Morton’s neuroma is a common cause of pain in the forefoot, and ultimately makes wearing tight, or even normal width footwear painful. It can also become difficult to stand comfortably at work, or at home, as well as enjoy exercise and recreational activities. So what is Morton’s neuroma? and how do we treat it?
Morton’s neuroma is a condition affecting nerve tissue in the forefoot, often resulting in thickening of the outer sheath and the development of fibrous tissue. Many theories have been proposed as to what causes the development of Morton’s neuroma, however to date, health practitioners still remain unsure as to how exactly the problem comes about.
The treatment for Morton’s neuroma often depends on a few factors; how long the problem has been present, how painful it is, the amount of required standing or walking in your work and personal life, and the level and type of physical activity you currently do, or would like to undertake.
Simple non-invasive treatments are usually first line for Morton’s neuroma. This involves things like footwear changes and use of orthotic devices in shoes. When pain is impacting on everyday life, Morton’s neuromas may also be treated with injections of steroid medication, alcohol, or radiofrequency ablation. The choice of injection technique often comes down to personal preference, availability and cost of treatment, and is best discussed with a trusted healthcare provider.
Where conservative treatment fails to relieve pain associated with Morton’s neuroma, surgical management can be considered. Recent evidence suggests that injection therapies and operative management provide the best outcomes for patients, with surgery resulting in even better outcomes than injections. A recent systematic review found a 94% success rate in patients undergoing Morton’s neuroma excision and decompression of the interspace at the forefoot, compared with 48% of patients having success with conservative treatment.
To discuss treatment for painful Morton’s neuroma, call 08 9383 3851 to make an appointment with our specialist Podiatric Surgeon, or alternatively book online at https://www.perthpodiatricsurgery.com/appointments/
Valisena, S., Petri, G. J., & Ferrero, A. (2018). Treatment of Morton’s neuroma: A systematic review. Foot and Ankle Surgery, 24(4), 271–281. https://doi.org/10.1016/j.fas.2017.03.010
Preserve motion, avoid fusion!
The Cartiva implant is a revolutionary approach in modern foot surgery techniques and is now widely used throughout the world for treatment of conditions affecting the big toe joint. Hallux rigidus, also known as hallux limitus, is a painful foot condition in which arthritis develops within the big toe joint. The condition can be likened somewhat to osteoarthritis of the knee or hip joints, where the condition usually worsens with time and often eventually involves surgery being undertaken to reduce pain and improve overall function.
Where non-surgical interventions have failed to relieve pain associated with toe joint arthritis, the Cartiva provides a means to restore movement to the joint, reducing poor foot loading patterns and pain. The implant acts in a similar way to natural joint cartilage, and is placed inside the joint after damaged cartilage and bone spurs have been removed.
The Cartiva procedure takes on average 30 minutes to perform, with minimal downtime compared with traditional more invasive methods such as joint fusion. Patients are able to weight bear in a special provided sandal immediately after the procedure, with close monitoring in the period following surgery by a dedicated team of health professionals.
Rehabilitation is important to obtain optimum results following a Cartiva implant. Exercises will be prescribed to you within two weeks of your procedure, and these will continue to be progressed as your strength, function and big toe joint movement continue to improve.
If your big toe joint pain is making it difficult to walk, exercise, or fit into shoes, the team at Perth Podiatric Surgery is here to help. Perth Podiatric surgery is proud to offer the Cartiva procedure, along with a range of other procedures to address big toe joint arthritis. Contact us today for more information, or book an appointment online with our specialist to see if you are a suitable candidate.
Please note:
This website is intended for general information purposes only. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
What is rehabilitation?
The term rehabilitation is used in a variety of different settings and contexts. It can be defined as the process of optimising physical and functional states following injury, illness or disease. Post-surgical rehabilitation is type of rehabilitation that aims to return the person to their pre-injury or pre-operative level of function. It not only involves physical interventions; education forms a fundamental aspect that is vital to success in achieving set goals.
Why is it important after foot surgery in Perth?
We know from documented research that changes in the body take place on a physiological level after a period of immobilisation. For example, the time period when wearing a post-operative shoe or moon boot, which is common after foot and ankle procedures. Immobilisation results in decreases in muscle strength, weakening in ligament insertion sites and changes to joints and cartilage quality, amongst other things. The good news is, these changes can be reversed with an appropriately structured rehabilitation program through a qualified health practitioner.
What should I expect from my rehabilitation?
