Foot Procedures & Treatments

A bunion is a bony prominence that forms on the knuckle of your big toe, forcing it to press on the other toes. Its medical name is hallux valgus and it can become extremely painful over time.

Bunions are a common problem and tend to get larger and more painful over time. Sometimes the pain can prevent you from doing normal, everyday things like walking. Bunions can also start to force your second toe out of place causing permanent deformity and pain.

What is the treatment?

Non-Surgical treatments
These can help to ease the pain include:

• painkillers
• bunion pads
• shoe insoles
• ice packs
• wearing comfortable shoes.

However, if these haven't helped and the pain is preventing you from living a normal life, surgery to remove your bunion could be the right option for you. It's a relatively straightforward operation and for most people, the benefits of pain reduction are much higher than any potential disadvantages.

Surgical treatment
Bunion surgery is usually carried out under general anaesthesia, which means you will be asleep throughout the procedure, but sometimes local anaesthetic can also be used.

There are many different surgical procedures to remove a bunion, and your consultant will discuss which procedure is best for you, but one of the most common types is called an osteotomy. The first metatarsal bone will be cut, realigned and fixed with 1 or 2 screws in an improved position. In many cases the proximal phalanx will also need to be realigned with a second osteotomy, which will be fixed with either a screw or a staple. This is carried out under x-ray guidance during the procedure to achieve the best possible position.

If you have this kind of operation, which usually takes under 60 minutes, the surgeon will make a cut near your big toe to gain access to the bones and the joint. How this is done will depend on the severity of the bunion and its location.

After the operation your foot will be bandaged tightly and you need to wear a protective postoperative shoe for protection.

Another form of surgery is fusion (arthrodesis), which involves fusing two bones in your big toe joint together, but this is only used for patients who have bunions with osteoarthritis, patients with very severe deformities of the big toe joint or very elderly where the bone density makes realignment difficult or impossible.

Hallux rigidus is arthritis of the big toe (great toe). It specifically affects the 1st metatarsal phalangeal joint.

As a result the cartilage in this joint becomes thinned. The joint becomes stiff, swollen and bony spurs form at the edges of the joint called osteophytes.

Symptoms?

Pain, swelling and stiffness are the main symptoms. Because movement of this joint is required to go up on tip toes, walking and running are painful. The spurs (osteophytes) can rub on footwear. Inflammation can make the soft tissues around the big toe swell up.

What is the treatment?

Non surgical
Painkillers and anti inflammatory medication can be used. A stiff insole can be used and this can be combined with a shoe modification called a rocker bottom sole to help with walking.

Surgical

Injection and manipulation - Injection of local anaesthetic and steroid can be used in early disease but often this only works in the short term.

Arthroscopy - Occasionally arthroscopy of the 1st metatarsal phalangeal joint can be indicated. This is aimed at tidying up the inside of the joint to make it move more freely.

Cheilectomy - This operation removes the spurs (osteophytes). Cheilus is Greek for lip so essentially the lip of bone at the edges of the joint are removed. The aim is to relieve pain and achieve more movement in the joint to improve function. It does not cure the arthritis but it can work well in mild and moderate disease. The operation is done as a day case and full weight bearing can occur straight away in a post op shoe. At two weeks post operation full mobilisation can occur in a normal shoe.

Arthrodesis (Fusion) - This operation can turn a stiff painful great toe into a completely stiff but pain free toe. It is used for severe osteoarthritis of the great toe metatarsal-phalangeal joint with or without deformity. Internal fixation with plate and screws is used to hold the position.

Cartiva synthetic cartilage implant - This is a cartilage replacement device that maintains movement. It is suitable for Hallux Rigidus without or with only a small deformity. This is the latest development in treatment for Hallux rigidus and replaces the fusion operation for suitable patients. A further advantage is the ease of conversion to fusion, should this become necessary after the implant has worn out. 

Procedure to remove a toenail that has grown into the surrounding skin.

An ingrown toenail happens when one of your toenails grows into and pierces the skin at the sides of your nail. It can be an extremely painful and unsightly problem.

Ingrown toenail surgery is a relatively straightforward procedure that removes all or part of the nail while the area has been numbed with a local anaesthetic.

Symptoms

• pain if pressure is placed on the toe
• inflammation of the skin at the end of the toe
• a build-up of fluid in the area surrounding the toe
• an overgrowth of skin around the affected toe
• bleeding
• white or yellow pus coming from the affected area.

What is the treatment?

Non-surgical
Sometimes the problem can be solved by washing your feet regularly, changing your socks regularly, cutting your toenails straight across to stop them digging into the surrounding skin, gently pushing the skin away from the nail using a cotton bud.

However, in some cases surgery is the only solution.

Surgical
During the operation all or part of the nail is carefully removed and the nail will grow back. Sometimes the underlying nail bed needs to be removed, however, this means the nail will not grow back. It is usually performed as a day-case procedure using local anaesthesia so although you won’t feel anything, you will be awake. Very rarely, the operation is done under general anaesthesia so you will be asleep throughout the procedure and feel no pain.

After a local anaesthetic has been given, your surgeon will use the most suitable technique to remove the nail depending on how ingrown it is, whether one or both sides are affected and whether there’s an infection.

Sometimes your surgeon will remove the whole nail or remove only the small wedge of nail growing into your skin – this is the most common approach. Folds of skin alongside the nail may also be cut away.

Once the nail has been removed, an antibiotic ointment is usually applied to the operated area and the toe is dressed with bandages.

If this is a recurring problem, your surgeon will apply a chemical called phenol after the operation to help stop the problem recurring.

If your nail is infected, a course of antibiotics may be prescribed and any pus will be drained away. Your foot will then be wrapped in a bandage.