Mr Jason Nandlal MSc FCPodS
CONSULTANT PODIATRIC SURGEON

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Scope of practice

 

Hallux valgus (Bunion surgery)

 

Hallux valgus this is a malalignment of the big toe joint which causes the big toe to go off at an angle. As a result the big toe starts to crowd the smaller toes. It makes the foot wider which causes footwear fitting difficulties and also can give rise to pain within the big toe joint and the development of painful calluses. Because the big toes joint does not bear weight normally it can also cause pain under the second   joint which will feel like walking on a pebble. Although this foot problem can be made worse by certain shoe types it is an inherited condition.
A painful enlargement of the joint situated at the base of the big toe. A bunion actually refers to the bony prominence or exostosis on the side of the big toe.
 A large sac of fluid, known as a bursa, can form over the enlarged joint which can then become inflamed and painful.

Surgery to remove the bony prominence is called a bunionectomy. There are over 130 different procedures recorded for treating this condition. The Podiatric Surgeon will choose the right procedure for the individual patient. Smaller bunions can also develop on the outside of the little toe joint, these are known as Tailors bunions and are also treated surgically using similar techniques.

Podiatric Surgery is the surgical treatment of the foot and its associated structures. It is carried out by a Podiatric Surgeon, usually as a day case procedure and often under local anaesthetic. Podiatric Surgery is available in many NHS trusts as well as in private hospitals and clinics. A Podiatric Surgeon manages bone, joint and soft tissue disorders.

 

Most commonly performed surgery: Scarf osteotomy.

 

WHAT CAUSES BUNIONS

We do not know the exact cause of bunions. We do know that the following factors can be important:

Family history of bunions, Footwear ,Shape of the metatarsal head, Biomechanical factors, Some types of arthritis.


 

 

 

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Hallux limitus/rigidus
This arthritic condition of the big toe joint can cause pain and loss of motion. Walking requires the big toe to bend upwards or dorsiflex. Without this movement the big toe joint wears out or may even seize up completely. The condition can be treated using a variety of surgical techniques ranging from remodelling the existing joint to joint replacement.

It is essential to find the true cause of the condition. The condition is known to be caused by a long metatarsal, or by a number of other biomechanical imbalances. Podiatric surgeons sometimes use artificial joints to treat the condition if the joint is beyond repair. These can be made of silastic rubber, titanium or even ceramic. The choice of the type of implant depends on the individual patients needs.

Cartiva SCI is a proprietary polyvinyl alcohol (PVA) cryogel device that mimics natural cartilage. The durable, viscoelastic surface replacement provides flexible cushioning intended to maintain natural joint mechanics by repairing focal cartilage defects while minimising the resection of healthy tissue.

 

Most commonly performed surgery: Debridement, Cheilectomy or Fusion.

Cartiva

 

 

   
Hammer, Mallet and Claw toes
Deformities in the lesser toes are usually caused by tendon or joint imbalance. Hammer toes can be painful and unsightly. The Podiatric surgeon is able to correct this deformity under local anaesthetic as a day case procedure. Surgery to correct the hammer, mallet or claw toe deformity will usually permanently cure the formation of painful corns on skin overlying these joints.

Most commonly performed surgery: arthroplasty, Arthrodesis fusion.

 

 

Plantar Corns
Many corns cannot be resolved with conservative treatment alone, however, they may be permanently removed surgically. Often there is an underlying bony abnormality that needs to be addressed. Corns under the foot often result from a prominent metatarsal bone. Various operations are used to elevate the metatarsal so that the corn no longer forms.

 

 

 

 

Neuroma
An enlarged nerve, usually between the 3rd and 4th toes is caused by nerve irritation and entrapment between bones. The podiatric surgeon routinely removes neuroma's under local anaesthetic. Delicate surgical techniques generally result in permanent resolution of this sometimes extremely painful condition.

Most commonly performed surgery: Excision through a dorsal approach.

Plantar Fasciitis
An inflammation of the connective tissue found on the underside of the foot. Most patients respond to non surgical treatment such as the prescription of orthoses, but on occasion surgery is required. Key hole techniques maybe  used to treat this condition.




Injection Therapy
Injections of substances such as corticosteroid or hyaluronic acid are given both x ray and Ultra sound  guided   as effective relief from heel pain ( 85% successful in last audit) and some joint pathology. It is sometimes an alternative to a surgical procedure.  

 

 

Heel bumps (Haglund's Deformity)
An enlargement of the bone at the back of the heel which can encourage bursitis to develop. Various operations are utilised, ranging from bone removal to the "tilting" of bones into a better position to alleviate the problem. 

 

 

 

 

 

 

Lumps, bumps, cysts and ganglions
Patients often attend the centre with painful lumps that press and rub on the shoe. If a change in footwear does not resolve such problems, surgery can take place to remove such bony prominences or soft tissue formations.

 

 

 

 

Bone spurs
An excessive growth of bone causing pain or limitation of movement. Spurs can develop at the edges of joints, tendons and ligaments. Their removal can usually be undertaken under local anaesthetic.

 

 

Achilles Tendon Problems
Most patients respond to non-surgical treatment. On occasion the tendon will be stripped of its inflamed thickened tissue. Tendon lengthening is sometimes required to treat the condition

 

 

 

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