Blog's main page The images are from a case that underwent surgery a few weeks ago. The patient had a painful 1st MTPJ, but the main symptoms were felt on the lateral hallux and medial 2nd toe, involving pain and a corn formation. The conservative care had failed to provide enough relief. Note the signs of [...]
Blog's main page This patient presented in early March with a history of a sudden severely inflamed and painful right 1st MTPJ after a run completed the previous month. The joint became swollen and stiff after the run, and symptoms have slightly settled. The patient has had a generalised ache in the joint for a few [...]
Blog's main page Complications can occur with all surgery, some more serious than others. Deep vein thrombosis (DVT) / venous thromboembolism (VTE) is something that all podiatric surgeons must be aware of when doing any surgery. A risk profile is done for every patient who has surgery carried out by my team. If there are known [...]
Blog's main page This case shows just how strong genetics can play in the development of bunions. This is the foot of a 16-year-old. The parents and podiatrist have been diligent with orthotics and ID wedging from an early age. There is a strong family history of bunions, and the genetic predisposition for the first metatarsal [...]
Blog's main page I operated on this patient last week. She had suffered from marked left 1st MTPJ pain. She had been treated for her bunion via rest, orthotics, mobilisation, medication and various splints. No pain relief was achieved, and she noted that the joint was becoming slightly stiff and more symptomatic. X-ray assessment showed a [...]
Blog's main page This patient presented with a history of markedly painful posterior heel "bumps". She has noted them for approximately two years. The patient is now having major problems with any enclosed shoes. The area rubs become red and enlarged and can blister. She feels she has exhausted conservative care. She is young and is [...]
Blog's main page In the last few months, I have had two patients with symptomatic foreign objects located deep to skin. These objects cannot be seen or palpated through the skin. It is vitally important to keep plantar skin incisions to a minimum to reduce the risk of creating a plantar scar. Due to weight-bearing forces, [...]
Blog's main page This case was referred to me as the patient has had a long history of anterior ankle pain with chronic 'tight' right ankle. The patient has been trying for many years to have the anterior pain resolved and regain pain-free motion. Many stretching programs have been attempted. However, the patient felt the ankle [...]
Blog's main page This patient had marked 1st MTPJ pain that had been recalcitrant to conservative care, including various orthotics. Her range of motion was mildly reduced; however, she had crepitus present. The radiograph was reported to have only mild degenerative disease in the joint; however, there are some subtle changes in the position of the [...]
Blog's main page These things can be so painful! One of my favourite procedures to carry out is the excision of the interdigital corn. As surgery goes, they are quite simple to do and produce great results with minimal recovery time. These corns are caused by the skin in the webbing being compressed by the underlying [...]
Blog's main page Tarsal coalitions are rare in the general population. I suspect this may be the reason why many of these are missed or wrongly diagnosed. The patient seen in the imaging below has had marked foot pain for many years and has consulted various health professionals over the years. One intervention, approximately ten years [...]
Blog's main page The images depict a recent case involving a patient who was referred to me for a markedly painful long-standing interdigital corn. This had recently developed an ulcer on the medial 5th toe that would not resolve. The referring podiatrist arranged an X-ray, and an obvious cause was identified. Past trauma to the PIPJ [...]
Blog's main page There have been many advances in foot surgery over the years, with minimally invasive surgery (MIS) or keyhole surgery being one such modality. The below before and after images are from a patient I recently performed surgery on. The left image is before, and the right is one-week post-operative. The patient is still [...]
Blog's main page This patient has presented with concerns about painful bunions. He also suffers from gout. On questioning, he has been less than conscientious with his taking of gout prophylactic medications. On the clinical images on the left, he does look as though he has bunions, plus he has painful 1st MTPJs that could be [...]
Blog's main page This is a patient who presented with a severely debilitating right flat foot. This has been progressing for approximately two years; however, three months ago, the pain and disability markedly increased. He can no longer carry out weight-bearing exercises, work at his usual job or play with his kids as desired. Conservative care [...]
Blog's main page This is an image from one of my cases last week. The patient is another example of the need to continue your investigations into those long-standing and chronic markedly painful feet. This patient had a painful lateral rearfoot with no success from conservative care. X-rays were negative, and the patient's biomechanics were not [...]
Blog's main page A patient has presented this week with pain in the forefoot. The pain was marked and typical for generalised forefoot pain. Her recent treatment has focused on a 'neuroma' or 'bursitis'. The treatment interventions have been unsuccessful, and she was referred to me. On examination, her pain was solely focused around a slightly [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page This is a great example of how poor biomechanics impacts foot pathology. This is a case of juvenile bunions with flat feet that has recently been presented in my rooms. I have successfully corrected the mother's bunions and she is now showing concern for her daughter's painful feet. Pain in the long medial [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page 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, [...]
Blog's main page 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 [...]
Blog's main page 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, [...]
Blog's main page 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 [...]
Blog's main page Just a reminder of the importance of removing hypergranulation tissue during a partial nail avulsion with penalisation (PNA). This young boy had this recalcitrant ingrown toenail for over a year (hence the length of the nail). His GP and podiatrist had attempted various options over the year including previous surgery; all unsuccessful. The [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page 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 [...]
Blog's main page A recent review of a very happy bunion patient. This just shows you how foot surgery has advanced over the years, particularly bunion surgery. Modern procedures allow for small incision, quick recuperation, and research confirms long-term results are achievable. Typically the surgery is day surgery, incisions are much smaller now and recuperation is [...]
Blog's main page This post is about assessing patients with flat feet, particularly the paediatric foot. If the foot, particularly the rear foot, is fixed or rigid, something more complex may be present and further in-depth investigation should be carried out. In recent months I have had a few children present with markedly painful flat feet [...]