Everyone is different, so no two rehabilitation programs will be exactly the same. There are a number of key elements that should be considered by the health practitioner when designing your rehabilitation program.
Condition-specific – the interventions prescribed should be specific to the type of procedure you have had performed. For example, a program designed for someone who has had bunion surgery will be different from someone who has had plantar fascia surgery. The actual structures involved in these procedures, that being the bone, tendons, fascia and joints, are completely different, hence why rehabilitation needs to target the specific structures affected.
Patient-centred – Rehabilitation needs to consider the qualities, functional ability and goals of the person we are working with. For example, the needs of a 15 year old elite gymnast with a traumatic foot fracture will be different to that of an elderly female who has fallen and sustained a similar foot fracture.
Evidence-based – The evidence for certain interventions in constantly changing and evolving, and a forward-thinking practitioner will be aware of the current best-practice management in their specialist area. Research allows us to know which treatments work, and which don’t, plus those that require further study to really evaluate their outcome.
In conclusion, rehabilitation is vitally important following many types of foot surgery procedures, including bunion surgery, hammertoe surgery, heel pain surgery and many more. It should form a key part of your foot surgery journey and commitment will promote optimal functional ability and return to activity.
Our team at Perth Podiatric Surgery are able to assist patients in their rehabilitation after foot surgery in Perth. Feel free to book an appointment today by calling 08 9383 3851 or visit https://www.perthpodiatricsurgery.com/appointments/
The presence of heel pain in children can significantly limit their ability to participate comfortably in sport and exercise, and at times can cause children to stop playing sport for a period of time altogether. The most common cause of heel pain is a condition known as Sever’s disease, which occurs due to inflammation at the growth plate in the heel bone.
Treatment of Sever’s disease involves addressing a number of common issues that may be contributing to the problem, and is best assessed by an experienced podiatrist. Our experienced practitioners at Perth Podiatric Surgery in Perth, are here to help your children suffering with heel pain. Treatment is simple and non-invasive, and will get your kids back on the field as soon as possible. Book an appointment today by calling 08 9383 3851 or visit https://www.perthpodiatricsurgery.com/appointments/
Results after Heel Spur Removal Surgery in Perth
What is a Heel Spur?
A heel spur is a common complaint at Perth podiatry practices, and is often found incidentally when a patient’s foot is X-rayed for other purposes. Having a heel spur is not a sure predictor for pain in the heel, for example a person can have a heel spur and have no pain in their heel, or can have debilitating heel pain with no associated spur. In this blog we’ll explore why this occurs, what solutions are available for heel spurs and what to expect after heel spur surgery.
Heel spurs form when calcium deposits at areas where tendon attaches to bone, therefore spurs can form at both the posterior (back) of the heel and plantar (bottom) of the heel. Plantar heel spurs, which occur where a strong structure called the plantar fascia attaches to the heel bone, are more common than those that occur posteriorly at the attachment of the Achilles tendon.
Treatment for Heel Spur
There are many conservative treatment options available to treat heel pain relating to plantar fasciitis and heel spurs. Some treatments include specific footwear, orthotics, physical therapy, life-style modifications, non-steroidal anti-inflammatory medications and injections. Only a small percentage of people who experience heel pain have little or no benefit from conservative treatment options.
As a final option, surgery can be performed to partially release the plantar fascia, just distal to where it attaches at the heel bone, as well as to remove the bone spur if required. Plain X-ray imaging will clearly show whether a heel spur is present, however magnetic resonance imaging gives us further insight into whether the heel spur is chronically inflamed. This form of imaging may be recommended prior to considering surgical treatment.
Surgery for Heel Spurs
Heel spur surgery can be performed in Perth as a day procedure and patients can weight-bear immediately afterwards in a special splinted sandal. This is generally worn for the first 2 weeks after surgery, after which time the patient can transition into a supportive sneaker style shoe. The procedure is performed through a key-hole incision, using X-rays intra-operatively to guide removal of the spur. The keyhole approach ensures minimisation of scar tissue and allows patients to recover faster from surgery with less overall pain. Patient’s undergoing heel spur surgery by our specialist in Perth, generally have minimal pain immediately afterwards and get back to normal activities within 2-6 weeks. Your post-operative recovery will also incorporate a range of stretching and strengthening exercises which are necessary to minimise long term stiffness and weakness.
For more information about heel spur surgery, visit https://www.perthpodiatricsurgery.com/ or call our friendly team on 08 9383 3851.
