Adult Podiatry

Problems affecting the big toe

Bunions

bunionsBunions are a common foot problem which affect the big toe joint, resulting in progressive angular deformity of the big toe. Bunions can affect people of any age or gender and can occur due to hereditary, mechanical or traumatic reasons. Patients that suffer from this problem typically describe problems fitting into normal footwear, shooting pain or numbness across the big toe joint, and concerns of cosmesis. In later stages, the big toe joint may also develop secondary arthritis and associated joint pain, due to the long-standing malalignment of the joint. Both non-operative and surgical podiatry treatments are available for patients with bunions. Patients who suffer from this problem should have it assessed by our foot specialist who can advise on the most appropriate treatment option, which will depend on the degree of the deformity, quality of the bone and joint, and general health of the patient.

Arthritis of the big toe joint / hallux limitus

arthritis-of-the-big-toe-joint-hallux-rigidusArthritis of the big toe joint, also known as hallux limitus/rigidus is a condition in which there is progressive limitation of movement of the big toe joint secondary to spurring around the big toe joint. Patients may initially complain of stiffness within the joint that is associated with pain, worsened by activity. The exact factors that lead to the development of this problem in adults are often unknown, or perhaps multifactorial in nature, including traumatic, inflammatory, structural and functional causes. Podiatry treatment for hallux limitus/rigidus is aimed at reducing pain and associated symptoms. In early stages of the problem, non-operative treatment with a custom-made orthotic may be performed, or surgery aimed at increasing motion and decompressing the joint may be suggested. Patients who suffer from this problem should have it assessed by our foot specialist who can advise on the most appropriate treatment option, which will depend on the patient’s symptoms, degree of the arthritis present, quality of the bone and joint, and general health of the patient. Information on custom-made orthotics can be found here.

Ingrown toenail

in-grown-toenailsAn ingrown toenail is a painful condition that can become infected and may require surgical treatment by podiatric surgery. It can occur at any age and has a multitude of causes including improper nail cutting technique, tight-fitting footwear, trauma, anatomical factors such as thickening of the nail plate, pincer-shaped toenail, and pressure from abutting toes caused by bunions, hammertoe deformities, or bony spurs underneath the toenail. Treatment for ingrown toenails will depend on the severity of the problem, previous history of the condition and general health of the patient. A minor surgical procedure is often provided to permanently correct the nail shape in patients who have experienced recurrent ingrowing toenails.

Sesamoiditis, sesamoid deformity and sesamoid fractures

sesamoiditis-sesamoid-fracturesThe sesamoid bones are small accessory ossicles which lie underneath the big toe and have a series of intricate attachments to the flexor tendons and big toe joint. They play an important role in the movement of the big toe joint and can become painful following an injury, or spontaneously due to congenital deformity in their shape. Treatment largely depends on the cause of the underlying problem and may initially involve non-operative management through custom-made orthotics, anti-inflammatory medications, steroid injections. Surgical excision of painful sesamoid bones which have not responded to standard podiatry care may also be performed. Patients who suffer from a sesamoid bone problem should have it assessed by our foot specialist who may order an x-ray or MRI to evaluate the problem further and provide comprehensive podiatric advice.

Hallux extensus aka ‘cock-up’ toe deformity

hallux-extensusHallux extensus, also known as ‘cock-up’ toe is a problem in which the big toe joint is permanently hyperextended, causing the toe to have a significant bowing / ski jump appearance. This problem may occur congenitally, can be acquired through injury or overstretching of the toe tendons from activities such as ballet, or may be associated with a neurological disorder. It may cause cosmetic problems for some patients, and is often associated with progressive damage to the big toenails and excessive wearing-out of the shoe toebox due to constant pressure on the area. This problem is primarily managed through surgical correction which may involve lengthening of the big toe tendon, or fusion of the toe joint to straighten it permanently.

Nail damage, deformity & subungual exostosis

nail-damage-deformity-subungual-exostosisNail damage and deformity in shape may result secondary to trauma, or spurring underneath the toenail know as a subungual exostosis. This is one of the most common patient foot complaints, yet the underlying cause of the nail deformity often goes unrecognised by practitioners. It often causes cosmetic problems for patients and can affect people of any age or gender and may be congenital, or develop secondary to direct trauma to the toe. Patients with this condition may complain of pain upon compression of the toenail in enclosed footwear, or suffer from nail dystrophy (e.g. thickening, discolouration) secondary to the chronic pressure from the spur. This problem can be corrected through a minor podiatry surgical procedure, or it can be managed non-surgically through general podiatric care.

Fungal toenail infection

fungal-toenail-infectionOnychomycosis, or nail fungus, affects approximately 7.8% of the Australian population in any given 12 months. While some people are genetically prone to it, others, like athletes, may be more likely to get it due to damp feet. Nail fungus is often merely a cosmetic problem, but over time it can also cause pain or abnormal growth. Nail fungus is an embarrassing chronic condition that impacts a patient’s quality of life and can lead to serious health problems for those with diabetes or immune disorders. The treatment of nail fungus is difficult because the infection is under and inside the nail, making it hard for other treatments to reach it. Patient’s suffering from this problem can receive specialist laser treatment through our practice.

