The Waverley Orthopaedic Clinic provides treatment for and education about foot and ankle conditions, including medical and surgical management. Mr. Lowe has been practising Orthopaedic surgery for more than 30 years, and during this time has done many foot and ankle procedures, and treated many patients for foot disorders. Mr. Danny Keogh, our orthotist here for more than 20 years, is very experienced with orthotic manufacture and fitting, and advice about, and fitting of orthopaedic shoewear.

Foot and ankle problems usually present with pain and difficulty with shoewear, and deformity in the forefoot or hindfoot. Medical management may be prescribed initially, with advice regarding activity, and shoewear, physiotherapy and fitting prescription orthotics or a calliper. Some conditions may require treatment with medications, or injections, but there will be some foot and ankle conditions that require an operation. the following is a brief description of some of the commoner foot and ankle disorders requiring operation.

Bunions and Hammer toes: A "bunion" is a bump, often painful, on the medial (inner side) of the joint of the first toe. Apart from pain, this bump causes difficulties and discomfort fitting shoes, and some people regard it as unsightly. A bunion is often associated with deformities of the adjacent toes, which may be painful. The "bunion" is due to prominence of the first metatarsal bone, which becomes deviated inwards, and an associated soft tissue swelling over this prominence ( a bursa). Medical management involves adjustments to shoewear to relieve pressure and therefore pain. The deformity can only be corrected surgically. Many different operations have been described and done to correct bunion deformity, but the commonest used now requires correction of the deformity by cutting and re-aligning the bone surgically (an osteotomy).

The operation is done under a general anaesthetic, and may require two or three days in hospital. A protective bandage and plaster is needed for two weeks after the operation, and care with activity for 6 weeks until the bone cut unites.The results are uniformly satisfactory, and complications relatively uncommon.

Arthitis (Hallux rigidus) First toe: Osteoarthritis can develop in the first toe joint (Metatarso-phalangeal joint). This condition causes pain due to the arthritic joint, and also due to pressure on the toe because it is stiff and does not move freely at the joint. The operation chosen to treat this condition depends on the severity of the arthritis and the restriction to joint movement. A cheilectomy involves trimming spurs from the joint to improve movement. Other operations that may be used include a fusion(stiffening) of the joint, or an arthroplasty (Replacement) procedure.

Rupture of Achilles Tendon: The Achilles tendon is the large tendon behind the ankle. The power of the calf muscle is transmitted through the Achilles tendon to enble the function of the foot "pushing off", in walking or running. The tendon may snap (rupture) with sudden forces, causing severe pain, and inability to walk. This serious injury  commonly  occurs during sport, when sudden "push off" occurs, in sports such as squash, tennis, basketball. A ruptured Achilles tendon must be repaired surgically. Following the operation a cast is needed for six weeks, followed by an extended period of physiotherapy.  Functional recovery is usually satisfactory, but there may often be some permanent calf weakness after a ruptured Achilles tendon.

Complications: Foot operations are generally satisfactory in improving foot symptoms. Complete cure of some foot problems is not always possible with foot operations, and relapse or recurrence of symptoms can occur, and other complications such as infections, occasionally result. You must ask about and discuss the risk of complications, and the likely benefits of operation at  your consultation with your surgeon.