Cost of orthotics in Perth
Orthotics are therapeutic devices prescribed by podiatrists that are worn inside shoes to control biomechanical abnormalities and relieve foot pain and pressure. Orthotics in Perth can be ‘off the shelf’ which is a pre-made device with no special modifications to suit the individual, or can be custom made. Custom made orthotics are specifically designed to prescription measurements taken by a podiatrist and are moulded to suit the shape of the arch profile. This allows for a much better overall fit and increased comfort for the wearer. Many different health professionals in Perth do sell orthotics to the public, however podiatrists are the most suitably qualified practitioners to provide this treatment due to their extensive training in the anatomy and biomechanics of the feet.
Custom made orthotics Perth
Perth Podiatric Surgery uses the latest in 3D orthotic scanning technology to ensure precision in the overall fit of the orthotics. At your appointment, an image of both feet is captured using a 3D camera and a biomechanical examination is undertaken including analysis of your gait and range of motion examination. Modifications to the 3D impressions of your feet are then made based on the measurements taken by the podiatrist and a prescription is prepared. Orthotics take approximately 1 week to be manufactured, at which time you will return for a fitting appointment.
Orthotics in Perth can be made to suit a variety of different type of shoes, from sneakers, boots to sandals. They are made from either a semi-rigid plastic polypropylene or EVA material, or carbon fibre. In either way, the materials are fairly durable and will generally last several years before they may need to be refurbished or replaced. We recommend your orthotics are reviewed on an annual basis by the podiatrist in order to ensure optimum control and function is being provided. Sometimes small changes are need be made periodically to maintain proper correction as feet can change over time.
The total cost of custom orthotics at Perth Podiatric Surgery will vary according to what you specifically require to be made. Generally costs for the orthotics are billed over a period of several appointments, which are divided into 1. your initial consultation with biomechanical examination and 3D digital scanning, 2. manufacture of orthotics and an orthotic fitting appointment and 3. a progress review appointment with the podiatrist. If further modifications are required to your orthotics during the first 3 months of treatment there are no additional costs incurred.
REBATES FOR orthotics IN Perth
All private health insurers provide rebates on custom made orthotics, and generally cover about 50% of costs for the manufacture of the devices. Patient’s are therefore only required to pay ‘the gap’ on their orthotics, as most of the cost is rebatable on-the-spot via HICAPS.
The below item numbers can be provided to your health fund in order to determine what rebate you will be eligible to receive.
HBF Members:
F014 Subsequent Appointment – $100.00
F111 Muscle Testing – $60.00
F114 Range of Motion Study – $60.00
F117 Gait Analysis – $60.00
F221 Custom Orthotic (Single) – $330.00
All Other Health Funds:
F014 Subsequent Appointment – $100.00
F118 Biomechanical Assessment – $120.00
F303 3D Laser Orthotic Scan – $60.00
F221 Custom Orthotic (Single) – $330.00
To book an appointment with our Podiatrist Dr James Knox to determine if you require orthotics, please contact our friendly team on 9383 3851 or book online at https://www.perthpodiatricsurgery.com/appointments/
Podiatry for Children in Perth
Children’s foot problems are a common presentation in Perth podiatry clinics and can begin in the early years of life. Foot problems can range from acute sports injuries to more complex structural problems present from birth. When having your child’s feet assessed, it is important to see a specialist podiatrist with experience in paediatric foot problems who can accurately diagnose and treat their problem. Here we will discuss some common children’s foot problems treated in Perth.
Ingrown Toenails in Perth
Ingrown toenails are one of the most common children’s foot problems and can occur due to ill-fitting footwear, poor nail cutting technique, hygiene, or inherited nail shape. The edge of the nail pressing into the adjacent skin can cause pain, swelling and sometimes even infection. Ingrown toenails do sometimes require a procedure to treat them, however most can be treated and prevented with advice on nail cutting technique and clearing of the edge of the nail. Please click here for information on ingrown toenail surgery in Perth that we offer.
Plantar warts in Perth
Plantar warts are particularly common in children and occur due a virus called the Human Papilloma Virus (HPV). This causes a growth of tissue that is non-cancerous however can cause pain and discomfort. Plantar warts occur on the bottom of the foot and tend to cause more discomfort due to repeated pressure on the area when walking. Warts can usually be resolved with treatment by a Podiatrist, however resistant infection sometimes requires surgical removal if the pain is affecting day-to-day life.
