Bunions affect millions of women, resulting from their high heels; approximately one in three women experiences this issue.
This hereditary condition, which can also impact men, causes the bone of the big toe to angle towards the second toe.
As a result, the metatarsal bone beneath is pushed outward, resulting in a painful and unattractive lump on the side of the foot.
When treating bunions, a surgeon may need to insert a wire into the toe to correct its position; this wire remains outside the foot for up to four weeks.
In certain cases, the joint must also be fused by the surgeon, significantly limiting mobility.
The newest approach utilizes specially crafted surgical screws that are embedded in the bone and do not require removal, resulting in a lower risk of infection and a more comfortable recovery process.
In another technique, the surgeon removes a wedge from the inner side of the long foot bone that is pushing outwards, allowing it to sit straight once again.
The excised wedge of bone is then attached to the outer part of the bone, acting as a support that prevents it from shifting out of position again.
This technique also eliminates the need for wire and prevents fusing of the joint.
‘This provides a superb alternative for younger individuals suffering from significant bunions while preserving all foot joints,’ states podiatric surgeon Ralph Graham.
BIG TOE ARTHRITIS
Big toe arthritis results from joint wear and tear, leading to inflammation and the formation of small bony growths known as bone spurs on the joint’s surface.
These spurs are the body’s effort to mend a damaged joint, but they often do more harm than benefit.
The spurs interfere with movement, pinching the joint when walking, bending the toe, or pressing against shoes.
Surgeons are innovating methods to tackle this condition without resorting to open surgery and avoiding joint fusion, which leaves the toe immobile.
They have begun performing surgeries through a small 6mm incision, using a specialized drill to reduce the spur to a paste, which is then gently massaged out.
‘Patients can immediately bear weight on the foot and wear regular shoes within three to four days, instead of being confined to surgical shoes for weeks,’ claims orthopaedic surgeon David Redfern.
‘About 80 percent of patients report being happy or very satisfied with the results.’
BUNIONETTES
Although lesser-known than bunions, bunionettes are surprisingly common, affecting one in five individuals; these bumps occur on the outer side of the foot where the little toe connects with the long toe bones.
This condition, previously referred to as tailor’s bunions, arose since tailors, who often sat cross-legged, experienced pressure at the outside edge of their feet.
Like bunions, bunionettes have a genetic component but can be exacerbated by the use of tight high heels.
Keyhole surgical techniques for bunionettes have only emerged in recent years.
In this procedure, the surgeon creates a 3mm to 4mm incision atop the foot and uses a fine drill burr to remove the bump, allowing the shavings to escape through the opening.
Due to the incision’s small size, patients require only a minimal bandage.
‘This has revolutionized practice,’ remarks David Redfern.
‘Patients are able to return to normal footwear within a few days and can resume work immediately.’
MORTON’S NEUROMA
This painful condition arises when a nerve becomes trapped between foot bones, leading to discomfort in the ball of the foot and at the toes’ base.
The problem can be intensified by wearing high heels and experiencing hormonal shifts, like menopause.
Options for treatment include utilizing supports placed inside shoes and administering injections of steroid, alcohol, or liquid nitrogen directly into the nerve.
If these treatments fail to provide relief, a 15-minute surgical procedure can be performed, during which surgeons excise a piece of the nerve about the size of a fingernail.
Research indicates that this procedure is successful in 80 percent of the cases.
Mike O’Neill, a podiatrist and spokesperson for the College of Podiatry, notes, ‘Patients who have endured years of severe pain often find that the issue is permanently resolved.’
‘However, in 20 percent of cases, the nerve stump may regenerate, necessitating a repeat procedure,’ he adds.
Another method available is cryosurgery, where surgeons use a freezing probe chilled to minus 70°C under local anesthesia to treat the thickened nerve.
FLAT FEET
Approximately one in five adults experiences flat feet, a condition that results from the major tendon in the foot failing — often due to age-related wear and tear or injury.
This leads to the heel and toes shifting outward, and the misalignment causes bones to rub against each other, potentially resulting in arthritis and pain.
A recently developed technique in the U.S., now available at the BMI Sefton in Liverpool, allows surgeons to remove the faulty tendon and replace it with a tendon harvested from the smaller toes.
This tendon is then wrapped around the bone in the arch of the foot to restore its natural curvature.
This offers a significant enhancement over previous methods that involved fusing four small bones, which inhibited patients’ ability to rotate their foot.
Additionally, surgeons can replace a ligament on the foot’s inside with a hamstring tendon taken from the back of the leg, which helps restore the natural arch.
HAMMER TOES
An estimated one million Australians suffer from hammer toes, a condition where the smaller toes bend over resembling a hammer’s head.
It can be hereditary and is often worsened by tight footwear or ailments such as rheumatoid arthritis.
This condition may lead to painful rubbing of the toe’s top against the shoe or result in patients walking with their weight on the balls of their feet, causing discomfort.
Traditional surgical methods involve removing the middle joint of the toe, followed by stabilizing the toe straight with a thick wire for six weeks while the bone ends fuse and heal.
The wire protrudes from the toe, requiring the patient to wear an open-toed surgical sandal.
There is a 5 percent chance that the wire may shift position or even come loose, necessitating a repeat surgery.
The innovative Smart Toe implant consists of a 1cm metal clip inserted into the toe.
This ‘smart metal’ expands at body temperature, securely joining the two bone ends together, ensuring they heal in alignment.
According to Nick Cullen, a consultant orthopaedic foot and ankle surgeon, ‘Patients can take baths and wear standard footwear just two weeks after surgery.’
‘Furthermore, since there are no wires, there’s no need for patients to return for removal, significantly lowering the infection risk to less than 1 percent.’
by Susan Floyd
