoes with wide toe boxes. There are various types of surgery for bunions. Soft tissue correction is generally carried out for children and in adults bony operations, along with soft tissue corrections are required to rectify the deformity. Good results can be achieved following surgery.
This is due to arthritis of the big toe joint at the base. It is often very painful to walk and wear shoes. Early stages of hallux rigidus can be treated by non-surgical means. Surgery depends upon the degree of the damage and the patient’s acceptance. There are three types of surgery available:
1. Cheilectomy (trimming the lips of the joint).
2. Arthrodesis (fusion of the joint).
3. Arthroplasty – new joint usually in older patients.
This is infection on to the sides of the toe nail due to improper nail cutting and hygiene. These infections are usually very difficult to treat, even with antibiotics. Surgery is often helpful and there are various types of surgery. The operations can be carried out using local anaesthesia.
This is quite common in all age groups. In children, Sever’s disease, where the back of the heel bone becomes inflamed due to repeated trauma. Tendonitis and plantar fasciitis are some of the causes in adults. Stress fracture of the heel bone can occur in the older population.
Management of heel pain – surgery is not usually indicated. Orthoses, physiotherapy, cortisone injections etc can help in appropriate cases.
This is quite common in children and others. When flat feet are painful, conditions like PTTD (posterior tibial tendon deficiency), tarsal coalition, subtalar joint arthritis etc, should be excluded. Mild to moderate degrees of flat feet do not usually require any treatment. Other cases may be treated by orthosis (insoles with appropriate arch support) or surgery (PTTD).
This is opposite to flat feet and is referred to as pes cavus. This is often associated with neurological problems. The causes of pes cavus must be ascertained in the first instance. Feet are usually treated with orthosis, modification of shoes. Surgery may also be required.