Heel Pain in Children
Heel pain can occur at any stage of life, however the cause of heel pain in children is different to the cause in adults. The most common cause of pain in children is a condition called Sever’s disease, whereby discomfort occurs around the area of the growth plate in the heel. Symptoms often ease with time, however several interventions such as stretching and strengthening, footwear modifications, orthotics and activity modifications can significantly reduce the frequency and intensity of pain in children.
Flat Feet in Children
Flat feet in children can not only cause pain in the feet and ankles, altered biomechanics can result in issues with the knees, hips and lower back. Flat feet should be assessed by an experienced podiatrist or podiatric surgeon in Perth and appropriate intervention discussed. This may differ depending on your child’s age, weight and activity level. Some children may need a prescription for specialised supportive footwear, others may require orthotic support or in extreme cases, rolling in of the foot or ‘pronation’ can be limited by placing a small implant into the hind foot. Please click here for information on hyprocure flatfoot correction in Perth that we offer.
To summarise, children’s foot problems in Perth can be just as complex as those occurring in the adult population, and assessment by an experienced practitioner is imperative to good clinical outcomes for your child.
Book An Appointment with our Specialist
Dr Andrew Knox has experience in dealing with both child and adult foot problems and can provide both surgical and non-surgical solutions to painful feet. To make an appointment, visit https://www.perthpodiatricsurgery.com/
Custom Made Orthotics for Heel Pain in Perth
Custom made orthotics are prescribed by Perth podiatrists every day for a number of different foot, ankle and lower limb problems. Podiatrists are university trained health professionals who assess, diagnose and treat all types of foot and ankle pain, as well as mechanical pain of the back, hips and knees as a result of altered foot mechanics.
What are custom made orthotics in Perth?
Most people have seen generic orthotics or shoe inserts which are often sold in pharmacies, sports stores and sometimes even supermarkets, however proper custom made orthotics are only prescribed by podiatrists. Orthotics are a pair of devices worn inside the shoes which can reduce pressure, provide cushioning, correct faulty foot mechanics and offload painful areas of the feet
How are orthotics in Perth made?
Making a custom pair of orthotics in Perth first requires a 3D digital scan of both feet using specialized equipment. A customized prescription is then completed by the podiatrist which takes into account how much correction is needed, the material, areas of cushioning and offloading and shape/fit depending on the type of footwear the orthotics will be worn in. Orthotics are extremely versatile essentially no two pairs will be the same!
How do orthotics help with heel pain in Perth?
Orthotics are often one of the first lines of treatment when fixing heel pain when biomechanical problems are involved. This is usually along with stretching and strengthening and footwear modifications. Orthotics work to correct malalignment of the foot, ankles and knees, thus reducing associated tension on areas of the heel. Orthotics also help to activate something called the ‘Windlass Mechanism’ which is an integral part of normal foot function.
What other foot problems in Perth can orthotics help with?
Orthotics can help with other foot problems such as Achilles tendonitis, Morton’s Neuroma, bursitis, foot ulcers and recurrent stress fractures. They can also help with other lower limb issues such as medial tibial stress syndrome (shin splints), patellofemoral pain syndrome, ilio-tibial band syndrome, Osgood Schlatter’s disease and mechanical pain of the hips and lower back.
If you have further questions regarding how custom made orthotics may improve your pain, please visit our website and ask away on our FAQ page https://www.perthpodiatricsurgery.com/frequently-asked-questions/
To book an appointment with Dr Andrew Knox, Podiatric Surgeon to discuss your issues relating to foot pain, please call 08 9383 3851 or book online at https://www.perthpodiatricsurgery.com/appointments/
Rehabilitation after Bunion Surgery Perth
Rehabilitation after bunion surgery in Perth constitutes a vital part of the recovery process, and usually follows a period of rest and restricted activity. Whether you have undergone a simple tendon release, or a more involved procedure such as an osteotomy (cut in the bone), rehabilitation will shorten your recovery time, reduce stiffness and swelling and get you back to activities of daily living as quickly as possible.
Post-operative rehabilitation involves a structured program prescribed by someone with appropriate knowledge and training in the area, such as a podiatrist, physiotherapist or your surgeon. Much of this can be performed at home, however regular checkups and guidance from your practitioner means exercises can be tailored to your current needs, progress and future goals. Below are some of the goals we focus on when rehabilitating patients after bunion surgery.
