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Foot

Bunions (Hallux Valgus)

Bunion is an enlargement of the first metatarsal bone at the base of the big toe. The big toe deviates towards the second toe. The symptoms bunions include redness, swelling, and pain at the site of the enlargement. These symptoms occur when wearing shoes that rub against the enlargement, irritating the soft tissues underneath the skin and producing inflammation. Overtime they can develop callosities, deformities of lesser toes and arthritis in the big toe joint. Bunions need not be treated surgically unless they are painful and interfering with daily activities. Recent advances in surgical techniques have led to a very high success rate in treating bunions.
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Hallux Rigidus (Stiff Big Toe)

Hallux rigidus is a condition caused by arthritis at the base of the big toe. It commonly affects active people as a result of repeated minor trauma. The stiffness of the toe is especially noticeable on the upward bending caused by walking
or running. This stiffness causes pain. A bump on the top of the big toe can be noticed. Surgery should only be undertaken if your symptoms are significant.
Surgery involves removing excess bony prominence, fusion of the big toe joint or a total toe joint replacement.


Tailor's Bunion (Bunionette)

Tailor's bunion is an enlargement of the fifth metatarsal bone at the base of the little toe. The symptoms of tailor's bunions include redness, swelling, and pain at the site of the enlargement. These symptoms occur when wearing shoes that rub against the enlargement, irritating the soft tissues underneath the skin and producing inflammation. Surgery is often considered when pain continues despite wearing comfortable shoes. Surgery is highly successful in the treatment of tailor's bunions.


Hammertoes

Hammer toe is  bending of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing callosities to develop. Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and surgery is needed to correct the deformity.


Morton's Neuroma

A Morton’s neuroma is a thickening of nerve tissue that may develop at the base of the second, third or fourth toes. A neuroma is the result of compression and irritation of the nerve. You will probably have Pain, Tingling, burning, or numbness in the foot. Surgery may be considered in patients who have not received adequate relief from other treatments.


Cavus Foot (High-Arched Foot)

Cavus foot is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability. It can develop at any age, and can occur in one or both feet. Cavus foot is often caused by a neurologic disorder or other medical condition—for example, cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy, or stroke.
If non-surgical treatment fails to adequately relieve pain and improve stability, surgery may be needed to decrease pain, increase stability, and compensate for weakness in the foot. Surgery is also considered for cases that are likely to get worse—even if there is currently no pain or instability. In these instances, the goal of surgery is to help reduce the severity of future problems.

The surgeon will choose the best surgical procedure or combination of procedures based on the patient's individual case. In some cases where an underlying neurologic problem exists, surgery may be needed again in the future due to the progression of the disorder.


Flexible Flatfoot

Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and generally progresses in severity throughout the adult years. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed.

If you experience symptoms with flexible flatfoot, the foot and ankle surgeon may recommend various treatment options, including  Activity modifications, Weight loss, Physical therapy, Orthotic devices, Shoe modifications and Surgery.


Flat Foot (Adult type) “Adult-acquired flatfoot”
Posterior Tibial Tendon Dysfunction (PTTD) 

Posterior tibial tendon dysfunction (PTTD) is an inflammation and/or overstretching of the posterior tibial tendon in the foot. An important function of the posterior tibial tendon is to help support the arch. But in PTTD, the tendon’s ability to perform that job is impaired, often resulting in a flattening of the foot. Overuse of the posterior tibial tendon is frequently the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs. The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle.

In many cases of PTTD, treatment can begin with non-surgical approaches that may include Orthotic devices or Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal

In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Surgical treatment may include repairing the tendon, realigning the bones of the foot, or both. Your foot and ankle surgeon will determine the best approach for your specific case.


Heel Pain (Plantar Faciitis)

Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they've been sitting for long periods of time.
After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.  The main stay of treatment is exercise program to stretch the fascia. A soft insole is used to help the pain. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.