Problems affecting the lesser toes & ball of the foot

Hammertoes & toe deformity

hammertoes-toe-deformityHammertoes and toe deformity refer to problems in which the lesser toes become retracted, or deviate from their normal position of alignment. They can affect people of any age or gender and typically occur due to congenital, mechanical or neurological reasons. Patients may develop painful local skin lesions such as corns or callus secondary to the toe deformity and may also experience local pain within the affected joints or underneath the ball of their foot. This problem is generally managed through surgical treatment which is aimed at correcting the contractions in the overlying skin, associated tendons and small toe joints.

Tailor’s bunion

tailors-bunionTailor’s bunion refers to a condition in which the 5th metatarsal bone is prominent at its head and is associated with overlying callus, painful rubbing in footwear, and/or joint and nerve pain. It may be caused by a local enlargement of the bone, or secondary to malalignment of the 4th and 5th metatarsal bones. Both non-operative and surgical podiatry treatments are available for patients with Tailor’s bunion. Patients who suffer from this problem should have it assessed by our foot specialist who can advise on the most appropriate treatment option, which will depend on the degree of the deformity, quality of the bone and joint, and general health of the patient.

Corns, calluses & metatarsalgia

corns-calluses-and-metatarsalgiaCorns, calluses and pain under the ball of the foot known as metatarsalgia may occur for a variety of osseous or mechanical reasons. Areas on the sole of the foot where there is a local increase in pressure or shear forces may also be associated with a painful overlying callus or corn that requires regular podiatric treatment, which involves shaving the hard skin off the area. A podiatry assessment is performed to identify any underlying mechanical foot problems or bony prominences which may be contributing to the development of the problem, and can be treated through a custom-made orthotic, or through surgical means. Patients who suffer from this problem should have it assessed by our foot specialist who can advise on the most appropriate podiatric treatment option, which will depend on the patient’s symptoms, cause of the underlying problem, quality of bone, and general health of the patient.

Morton’s neuroma / bursitis

mortons-neuromaMorton’s Neuroma refers to a condition in which the interdigital nerve that is responsible for providing sensory feedback to the toes becomes entrapped and scarred, resulting in sensory disturbances of the affected toes. This condition is more commonly observed in women than in men, and may be aggravated by certain types of footwear including high heels. Patients who suffer from Morton’s Neuroma may describe feeling as though they are ‘walking on a pebble’ and may experience intermittent shooting pains in their toes. Treatment for Morton’s Neuroma depends on a variety of factors including the size and location of the neuroma, duration of symptoms, and general health of the patient. Non-operative treatment can be helpful in the early stages which may involve footwear modification, padding, custom-made orthotics and local injection into the neuroma. Surgical podiatric treatment offers a fast and effective approach to treat neuromas which have not responded to standard care, and involves local excision of the scarred nerve through a small portal incision. Patients who suffer from this problem should have it assessed by our specialist who can advise on the most appropriate treatment option.

Toe fractures & dislocation

fracturesToe fracture and dislocation may occur following an acute traumatic injury. They can be a source of ongoing pain, swelling and future deformity for patients if they are not managed correctly, and may be treated through both non-operative and operative management. Proper assessment of this injury should be performed by our specialist and will involve x-rays, clinical assessment, and sometimes an MRI if there is concern about concurrent soft-tissue injury. It is best to treat these podiatric injuries as soon as they can occur because delayed diagnosis can lead to malunion and sometimes non-union of the bones, leaving patients with permanent deformity of the foot.

Problems affecting the sole of the foot, arch & heel

Plantar fasciitis / heel spurs

plantar-fasciitis-heel-spursPlantar fasciitis and heel spurs are a common cause of heel pain which may occur due to degeneration of the collagen fibres in the plantar fascia, or from poor foot mechanics. Patients with this condition typically describe pain in their heel, worse during the first few steps in the morning which decreases after warming-up, and may recur after periods of prolonged standing or activity. The assessment of heel pain by a qualified podiatry specialist is important in order to determine the exact cause of the patient’s symptoms to help guide treatment options. Treatment for this condition is generally performed in its early stages through custom-made orthotics, specific muscle stretches, and sometimes cortisone injections. Patients with plantar fasciitis who do not respond to standard conservative treatment may benefit from surgery, which is performed through a portal incision and involves releasing tension from the plantar fascia near its origin in the heel bone.

