Osteoarthritis

Osteoarthritis occurs when cartilage wears out due to abnormal wear and tear or, occasionally, due to the immune system. Cartilage is the soft tissue that covers the end of a bone, forming a joint. As cartilage thins, bones rub directly against each other, causing pain as the nerve endings are exposed.

It is generally better to keep using a painful arthritic joint to prevent it from stiffening.

Pain relief for chronic arthritis in the foot can be achieved in several ways:

• Analgesics, both oral (regular paracetamol) and topical (anti-inflammatory gels).
• Cortisone injections (not curative, with only limited injections recommended).
• Orthotics or arch supports to alleviate pressure/stress on the affected joint.
• Surgery (removing arthritis or fusing joints).

Risk factors for developing plantar fasciitis include:

• Obesity
• Flat foot posture
• Occupations involving prolonged standing
• Tight calf muscles
• Medical conditions (e.g., diabetes, rheumatoid arthritis)
• Age (usually over 40)
• Sporting activities (e.g., running)

A heel spur is a small bony growth at the site where the plantar fascia originates on the underside of the heel. It is usually painless and a sign of the condition rather than the cause of pain. Many people without plantar fasciitis also have a heel spur.

Plantar fasciitis is typically a mechanical problem, so effective treatments address the condition’s cause, such as:

• Orthotics (heel cushions, insoles, splints)
• Stretching exercises
• Footwear advice
• Weight loss
• Activity modification

Orthotics may be custom-made by a podiatrist or orthotist. Footwear advice usually involves wearing supportive lace-up shoes with cushioned soles. Some find shoes with a small heel (below 1 inch) helpful to reduce strain on the plantar fascia.

Other treatments focus on reducing inflammation, such as applying a cold compress, using anti-inflammatory gels or tablets, and cortisone injections, which can help reduce acute pain but may not cure the condition entirely.

Evidence suggests that plantar fasciitis resolves in 90% of cases within one year. For some, pain may resolve and later return or affect the other foot. Continuing mechanical treatment even after pain resolution is often important.

Surgery is rarely indicated as the condition usually resolves over time. It may be considered only if the pain is severe, unresponsive to all conservative treatments, and persists for 12 months.

Metatarsalgia can occur for several reasons. It may result from other foot deformities such as bunions or toe deformities. Often, it is because the affected bone is either too long or angled too sharply, making it prominent on the sole of the foot.

Pads, foot orthoses/insoles, and special shoes can provide comfort and redistribute pressure away from the painful joint(s). If these measures fail and the joint remains uncomfortable, an operation may be recommended.

The operation involves breaking a bone behind the toe to slightly shorten or elevate it. The fractured bone is held in place with a screw, which is not removed unless it causes problems. The surgery is performed under general or local anaesthetic. Both feet can be operated on at the same time if required, but this further limits your mobility during the first month after surgery. The foot will be heavily bandaged after the operation.

As with all operations, there are risks associated with the anaesthetic and surgery. Occasionally, complications such as infection, prolonged swelling, or recurrence of the condition may occur. It can take the foot a good six months to fully settle down after surgery.

The operation is usually a day case, but you may need to stay overnight in hospital. The podiatric surgeon will discuss this with you. You will be given special shoes to wear over your bandages, which must be worn whenever you walk. The shoes must be worn for four weeks. You usually do not need to use crutches.

For the first 48 hours, you will rest in bed with your legs elevated and take the prescribed painkillers. You will be asked to do some foot exercises during this time. The bandages will be left on for two weeks. You will have an orthopaedic and fracture clinic appointment to have the bandages removed. You can return to work two to six weeks after the operation, depending on whether your job requires a lot of standing or walking. You will not be able to drive until you come out of the post-operative shoe.

Morton’s neuromas are quite common, especially in females. Tight-fitting shoes, high-heeled shoes, and flat feet can contribute to the development of a neuroma. Toe deformities and bunions also increase the risk.

