Minimally invasive fracture fixation

By |2022-06-13T21:46:54+10:00May 23rd, 2022|Foot pain|

Surgical intervention is continuously evolving. Minimally invasive surgery, or keyhole as it is commonly known, has progressed markedly over recent years as this case depicts. This patient presented with a painful non-union of the base of the 5th metatarsal. Commonly called Jones fracture, however, this actual fracture is at the margins of a Jones fracture and [...]

Is it posterior tibial tendon dysfunction?

By |2022-06-05T17:13:41+10:00May 5th, 2022|Flat feet, Tendonosis|

An astute podiatrist referred this patient to me recently with a history of treatment for supposed posterior tibial tendon dysfunction (PTTD). The patient has been symptomatic on the medial navicular region radiating slightly proximal. She had been treated for PTTD for many months, including rest, orthotics and physiotherapy with no poor results by another previous practitioner. [...]

Post-operative wounds

By |2022-05-29T14:19:33+10:00April 29th, 2022|Foot pain, Hallux limitus, MTPJ, Post operative|

The images show how a foot can look at six weeks post-op. This patient had chronic painful 1st and 2nd MTPJs. On clinical and radiographic imaging, it was shown she had hallux limitus with an abducted hallux and chronic overload to the 2nd MTPJ. The image on the left is intra-operative and shows severe cartilage loss [...]

The problems with keyhole bunion surgery

By |2022-04-11T20:24:45+10:00March 24th, 2022|Bunions, Foot pain|

There have been marked improvements in bunion surgery over the years to the point where, typically, the procedure is day surgery, the pain is controlled and long-term good results are achieved. Keyhole surgery, better known as minimally invasive surgery, is very much the "flavour of the month". It does have a place, but I find many [...]

Plantar fasciotomy post-op

By |2022-05-29T14:21:50+10:00February 18th, 2022|Heel pain, Post operative|

Following on from a post (Chronic Heel Pain, October 2021) I shared a few weeks ago about the minimally invasive plantar fasciotomy for chronic recalcitrant plantar fasciosis/fasciitis. A patient presented this week with a problem, involving DJD/OA of the left 2nd MTPJ. She is an existing patient, whom I carried out a plantar fasciotomy eleven years [...]

Heloma molle/soft corn

By |2022-02-20T12:21:04+11:00February 9th, 2022|Interdigital corn, Uncategorized|

Interdigital soft corns are a common occurrence and in most situations, regular debridement and ID pads can control the problem. Some of these corns can be resistant to conservative treatment and can even become infected and scarred. In these recalcitrant lesions, a simple and effective alternative exists. As you can see by the images, the lesion [...]

Post-operative pes planus/flat feet/excess pronation

By |2022-05-29T14:20:40+10:00February 4th, 2022|Flat feet, Uncategorized|

The images are of a recent patient who is 4 weeks post-op, following Hyprocure insertion. This patient had the typical signs and symptoms seen with pes planus and her symptoms could not be controlled with orthoses solely. Note the excellent alignment seen both anteriorly and posteriorly. On the anterior images, you can observe the small eschar [...]

Pes planus

By |2022-03-18T10:59:54+11:00November 19th, 2021|Flat feet|

Flat feet and the plethora of symptoms associated must be one of the most commonly seen conditions in the office of a podiatrist. Typically with the help from orthoses, strengthening and stretching exercises, symptoms will resolve. The case below presented in my rooms this week. He has had marked recalcitrant symptoms in his feet, knees and [...]

Chronic heel pain

By |2022-02-20T14:20:17+11:00October 27th, 2021|Heel pain|

This 24-year-old male presented at my rooms with an 8-year history of bilateral "plantar fasciitis". He had been treated with various modalities and health practitioners over the years, including 4 steroid injections in each heel and was actually wearing a CAM/moon boot on his right foot. The patient presented with radiographs and ultrasounds with a diagnosis [...]

Accessory navicular with pes planus

By |2022-03-18T11:00:03+11:00October 19th, 2021|Flat feet|

Approximately 2.5% of the population are born with an accessory navicular. There are three types of this condition with type 2 being the most commonly symptomatic. The fibrocartilagenous union between the ossicle and the navicular can be torn, particularly when it occurs in an excessively pronated foot type. The tibialis posterior tendon will contract and pull [...]

