Clinical Fact Sheets

Foot Pain Consultant Birmingham - Podiatric surgical services at Spire Little Aston Hospital

Please bear in mind that many of my fact sheets require patient consultations and using such information is designed to support that consultation, not replace it. The reader must use common sense judgement about any interpretation from my site or others on the subject of foot surgery.More details are also available within my ‘Treatment Centre’ Patient access only. Contact my secretary for the passcode if you are registered with this practice.You will also find the passcode on the inside of your introductory leaflet provided at your first consultation. The passcode will change at each reprint.

Click on the sections below to search through our library of Foot Pain articles

FOOT CONDITIONS

When it is not nail pain (33)

The information features foot pain associated with infection affecting toe nails and bone pain (exostoses & osteochondroma) requiring podiatric foot surgery

What are sesamoids? (3)

I look at the basic biomechanics of sesamoids. These small bones are important in the formation of bunion deformities.

Midfoot Arthropathy (58)

Foot pain caused by arthropathy affecting the middle of the foot and small foot joints is far from common. Podiatric foot surgery can now offer excellent assistance in appropriate patients.

Morton’s neuroma (101)

More information about neuroma or Morton’s neuroma on David Tollafield’s website www.consultingfootpain.co.uk

Flat foot, when to worry? (103)

Flat foot is so over diagnosed that it is easy to become paranoid that this is your ailment and you just have arch supports. Be careful of false promises and misleading claims. The College of Podiatry (London) tries to help patients with this condition through its caring professionals who can offer better advice and help. Seek more information about flat feet on David Tollafield’s website www.consultingfootpain.co.uk

Tendo-Achilles pain (104)

General information sheet produced by the College of Podiatry, Directorate of Podiatric Surgery on achilles tendon pain.

Intractable keratoma (107)

More information about corns (keratoma) on David Tollafield’s website www.consultingfootpain.co.uk. Updated July 2015

The painful big toe joint (109)

The condition hallux limitus and big toe joint pain is described with illustrations. This sheet is best read after the consultation which can be personalised for each condition. Conditions or suggestions presented, may not be typical to each patient.

LESS COMMON FOOT CONDITIONS

Delayed wound healing following surgery (49)

Wound dehiscence or wound breakdowns are problems that can arise after foot surgery and will form part of consent. Make sure you understand what is meant by wound problems before you undergo surgery. It is important to avoid smoking during the recovery period (also see sheet 41 if you smoke).

What is sesamoiditis? (4)

A relatively uncommon pain condition affecting the big toe easily missed and mistaken for arthritis in the big toe!

Trigger toe deformity and Pes Cavus (108)

Although rare, this condition may lead to a caves foot type if untreated. This is a detailed information sheet with colour illustrations. This sheet can be read with Guide book 2 (Treatment Centre), and fact sheet 104.

More about Bunion (hallux valgus -106)

More information about bunions on David Tollafield’s website www.consultingfootpain.co.uk

Complex regional pain syndrome (12)

There are few conditions that produce such bizarre and intractable pain which is difficult to manage. CRPS is a burning type pain condition and does not need surgery to invoke the problem. With lack of help groups in the UK, acquiring good advice can be difficult as many doctors still do not recognise the full impact. I work closely with specialist pain consultants in this regard. Seek more information about pain in feet and pain syndrome on David Tollafield’s website www.consultingfootpain.co.uk. Consider my pain specialist colleagues under About Us.

Removal of hardware (42)

Anything that goes ingot the foot may need to come out. Pins, wires, screws and plates all made of various metals. In some cases patients can become allergic or sensitive to such fixation systems. Low profile heads of screws and new methods of fixation are developed all the time and we try to use the most modern methods at our hospital at Spire Little Aston. Fixation is placed into bone and across joints under x-ray guided control offering better assurance for the patient and podiatric foot surgeon of good positioning to avoid later removal. Nothing however is guaranteed but as a high quality practice within an hospital we do all we can to make care better.

INFORMATION FOR PATIENTS PLANNING SURGERY (PR-OP)

Smoking and Surgery (41)

Smoking has undesirable effects for podiatric foot surgery and is a leading cause of foot and lower limb pain.