Plantar fibroma / fibromatosis

plantar-fibromaPlantar fibroma/ fibromatosis are soft-tissue tumours which consists of lumps of fibrous connective tissue and may occur in the sole of the foot. They usually occur alone, but may occur in groups throughout a region of the body, or throughout the entire body. They are most commonly found in the plantar fascia in the foot based, and are diagnosed based on on clinical findings and supported by imaging such as MRI. They do not require treatment if they are asymptomatic, but can become painful due to increased pressure on adjacent structures such as nerves. Treatment for plantar fibroma depends on a variety of factors including the size and location of the tumour, duration of symptoms, and general health of the patient. Non-operative treatment can be helpful for some patients which may involve footwear modification, padding, custom-made orthotics. Podiatric surgery is sometimes performed for cases, and involves local excision of the tumour. Patients who suffer from this problem should have it assessed by our foot specialist who can advise on the most appropriate treatment option.

Warts

wartsWarts, also known as verruca, are benign lesions which affect the skin and are caused by the human papilloma virus. They can occur at any age, but are believed to be most common in adolescents who have a developing immune system. Although not always painful, warts are highly contagious and can spread to other areas of the body or to other family members. They are generally managed through specially-compounded topical acid-based treatments which can be performed by a podiatrist at the time of an appointment. Warts which do not respond to standard treatments are sometimes managed through a surgical technique called curettage, which offers a fast and effective solution for resistant cases.

Flat feet & high-arched feet

flat-feetFlat feet & high-arched feet may occur for a variety of different reasons and should be assessed by a podiatrist in order to determine if any treatment if necessary. Although these variations in foot anatomy do not always cause symptoms, they are a mechanically unfavourable position for the feet and legs to be in and can result in long-term foot, leg, knee, hip or back problems. Most patients with these problems can be treated successfully through custom-made orthotics, in a similar way to how glasses can be used to accommodate for eye problems. Surgery is rarely required, and is only reserved for severe cases or those which continue to get worse despite non-operative treatment.

Accessory bone problems & accessory navicular

accessory-bone-problems-accessory-navicularAccessory bones are supernumerary bones of the human body which are considered to be an anatomical variant. They may occur in a variety of locations throughout the foot and ankle including the big toe, underneath the ball of the foot, side of the arch of the foot, and behind the outside of the ankle. Accessory bones are not always symptomatic, but can become painful particularly after an acute injury such as a sprain. One of the more common accessory bones which often requires treatment is the accessory navicular bone. It typically presents in adolescents as a painful bump on the side of the arch of the foot and is thought to be inherited. The problem requires specialist podiatry assessment and management if it is symptomatic and can be treated successfully through non-operative management including custom-made orthotics, rest, anti-inflammatories and immobilisation if it is detected early. Patients which continue to have symptoms despite conservative treatment usually benefit from surgical excision of the accessory bone. A similar approach is often considered for other accessory bone problems in the foot and ankle also.

Achilles tendonitis/tendonopathy

achilles-tendonitis-tendonopathyAchilles tendonitis & tendinopathy is a common problem which occurs due to recurrent strain, micro-tears and eventual degenerative problem of the Achilles tendon with scar tissue formation. It often occurs in individuals who have participated in jumping and running sports throughout their lives and affects males more frequently than females. This problem requires specialist assessment and imaging in order to determine the extent of the the tendon injury, which will help to guide treatment. Non-operative treatment may include custom-made orthotics, specific muscle-group stretching exercises, anti-inflammatory use, platelet-rich plasma injections, footwear modifications and activity changes. Operative management is performed for patients with significant damage and scarring of the tendon, and can be helpful for individuals who have not benefited significantly from conservative treatments.

Tumours of the foot and ankle / ganglions, lipomas, leiomyomas

tumours-of-the-foot-ankleSoft-tissue and bone-tumours are not uncommon in the foot and ankle, and may be a source of pain and concern. Fortunately, most of these tumours are benign however approximately 5% of tumours occurring in the foot and ankle may pose significant health risk from malignant transformation. We are able to provide specialist assessment, imaging and surgery for tumours occuring in the foot and ankle including ganglions, lipomas, fibromas, leiomyomas and angiomas. This will usually involve x-rays and an MRI initially, with biopsy and/or surgical excision if deemed necessary. Patients with suspicious lumps or bumps on their feet should not hesitate to make an appointment with our specialist for further advice.

Acute trauma, fractures & degenerative tendon conditions

Fractures & stress fractures

fractures-stress-fracturesFractures and stress fractures are not uncommon in the foot and ankle, due to the fact that the foot is a constantly weight-bearing structure and is subject to large forces during activities. Fractures and stress fractures in the foot and ankle ma occur following a direct trauma, injury, or can develop secondary to underlying medical problems. They require specialist clinical assessment by a podiatrist and imaging in order to determine if operative or non-operative management is required.

Tendon or ligament sprain, tear or rupture / ankle sprains

tendon-ligament-sprainTendon or ligament problems are common in the foot and ankle, and often occur following an acute injury, such as an ankle sprain. Proper clinical assessment and imaging of these problems is required in order to determine the most appropriate course of treatment, which may involve a period of immobilisation followed by rehabilitation, or urgent surgical management. Patients who have sustained an injury to their foot, such as a bad ankle sprain should not hesitate to make an appointment with our foot specialist for further advice.