Better-fitting shoes, pads, foot orthoses, and steroid injections can provide comfort and may completely resolve the pain for some people. If the foot remains uncomfortable despite these measures, surgery may be recommended.

The operation involves removing the swelling and the affected nerve. The underside of the two toes may be numb following surgery, which typically lasts for 18-24 months. The surgery can be performed under general or local anaesthetic. The foot will be heavily bandaged after the operation.

As with all operations, there are risks associated with the anaesthetic. Occasionally, complications such as infection, prolonged swelling, painful scar tissue, or recurrence of the condition may occur.

The operation is usually a day case, but you may need to stay overnight in hospital, which the Podiatric surgeon will discuss with you. You will be provided with special shoes to wear over your bandages, which must be worn whenever you walk. These shoes are worn for two weeks. It takes the foot approximately 4-6 months to fully settle down after surgery.

For the first 48 hours, you will rest in bed with your legs elevated and take the prescribed painkillers. Foot exercises will be recommended during this time. The bandages will remain on for two weeks. You will have an appointment at the Orthopaedic and Fracture clinic or your GP practice to have the bandages removed. You can usually return to work within 2-4 weeks after the operation, depending on the physical demands of your job. You should refrain from driving until you are out of the post-operative shoe.

Pain and deformity in the forefoot typically result from acute trauma or systemic conditions such as Rheumatoid arthritis or Diabetes.

Pads, splints, foot orthoses/insoles, and special shoes can offer comfort but may not correct the deformity. If the foot remains uncomfortable despite these measures, surgery is often recommended.

Several surgical options exist, and your surgeon will discuss the best option for you. Typically, surgery involves fusing the big toe joint and possibly removing or fusing a section of one of the remaining toe joints. Sections of bones from the ball of the foot may also be removed. To maintain corrected toe positions, wires are used and remain in place for 5 weeks. The surgery is usually performed under general anaesthetic, and the foot is heavily bandaged afterward.

As with any surgery, there are risks associated with anaesthesia and procedure. Complications may include infection, nerve or vascular damage, or some loss of correction. Swelling of the foot typically persists for around 6 months post-surgery, with full recovery taking up to a year.

You will likely stay in the hospital overnight; your Podiatric surgeon will provide details. For the first 48 hours, rest with elevated legs and take prescribed painkillers. Foot exercises will be recommended during this period. Special shoes must be worn over bandages whenever walking, typically for 5 weeks. If wires are used, they will be removed at this time. Crutches may be necessary.

You will have an appointment at the Orthopaedic and Fracture clinic to change dressings, usually at 2 weeks. The foot must remain bandaged until wires are removed, ensuring it stays dry during this period. Return to work is generally possible 8-12 weeks after surgery, depending on job demands. Driving is advised only after the post-operative shoe is removed.

Soft tissue masses typically develop due to irritation or acute injury to the soft tissues, sometimes exacerbated by underlying bony prominences. Certain individuals may be more predisposed to developing them naturally.

Padding, splints, foot orthoses, and special shoes can offer comfort around the soft tissue mass. In some cases, aspiration (using a needle to drain fluid) may alleviate discomfort. If these measures do not provide relief, surgery is often recommended.

During surgery, the soft tissue mass and its outer lining or sac are excised. If there’s an underlying bony prominence, it will also be removed. The procedure can be performed under general or local anaesthetic, with the foot heavily bandaged afterward.

As with any surgery, risks include complications related to anaesthesia, infection, nerve damage, or recurrence of the condition.

Typically a day case procedure, you may need an overnight stay in the hospital. Special shoes will be provided to wear over bandages, which are usually worn for about 2 weeks. Crutches are generally unnecessary. It may take 3-6 months for the foot to fully recover post-surgery.

For the first 48 hours, rest with legs elevated and take prescribed painkillers. Foot exercises will be recommended during this time. Bandages will remain for 2 weeks, with a follow-up appointment scheduled either at Outpatients or with your GP to remove them. Return to work is feasible within 1-3 weeks post-operation, depending on job demands. Driving is advised only after you stop using the post-operative shoe.