Joint movement after bunion surgery in Perth
Initially following bunion surgery in Perth, you will be required to wear a splinted sandal (post-operative shoe) to protect the area and limit motion through the joint. This is worn for 2-3 weeks depending on your individual needs. Following this period, is it normal for the joint to feel somewhat stiff to move, therefore physical therapy in the form of range of motion exercises is often the first stage of rehab. You will be shown how to safely move your big toe joint through its range of motion to loosen soft tissue structures.
Strengthening exercises after bunion surgery in Perth
Once you feel comfortable with manually moving the big toe joint, the use of a elastic band, known as a theraband, is used to apply resistance to the toe, allowing you to activate and strengthen the small tendons and ligaments that control motion. These muscles often become ‘lazy’ following surgery, however they begin to re-active fairly quickly once they are put under some tension.
Proprioceptive exercises after bunion surgery in Perth
After bunion surgery, often your foot not only looks different, however the way it functions and responds to stimuli also changes. Pressures are distributed throughout the foot differently when there is a large bunion present, compared to when there is not. Therefore it is also important to re-train our brains to recognsze where different areas of the foot are in space when walking. This is particularly important for our balance and stability. Proprioception training involves a series of balance type exercises that may utilise unstable surfaces such as a bosu ball to re-gain important connections between the brain and the foot. This type of training is similar to what is undergone after many sports injuries such as ankle sprains.
Regain normal foot loading patterns and joint function
Finally, ensuring normal gait patterns are re-formed is vital before embarking on any type of physical exercise. Physiotherapists and podiatrists are trained in biomechanical gait analysis and can often make small adjustments to your gait patterns by working with you one on one. Changes to gait may have formed as a result of having foot pain or deformity for many months or years, or may have occurred as a result of wearing a post-operative shoe.
If you have further questions regarding bunion surgery or rehabilitation, please visit our website and ask away on our FAQ page https://www.perthpodiatricsurgery.com/frequently-asked-questions/
To book an appointment with Dr Andrew Knox, Podiatric Surgeon to discuss your issues relating to bunions or other foot pain, please call 08 9383 3851 or book online at https://www.perthpodiatricsurgery.com/appointments/
Foot Surgery in Perth for Hallux Rigidus
Hallux rigidus essentially means arthritis of the big toe joint which results in progressive pain and sometimes bony deformity. There are a number of different factors which may cause hallux rigidus including previous injury, osteoarthritis or inflammatory conditions such as rheumatoid arthritis, or foot deformity.
Signs and Symptoms of Hallux Rigidus in Perth
Most people with hallux rigidus present with pain upon movement of the big toe joint. It often starts becoming sore during strenuous exercise, then as the arthritis in the joint progresses can become sore from walking and pressure from footwear. Some people will develop bony lumps around the joint which can make wearing footwear difficult. Sometimes pain under the second toe can develop due to changes in foot mechanics resulting in overload pressure at the second toe.
Diagnosis of Hallux Rigidus in Perth
Investigation for big toe joint pain first starts with an X-ray to assess the joint and determine the level of arthritis present. The health of the joint can be graded on a scale from 0-4. The common signs of hallux Rigidus seen on x-ray include, narrowing of the joint space, extra bony growth around the joint and damage to cartilage. X-rays can be performed on site on your day of appointment at Perth Podiatric Surgery so treatment options can be made available to you straight away.
Foot Surgery in Perth for Hallux Rigidus
In the intial stages of the problem, a procedure can be performed to essentially ‘clean up’ the joint. This involves the removal of excess bone that is limiting motion. Depending on the joint quality, sometimes this procedure can be performed through a keyhole incision, meaning healing times are reduced. Please click here for information on the chilectomy procedure for hallux rigidus
In cases where arthritis has progressed significantly, the most effective way to reduce pain associated with the condition is to fuse the big toe joint (arthrodesis). This is done by first preparing the bone, then using a special surgical plate and screws to hold two ends of the bone together. The procedure permanently stiffens the big toe joint, preventing movement and therefore preventing any pain associated with movement.
If you have further questions regarding Hallux Rigidus surgery and it’s recovery, please visit our website and ask away on our FAQ page https://www.perthpodiatricsurgery.com/frequently-asked-questions/
To book an appointment with Dr Andrew Knox, Podiatric Surgeon to discuss your issues relating to Hallux Rigidus or other foot pain, please call 08 9383 3851 or book online at https://www.perthpodiatricsurgery.com/appointments/
Disclaimer: This blog is intended for general information purposes only. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
