Foot and Ankle Surgery and Treatment
At London Bridge Orthopaedics, we offer a range of surgical and non-surgical treatments for foot and ankle conditions.
These include but are not limited to:
Lateral ligament reconstruction
In patients with ongoing instability problems, an intense physiotherapy programme may be all that is needed to help strengthen the ligaments. If this is not effective, then a specialist surgical operation (Broström) can be performed, under general anaesthetic, to tighten up the loose ankle ligaments.
This type of foot surgery involves repairing the damaged ligaments, which may mean shortening and reattaching the ligaments in order to reconstruct them. The surgery usually allows individuals to return to athletic activity without the risk of recurrent ankle injuries.
Arthroscopic surgery (keyhole surgery or minimally invasive surgery) involves inserting a small camera through an incision (about 1 cm) in the skin. Other small incisions are made to insert instruments that can diagnose, repair or remove damaged joint problems.
Arthroscopy can help to quicken recovery time, minimise scarring, and increase surgical success. Most patients go home the same day and resume normal activities at 3 to 6 weeks. Ankle arthroscopy is used for various conditions, including:
- Bone spurs: Using arthroscopy to remove these painful, hard lumps that form on the foot can help restore motion and reduce swelling and pain.
- Ankle sprains or injuries: Ankle arthroscopy is performed for chronic ankle symptoms after a sprain or injury to remove the build up of loose debris/scar tissue, and prevent arthritis.
- Ankle pain: Pain in the back of the ankle (posterior ankle pain) and certain types of tendonitis can also sometimes be treated with arthroscopic foot surgery.
- Big toe arthroscopy: Advanced arthroscopy is now used to treat smaller joints, such as problems at the base of the big toe and underneath the ankle joint.
Ankle fusion can be used to treat ankle osteoarthritis. In some patients, it can be carried out as a minimally-invasive operation, after other simple ways of treating osteoarthritis have failed.
With ankle fusion, any worn-out joint surfaces in the ankle are surgically removed. The ankle bones are then fused together with metal implants, and the bone surfaces heal in this position. This leaves individuals with a stiff but usually pain-free ankle. Ankle fusion is durable and suitable for younger patients who want to remain active.
Big toe cheilectomy
Cheilectomy surgery can be carried out for milder cases of big toe arthritis (hallidus rigidus) in patients who experience continuing pain. Cheilectomy involves shaving the bone spur on top of the toe joint, which removes the pressure caused by the bone spurs and improves joint motion. Patients can walk immediately after this surgery. Although the pain caused by limited motion may be reduced, the toe joint may still be arthritic, and the spurs can return. These patients may need a more extensive surgery called a big toe fusion.
Big toe fusion
Big toe fusion is used for treating chronic arthritic pain. In this surgical procedure, the two joint surfaces which generate the pain in the big toe are removed. The remaining joints are then fixed together surgically, using small buried metal screws. These joints then fuse together, as part of the normal healing process. After this, patients are left with a stiff but pain-free toe. They can resume sporting activities and do not walk with a limp.
Bunion and hammer toe surgery
In early or mild bunion cases, surgery can usually be avoided. Bunion surgery aims to straighten the toe joint, and tighten up the stretched tissues. This can range from operations to ‘trim’ parts of the joint to a total artificial replacement of the big toe joint.
Bunion surgery is often carried out in combination with operations to straighten a deformed second toe (hammer toe). This surgery involves either cutting the tendons in the hammer toe to relieve the pressure that causes the deformity, or fusing the toe joint together to permanently straighten it.
A Morton’s Neuroma is an abnormal growth of a nerve between the toes. Foot surgery to release this affected nerve is a simple procedure available at London Bridge Orthopaedics. Once the entire growth is removed, the pain is usually relieved. After surgery, patients will also notice a small area of numbness in the toe. The affected nerve tissue originally provided the sensation in this numb area. By removing the Morton’s Neuroma, an area of numbness occurs.
Ankle osteoarthritis surgery
Mild cases of ankle osteoarthritis can be managed surgically by clearing debris and bone spurs using ankle arthroscopy. If there is no good cartilage left, then the most proven treatment is an ankle fusion.
Physiotherapy for foot and ankle problems is an important part of our treatment services at London Bridge Orthopaedics. These help to improve rehabilitation, stability and mobility – before and after surgery.
We can work closely with your existing physiotherapist and forward them details of what we would like them to focus for your further care.
If you don’t already have a physiotherapist, we can either use one of our in-house team of chartered physiotherapists to work with you, or refer you to other independent physiotherapists closer to your work or home.
Orthotics and Insoles
Many foot and ankle conditions can be effectively treated through the use of an orthotic or insole that adjusts the way in which your foot hits the ground. By helping to correct the way in which you stand, walk and run, orthotics and insoles can often relieve your foot and ankle pain and prevent related problems. In some cases, a standard insole will be suitable. However, if a more complex prescription is required then we may refer you to a podiatrist who can look at your specific gait (foot movement) in more detail, and design an orthotic for your needs.
Steroid injections are often used in the foot to assist diagnosis (remember, there are lots of joints in the foot!) and to treat acutely inflamed areas. Injecting steroids into one or two specific areas of inflammation allows the doctor to deliver a high dose of medication directly to those areas. These injections can be given in the doctor’s office but the more difficult ones are done under ultrasound guidance by an X-ray doctor (radiographer).