Plantar Fibroma

A plantar fibroma is a fibrous knot (nodule) in the arch of the foot. It is embedded within the plantar fascia, a band of tissue that extends from the heel to the toes on the bottom of the foot. A plantar fibroma can develop in one or both feet, is benign (non-malignant). The characteristic sign of a plantar fibroma is a noticeable lump in the arch that feels firm to the touch. This mass can remain the same size or get larger over time, or additional fibromas may develop. People who have a plantar fibroma may or may not have pain. Non-surgical treatment may help relieve the pain of a plantar fibroma, although it will not make the mass disappear.

Stress Fractures

Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often caused by  increase in daily activity. They may be caused by an abnormal foot structure, deformities, or osteoporosis. Stress fractures should not be ignored, because they will come back unless properly treated.


Achilles Tendon Rupture

An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping. A person with a ruptured Achilles tendon may experience sudden pain (which feels like a kick or a stab) in the back of the ankle or calf, difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes

The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an US or MRI. Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient’s push-off strength and improves muscle function and movement of the ankle. 


Haglund's Deformity (“pump bump”)

Haglund’s deformity is a bony enlargement on the back of the heel that most often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone). In Haglund’s deformity, the soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. The foot and ankle surgeon will determine the procedure that is best suited to your case.


 
Lisfranc Injuries

The Lisfranc joint is the point at which the metatarsal bones (long bones that lead up to the toes) and the tarsal bones (bones in the arch) connect. The Lisfranc ligament is a tough band of tissue that joins two of these bones. It is important for maintaining proper alignment and strength of this joint.

Injuries to the Lisfranc joint most commonly occur in automobile accident victims, military personnel, runners, horseback riders, football players, and participants of other contact sports. Lisfranc injuries occur as a result of direct or indirect forces to the foot. A direct force often involves something heavy falling on the foot. Indirect force commonly involves twisting the foot. Anyone who has symptoms of a Lisfranc injury should see a foot and ankle surgeon right away.

Arthritis and problems with foot alignment may develop. In most cases, arthritis develops several months or longer following a Lisfranc injury, requiring additional treatment.


Charcot Foot

Charcot foot is a sudden softening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the arch collapses and the foot takes on a convex shape, giving it a rocker-bottom appearance, making it very difficult to walk. Charcot foot is a very serious condition that can lead to severe deformity, disability and even amputation. Because of its seriousness, it is important that patients with diabetes—a disease often associated with neuropathy—take preventive measures and seek immediate care if signs or symptoms appear. Charcot foot symptoms include warmth to the touch, redness in the foot, swelling in the area and pain.

Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain or trauma. When neuropathy is severe, there is a total lack of feeling in the feet. Because of neuropathy, the pain of an injury goes unnoticed and the patient continues to walk—making the injury worse.

Early diagnosis of Charcot foot is extremely important for successful treatment. To arrive at a diagnosis, the surgeon will examine the foot and ankle and ask about events that may have occurred prior to the symptoms.
 X-rays are also essential for diagnosis.
Following the surgeon’s treatment plan for Charcot foot is extremely important. Failure to do so can lead to the loss of a toe, foot, leg or life.

Preventive Care

The patient can play a vital role in preventing Charcot foot and its complications by following these measures:

  • Diabetes patients should keep blood sugar levels under control. This has been shown to reduce the progression of nerve damage in the feet.
  • Get regular check-ups from a foot and ankle surgeon.
  • Check both feet every day—and see a surgeon immediately if there are signs of Charcot foot.
  • Be careful to avoid injury, such as bumping the foot or overdoing an exercise program.
  • Follow the surgeon's instructions for long-term treatment to prevent recurrences, ulcers and amputation.

Ingrown Toenail

When a toenail is ingrown, the nail is curved downward and grows into the skin, usually at the nail borders (the sides of the nail). This “digging in” of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe. If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. The most common cause of ingrown toenails is improper trimming. Cutting your nails too short encourages the skin next to the nail to fold over the nail. Another cause of ingrown toenails is wearing shoes that are tight or short.  

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