Foot and ankle disorders
At Springfield Hospital we are able to offer treatment for the
vast majority of foot and ankle disorders. Mr Russell one of our
foot and ankle specialists has his own clinic for such
conditions, Click Here for more
Here are some of the treatments we include:
A bunion is a bony prominence on the inner aspect of the base of
the big toe. Bunions are extremely common in the United Kingdom.
The cause of bunions remains uncertain although they seem to be
more common in families where bunions are prevalent and there is
some evidence to suggest that wearing narrow shoes may also be a
cause. A large number of patients with bunions do not require
surgical treatment. It is only when they become painful and when
conservative treatment is unsuccessful that surgery should be
Bunions normally coexist with hallux valgus; a condition
characterised by the big toe drifting off towards the second toe.
Provided that there is no arthritis in the big toe joint, surgical
treatment for bunions involves removing the bony prominence and
also correcting the associated hallux valgus deformity by cutting
and realigning the bone; an operation known as an osteotomy.
There are three different type of osteotomies ; the chevron, the
scarf and the basal osteotomies to treat the spectrum of bunion
deformities which all have good results in the scientific
literature. The type of osteotomy recommended is dependent on how
severe the deformity is.
Lesser toe deformities
These are common deformities that often present with the
affected toe being painful and rubbing on shoes or the neighbouring
toe. Surgical correction is indicated if conservative measures
fail. The correction recommended depends on the nature of the
deformity which may be of two types; flexible or fixed.
For a flexible deformity, when the toe can be easily corrected,
a soft tissue procedure is recommended. The soft tissue procedure
performed depends on the position of the toe but would involve
either a tenotomy (tendon release), a tendon lengthening, a
capsulotomy (soft tissue joint release), or tendon transfer
(reattaching one tendon to another).
For a fixed deformity, when the toe cannot be corrected, a bony
correction is required. This involves removal of the stiff joint
affected and stabilisation with a wire which is removed after 4-6
Heel pain (Plantar Fascitis)
Plantar fascitis is a common cause of heel pain which typically
presents at the base of the heel and is worse in the morning. It is
normally self limiting but may take 18 months to resolve.
Conservative treatment involves pain killers, heel pads and
physio. Night splints, steroid injections and ultrasoundtherapy may
also be helpful. Surgical treatment involves the release of the
plantar fascia, although this is rarely necessary.
Arthritis of the foot and ankle
There are many different types of arthritis that may affect
joints; osteoarthritis and rheumatoid arthritis are the two
commonest seen in the foot and ankle. Osteoarthritis refers to a
degenerative loss of cartilage that normally lines the joint. It is
seen as patients get older or may be a result of a previous injury
that has disrupted the joint.
Rheumatoid arthritis is an inflammatory condition that causes
destruction of bone and cartilage. Both conditions commonly present
with pain, swelling and reduced mobility. If the pain is severe and
does not respond to conservative measures, then surgery is
considered. The options of surgical intervention for arthritis of
the foot and ankle include:
Steroid/local anaesthetic injection
This may be helpful in rheumatoid disease or osteoarthritis of
the big toe joint but it is unlikely to provide long lasting pain
Performed for the big toe where the upper part of the arthritic
joint is removed.
Arthroscopy with debridement
Useful for osteochondral defects and tears in the cartilage in
the ankle joint which may be curetted or shaved.
It involves the refashioning and subsequent stiffening of the
joint with high levels of patient satisfaction when correctly
Treatment for all fractures of the foot and ankle including
calcaneal, pillion and lisfranc injuries.
Sports injuries of the foot and ankle
Treatment for all sports injuries of the foot and ankle
including chronic ankle sprains, chondral/osteochondral defects of
the ankle, midfoot sprains, stress fractures, sesamoid injuries,
freibergs disease and nerve entrapment syndromes.
Surgical treatment includes the use of arthroscopy for some of
Tendon disorders of the foot and ankle
The achilles, peroneal and tibialis posterior tendons are most
This structure is very important in walking and by providing the
power to ‘toe off’. The tendon may become inflamed(tendinitis),
tear(complete or partial) or become degenerative. Conservative
treatment for Achilles tendon problems includes immobilisation in a
plaster(for acute ruptures not for surgery), physiotherapy
(tendinitis), orthotics and ultrasoundtherapy. Surgical treatment
is indicated as a primary treatment in most active patients for
conditions such as acute Achilles tendon rupture where there is a
lower re-rupture rate for surgery or in conditions when
conservative treatment has failed. Achilles Tendon Reconstruction
is indicated for complete/partial tears and for severe tendon
degeneration. It may be primary (direct suture of the tendon ends)
or secondary (using tendon lengthening/transfer techniques) for
delayed rupture when the tendon ends retract. Achilles tendon
decompression is considered for tendinitis resistant to
These tendons lift the foot up and out during walking. Following
a twisting injury, these tendons may tear causing pain and swelling
behind the fibula(outer bone of the ankle) or may dislocate to lie
in front of the fibula. Surgical treatment involves repair and
restoration of the normal shape of the tendon for tears and repair
of the supporting tendon sheath and deepening of the normal bony
grove for dislocations.
Tibialis posterior tendon
An important structure in walking that pushes the foot down and
also maintains the inner foot arch. Tendon dysfunction causes pain
behind the inner aspect of the ankle and a flat foot. Most forms
may be successfully treated conservatively with medial arch support
insoles and physiotherapy. Surgery is indicated for severe forms
which have not improved with conservative treatment. Surgery
involves reconstruction with a tendon transfer or in advanced
cases, partly fusing(stiffening) the foot.
This is a common cause of forefoot pain and tingling, typically
affecting the 2nd and 3rd toes. It is due to a swelling on the
nerve in the sole of the foot. Conservative treatment involves the
use of an insole which offloads this area. An ultrasound guided
steroid injection is often helpful. Surgical excision of the
neuroma is reserved for cases resistant to conservative
Information provided by
Mr R Russell
Consultant Orthopaedic Surgeon, Springfield