The rheumatoid foot is a whole subject in itself. Ninety per cent of patients with rheumatoid arthritis will have involvement of their feet. This usually affects the metatarso-phalangeal joints of both feet symmetrically. Patients develop hallux valgus deformities with gradual subluxation and dislocation of the […]
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|Definitive diagnosis of trauma injuries and chronic foot conditions is often the starting point to a successful recovery. We offer access to urgent MRI scans, surgery and non-invasive treatments. Using the latest techniques, including arthroscopic surgery, we aim to minimise the time before you are back on your feet and pain free.|
Bunions are one of the most common conditions we treat. A bunion is any swelling around the great toe MTP(metatarsophalangeal) joint but is often caused when the big toe joint moves out of alignment. Arthritis of the toe joint may also be present. Consultant Nick Harris frequently treats patients with this painful condition and describes the treatment in the press article on bunion surgery
Hallux valgus is a term used to describe lateral deviation of the great toe. The word bunion is derived from the Latin “bunio” meaning turnip. Hallux valgus is associated with a medial swelling or bunion. Approximately 30% of people who wear shoes will develop hallux valgus compared with 2% of people who don’t. The incidence is much higher in women than in men. A positive family history is found in 60-90% of patients with hallux valgus. Hallux valgus can be classified into 3 groups: Congruent, Incongruent, Degenerative
A congruent hallux valgus deformity is often found in younger patients and may reflect a congenital abnormality. The commonest form of hallux valgus deformity is incongruent. The first metatarsal escapes medially. The proximal phalanx through its attachment to the lateral sesamoid subluxes laterally. In time degenerative changes can develop due to the persistent subluxation.
The treatment of hallux valgus depends on the severity of the deformity, the age of the patient, the general health of the patient, but most importantly the symptoms suffered. Initially modifications to shoe wear and orthotics can be helpful. Surgery is indicated when patients suffer persistent intrusive pain despite appropriate conservative treatment. One of the most successful treatments for hallux valgus is to realign the great toe. This is usually achieved by undertaking a first metatarsal osteotomy and sometimes a further osteotomy to the proximal phalanx. This must be combined with a release of the tight lateral structures and a tightening of the medial soft tissues. In cases where there is significant arthrosis the options are more limited. One is to realign and arthodese the joint.
Foot conditions we frequently see at the clinic
Excessively high arches can be neuromuscular in origin which causes an imbalance between two pairs of muscles or structural in origin following trauma or underlying deformity. Pes Cavus is used to describe an excessively high medial longitudinal arch. The cavus deformity of the mid foot […]
Pes planus is a term used to describe flattening of the medial longitudinal arch. In the child pes planus can be broadly divided into 2 groups – physiological and non-physiological. All infants have flat feet and in the majority an arch will develop by the age of 6 […]
Syndactyly can be divided into two types zygosyndactyly and polysyndactyly. Zygosyndactyly consists of complete or incomplete webbing between the toes usually the second or third. It is rarely symptomatic and rarely requires treatment. In polysyndactyly there is often duplication of the fifth toe with webbing between it and […]
A mallet toe is a flexion deformity of the distal inter phalangeal joint of a toe. The deformity can be fixed or mobile. In the first instance consideration should be given to conservative treatment with padding, taping and orthotics. In the mobile deformity if conservative measures have […]
Metatarsalgia is a term used to describe pain in the forefoot around the metatarsal heads. This can be mechanical or neuritic in nature. Mechanical metatarsalgia can be localised as seen in conditions such as second metatarsal over length or instability of the second metatarso-phalangeal joint. Symptoms can also be […]