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Conditions
Procedures
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Achilles Tendonitis
Achilles tendonitis, also sometimes called Achilles tendinitis, is a painful and often debilitating inflammation of the Achilles tendon (heel cord). It is generally caused by the overuse of the affected limb and is common among athletes training under less than ideal conditions. Archilles tendonitis can be slow to heal due to the poor blood supply or cell acitivity in the achilles tendon. Hence treatments such as wearing elastic bandages and compression therapy can help to improve circulation which would accelerate healing. Wearing heels pads will also help to reduce strain on the tendon. Other treatments may include anit-inflammatyory drugs, physical therapy or rehabilitation program to strengthen tendon. Seeking professional consultation as soon as possible is vital because continued overuse can lead to an Achilles tendon rupture. Surgery by an orthopaedic surgeon will be required for severe cases.
Achilles tendon rupture
This serious condition typically occurs in activities where there is a sudden push-off such as basketball, squash or badminton. It can be managed either with a plaster cast or surgery. The healing times are the same. Surgery entails bringing the separated tendon ends together with stitches, followed by resting the ankle in a plaster cast and later a walking cast boot after surgery to allow the healing process to take place. Surgical repair is associated with a lower chance of re-rupture and a better push-off strength. Therefore, surgery is recommended for the active adult. Plaster cast treatment alone is reserved for the elderly patient with lower demands for activities such as running and jumping.
Arthritis
Arthritis, a joint disorder, comes in many forms ranging from those related to wear and tear of cartilage (e.g. osteoarthritis) to those associated with inflammation resulting from an over-active immune system (e.g. rheumatoid arthritis). Arthritis if left untreated will eventually become worst leading to excruciating pain which may result in restricted mobility. But with proper treatment, you can slow the development of arthritis and lead a more productive life. Our Island Orthopaedic Consultants specialists, who specialize in the nonsurgical and surgical care of foot and ankle problems, can diagnose and treat your arthritis.
Ankle Joint Arthritis
Mild cases can be managed by clearing debris and bone spurs by ankle arthroscopy(keyhole surgery). In the early stages of ankle arthritis, microfracture of the cartilage defect is performed. For larger defects, cartilage grafting or re-alignment of the ankle joint can be performed. If the cartilage wear is severe, the most proven treatment is an ankle fusion. Buried metal screws hold the tibia and talus (ankle joint bones) to provide a stable but pain- free ankle. In selected patients, ankle replacement is also an option.
Cartilage Damage
Treatments for cartilage damage (cartilage defect) and the treatment of arthritis are not the same. Nonsurgical treatments for cartilage damage include physical therapy, medications, injections and other options. Surgery will be required if these treatments do not work.
Microfracture is a procedure used to stimulate the body to grow cartilage in an area of damage. This is done by exposing the inner layers of bone where marrow cells exist and allowing these cells to access the damaged area and fill in the gap of cartilage. Cartilage transfer, on the other hand, involves moving cartilage from healthy parts of the joint to damaged areas. Cartilage implantation, also known as autologous chondrocyte implantation (ACI), is a more advanced procedure that involves the growth of cartilage cells in a cartilage cell expansion laboratory. Two surgeries are required: one removing cartilage for growth and the other, reimplanting the artificially grown cartilage into the damaged joint.
Fractures
A broken or cracked bone is known as a fracture. This can be a crack or buckle in the structure of the bone or a complete break.
Symptoms of fractures include swelling, bruising, bone sticking out or bending and grating feeling or sound. Patients may also become pale and clammy, and feel sick or light-headed due to the pain. Osteomyelitis or a bone infection may occur if the fracture is associated with an open wound that communicates with the fracture.
Although fractured bones are able to heal naturally by themselves sometimes the fractured parts of your bone may need to be re-aligned so that the bone is in the correct position when it heals. Surgery may be required for certain cases (e.g. to fix the bone together with metal plates, screws or rods to help them unite). Physical therapy will help promote healing, strengthen and increase your movement of the affected area.