Gout

By |2022-02-17T16:59:12+11:00September 21st, 2021|Uncategorized|

I have carried out surgery on three patients recently who have had moderate bunions on X-ray, however, clinically they appear to be much worse. On X-ray, you can see "shadowing" of the gouty tophaceous deposits on the medial aspect of the joint, which gives the impression clinically that the actual osseous deviation is larger. Luckily minimal [...]

Dislocated 2nd MTPJ

By |2022-05-29T14:22:18+10:00September 13th, 2021|MTPJ|

This patient presented recently with a long-standing markedly painful left 2nd metatarsophalangeal joint (MTPJ). Conservative care has been unsuccessful and hence she was referred for a surgical consultation. On examination, a firm, "lump" was noted on the dorsal aspect of this joint. This firm "lump" with a step-down prominence was palpated and deemed to be a [...]

Motion following hallux limitus surgery

By |2022-05-29T14:22:48+10:00September 7th, 2021|Hallux limitus|

Hallux limitus/rigidus or degenerative osteoarthrosis of the 1st metatarsophalangeal joint (MTPJ) is a very common condition in our practices. Once the condition deteriorates to the point where conservative care is not producing satisfactory pain relief, surgery can be suggested. Fusion/arthrodesis is still the most common procedure carried out and very occasionally I will fuse the joint [...]

Interdigital corn

By |2022-02-20T14:17:57+11:00August 23rd, 2021|Interdigital corn, Uncategorized|

This would present at a podiatry practice on a regular occurrence. This case was in a 27-year-old, who had been suffering from a lateral 5th toe corn (heloma durum), however, an interdigital corn (heloma molle) on the medial 5th toe was most symptomatic. Symptoms were marked and hard to control, and the patient, being young, was [...]

Subungual exostosis

By |2022-02-17T17:01:32+11:00August 18th, 2021|Uncategorized|

I see a regular amount of subungual exostosis throughout the year. Typically they have been treated as ingrown toenails (IGTN) first. The GP and the podiatrist may assume it is hypergranulation tissue or some other sign of an IGTN and, in some situations, a PNA may have been carried out (not in this situation). When the [...]

Hyperpronation cure

By |2022-03-18T11:00:11+11:00August 10th, 2021|Uncategorized|

Many of you may have heard of HyProCure (hyperpronation cure) and wondered what it is. The HyProCure website does a very good job of explaining in detail, both descriptively and via graphics and illustrations. In very basic terms during excess pronation the talus glides excessively across the calcaneus at the subtalar joint, this, in turn, unlocks [...]

Improvements in bunion surgery

By |2022-04-11T20:26:04+10:00August 3rd, 2021|Bunions, Foot pain|

Bunion surgery has advanced markedly in recent years. Traditionally the surgery has had a bad name. Procedures involved long recovery, large incisions, marked pain and poor outcome. This has all changed now; however, sadly, there still exist many surgeons who have not progressed. This case is a perfect example. This was brought to my attention recently. [...]

Platelet Rich Plasma (PRP)

By |2022-02-20T14:13:25+11:00June 15th, 2021|Uncategorized|

Surgery is often described as an art and science. This case from last week depicts exactly how science can help surgical outcomes. This patient had chronic, marked unremitting symptoms on her firm and enlarged posterior heel. Insertional Achilles tendinosis was the diagnosis, note the enlarged degenerated tendon and the marked inflammation in the posterior calcaneus on [...]

Remember functional anatomy and to x-ray

By |2022-02-20T14:10:41+11:00May 25th, 2021|Uncategorized|

This is an interesting case I have dealt with recently. The patient was sent to me with long-standing, markedly painful and stiff 1st metatarsophalangeal joints (MTPJ). Clinical examination showed no dorsiflexion with the patient guarding the joint due when any motion was attempted. All conservative care had been exhausted with no success. Weight-bearing radiographs exposed a [...]

Osteoid osteoma

By |2022-02-20T14:02:50+11:00January 7th, 2020|Bunions|

This case will hopefully outline the importance of utilising all your knowledge and not solely relying on other professionals' reporting. I carried out bunion correction on this 25-year-old, 4 years ago, with an excellent outcome. He has then presented subsequently in a CAM boot with a 6-month history of severe midfoot pain and oedema. He has [...]

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