When to drive following foot surgery? (47)

Perhaps obvious but we cover this as well just to make sure you are aware of risks to you and others.

Useful pre-operative information (100)

Developed by the College of Podiatry Directorate of Podiatric Surgery, this information booklet covers a wide range of information that is a must for anyone to read prior to having foot surgery. Being informed is important especially for those who like more information.

TREAMENT STRATEGIES

Steroid injections (19)

Steroid injections form an important non surgical method of managing inflammatory conditions. Many years of experience have led to development of this introductory leaflet.Steroid injections in feet do not have to be a painful experience especially if you are needle phobic. Consult us at Spire Little Aston Hospital.

Tendon stretching (24)

Methods for helping you to stretch can be advised at our Spire Little Aston hospital

Orthoses explained (25)

Be wary of paying high prices or being misled with this method of foot management. Learn more here, or ask for a consultation and have access to the ‘Treatment Centre’ where more information on orthoses can be downloaded.

Casts and casting (70)

A system to prevent movement around joints following pain and injury can be valuable in speeding up recovery. Look at the website fact sheet 70 for more information.

Removable plastic casts (71)

Gaining notoriety when David Beckham fractured his metatarsal, this system has been used for many years to help patients with pain and offers an alternative method of stabilising feet after surgery.

FACT SHEETS ABOUT FOOT SURGERY (PRE-CONSENT)

Fusion of the first toe (52)

A very popular method for managing foot pain associated with the great toe. Modern methods are improving all the time with new technology and recovery is becoming faster with less need for fixed casting. Seek a consultation at our hospital Spire Little Aston Hospital.

Amputation of toes (2)

Amputation (lesser toes) sounds repugnant. Often this simple procedure can benefit patients enormously saving them from complex surgery. Of course like everything in health, detailed discussion with the professional involved with your foot care is important.

Lesser toe (arthrodesis) surgery (5)

Arthrodesis is stiffening of a joint and this method of managing the small toes is valuable and can prevent excessive shortening but above all better stabilisation. The other method is an arthroplasty. This fact sheet is currently being updated in favour of a new technique and may not download presently. You can see this in Latest News and download from this location. Please see the Latest News blog 8th May 2015 in the interim.

Lesser toe (arthroplasty) surgery (6)

The arthroplasty benefits patients without the need for internal fixation, offers shortening but may not always be as stable as an arthrodesis.

Hallux valgus [Bunions] (7)

Often known as bunion surgery (hallux valgus), this is often more complex than patients realise and yet the benefits can be enormous. In the UK only two groups of people operate on this type of problem. Podiatric Surgeons are the only dedicated specialism in foot health management trained from University entry without going to medical school. A wide range of options exist in managing the deformity known as the hallux valgus suited to men and women.Juvenile foot surgery should be resisted where possible because of regression. More available within these website pages www.consultingfootpain.co.uk

Dealing with large bunion deformities (105)

When a patient has a larger bunion, due to the increased angle of bones, surgery needs to be more robust. In this fact sheet I advance the information further taking into consideration some techniques which will extend the recovery after surgery but will offer better long term results.

Hammer toe surgery mixing different methods to stabilise the metatarsophalangeal joint (8)

The toe is weakened by a torn or stretched ligament or dislocation, this provides a complex deformity so that when the toe is stiffened (see Factsheet 5) there is a chance it will stick up. The capsule is stabilised by a method of tightening the torn ligament. More available within these website pages www.consultingfootpain.co.uk

Haglunds excision (heel bump) (15)

The bump on the back of the heel can interfer with foot comfort, cause blistering and chilling. The operation is successful but can take longer to recover from than some may believe.

Cheilectomy and big toe salvage procedures (16)

This procedure covers bone shaving and the older procedure Keller excisional arthroplasty suited for the severe or damaged bog toe joint. The advantage with this procedure (fact sheet 16) allows faster recovery for patients who need to be back on their feet. Generally not regarded as ideal for younger patients as those with good bone quality. Consultation with a specialist in foot surgery is important as these procedures do not suit all patient groups.

Lesser Metatarsal surgery (17)

The smaller long bones or metatarsals can respond well to surgery and often have to be carried out together with lesser toe surgery.