If you think you have fractured your foot or ankle, call us at 6737 5683 to seek medical treatment immediately.
Gout
Gout is caused by a chemical in the blood called uric acid (urate). Uric acid is usually harmless, and is made in the body. Most is passed out with the urine, and some from the gut with the faeces (stools). In people with gout the amount of uric acid in the blood builds up. From time to time the level may become too high and tiny grit-like crystals of uric acid may form. The crystals typically collect in a joint thus irritating the tissues causing inflammation, swelling, and pain – a gout attack.
Lateral ligament reconstruction for chronic ankle instability
After an acute or repeated ankle sprain the ligaments may be torn and the ability to walk on uneven surfaces becomes limited. We call this chronic instability of the ankle and repeated ‘going over’ on the ankle increases the risk of other problems such as bruising of the cartilage and bone spurs, which can lead to ankle arthritis.
A physiotherapist-led ankle strengthening programme maybe all that is required to treat this, but if this fails then surgical reconstruction that tightens up the loose ankle ligaments can be performed. This allows individuals to return to all forms of athletic activity without risk of recurrent injury to the ankle.
Surgery for painful bunions or Hallux Valgus
Bunions come in all shapes and sizes causing a variety of symptoms. If a bunion does not cause pain or crowd the second toe then surgery is generally not necessary. If surgery is indicated, the technique varies with the degree of deformity. For mild deformities, a simple shaving of the bony prominence may suffice. For more advanced deformities the metatarsal bone will need to be broken and reset to narrow the forefoot and allow the big toe to be realigned straighter. The cut bone is held in place with small screws that can stay in the patient. The pain after surgery is minimised by special nerve block techniques and patients are allowed to bear weight on their heel in a special surgical sandal.
Click here to read more about the procedure.
Ankle arthroscopy
This is ‘keyhole surgery’ done through two or three 5 mm incisions allowing direct visualisation with a small camera for problems that may not have even shown up on an x-ray or a scan and special. Small instruments are also introduced into the ankle joint allowing us to treat the problem once it is identified. For some people, arthroscopy means a speedier recovery, less scarring and fewer complications than open surgery. An ankle arthroscopy is carried for pain, clicking or if there is a build-up of excessive scar tissue and bone spurs at the front of the ankle that can cause pain and restrict movement. Patients have a short anaesthetic and usually go home on the same day with crutches. Resumption of normal activities is possible at 3 to 6 weeks.
Click here to see patient brochure.
Cheilectomy for big toe arthritis
Arthritis of the big toe may present with pain which is worse with motion, stiffness or bony hard lumps on the top of the toe that get sore when the shoe rubs on them. The initial treatment is non-operative comprising of anti-inflammatory medication, stiffer soled and wide shoes. Surgery is indicted in patients who remain persistently symptomatic. Cheilectomy is performed for milder cases and entails shaving the spur that forms on top of the joint. This eliminates pressure caused by the spurs and often improves joint motion. After this surgery patients can walk from day one in a special post-operative sandal.
Fusion for big toe arthritis
Fusion of the big toe for arthritis is a salvage operation for very serve arthritis or when previous operations such as cheilectomy has failed over time. Typically, buried metal screws and/or a metal plate is used to fuse the big toe. They can resume sporting activities and do not walk with a limp. Joint replacement of the big toe is possible but there is no evidence that they work in the long run.
Morton’s Neuroma
A nerve that lies between the toes, typically in the 3rd webspace may be squashed or damaged from chronic compression or attrition. As a result the nerve becomes inflamed and enlarged. This enlarged nerve is called a neuroma. Anywhere else in the body, this would not pose a great problem but in the foot we keep walking on this painful nerve, compressing it with each step causing considerable pain and/or numbness. In most cases, surgery to release or exercise the nerve is a relatively simple procedure that can treat this often very painful condition.
If you have an ankle or foot pain that is persistently causing discomfort, please call our clinic at 67375683. We are committed to care for you, your family and friends.