Fifth Metatarsal surgery for bunionnette deformity(18)

The fifth toe and metatarsal contribute to wide feet and cause pressure problems. The treatment is slightly different for this section of the foot covered by factsheet 18.

Fasciotomy (21)

There can be few conditions that are both common and cause such discomfort. Often more notable in active patients treatment is now always quick. It is important to seek help and take action within six weeks to prevent the condition from becoming intractable.Surgery is used perhaps in 15% of my cases after I have tried conservative care.

Fasciectomy (22)

Lumps under the arch of the foot can be tricky. I am seeing more of these in my practice at Spire Little Aston Hospital. Small incisional surgery is not advocated due to the very real problem of high reoccurrence of the condition.

Morton’s neuroma and bursa excision (23)

This is a very common form of metatarsalgia, the general term for forefoot pain. The nerve is damaged and thickens leading to a painful foot when walking or wearing some shoes. It is more common in women than men and can arise earlier than the traditional texts books advice. Invariably this conditions requires investigations such as ultrasound, a lower cost method than MRI and more reliable. Be wary though, there is a slightly greater chance of complex regional pain syndrome developing in some patient categories. Read fact sheet 12 on www.consultingfootpain.co.uk/fact-sheets.

Ingrowing toe nail surgery (30)

This is a chemical method of stopping the nail growing. Benefits can bathe afterwards but can cause delayed healing.There are no sutures (stitches).

Complex nail surgery matricectomy (31)

Comes under various names such as Winograd. Cosmetically acceptable, has good healing ability, especially for diabetics and patients with high amounts of sweating. Recovery is slightly longer and stitches (sutures) are required.

Navicular (Kidner procedure) (45)

A lump on the side of the foot affecting any age but often in the teenage group. Excessive bone growth due to an additional (accessory bone) can affect tendon function and lead to flat foot appearances.

Replacement joints [Big toe] (50)

Replacement joints have fallen from favour in some cases but a resurgence of this method still plays an important part offering faster recovery after surgery and in some cases better function. This is not the only method for managing joint damage but discussing with your foot surgeon is worthwhile.

Midfoot fusion (53)

Midfoot pain is the unsung foot pain often ignored or not recognised. With 26 bones in the feet each bone shares partnership with other bones in a plethora of small, often interconnecting joints. At Spire Little Aston Hospital we have excellent facilities to ensure treatment is accurate diagnosed. Injection treatment can be highly effective and reduces the problem from going to surgery in many cases.

Plastic surgery for corns and verrucae (55)

A corn is not always a simple condition and where it cannot be managed by pedicure or professional podiatry care then seeking a specialist podiatric surgeon is recommended. Many corns in fact are infected with a virus damaging deeper skin structures. Go to clinician portal to read more about classification of corns and callus.

Soft tissue bumps and lumps (66)

Most lumps and bumps are harmless in feet. A second opinion can help supported by good diagnostic facilities. At Spire Little Aston Hospital I work with other specialists such as dermatologists to ensure broad advice options.

INFORMATION FOR PATIENTS WHO HAVE HAD SURGERY (POST-OP)

When can I fly after surgery? (48)

A common question asked. There are no absolute answers but based on flight time and type of surgery you should be able to work out the correct action to take.

Post operative expectations and problems (40)

Patients must be aware of the limitations of mobility and activity following surgery.This professional leaflet is issued to all my patients and supports the risks written on standard British consent forms in the NHS and Independent Sector.

Foot surgery recovery on ward discharge (43)

Developed as a broad guide mainly for bunion surgery (hallux valgus). This can be applied to more complex surgery. Smaller surgeries offer faster recovery. Spire Little Aston Hospital.

The Use of Icing after foot surgery(44)

Ice or cold is a first aid method for helping pain and swelling. This can be delivered simply by home remedies or by using modern products delivering cooling systems designed for the foot and ankle.

An aid to bathing after foot surgery (46)

Feeling human again after surgery is as important to patients making recovery as controlling pain. Systems such as the Limbo Cover offer better freedom.

Scar lines and wounds after surgery (102)

Scars happen after surgery and skin injury. Managing these early is essential to help recovery after foot surgery.

Thanks for reading Clinical Fact Sheets associated with foot pain and podiatric surgery. Consulting Foot Pain – David Tollafield, Birmingham