Foot Clinic

Mr Ray specialises in the medical and surgical treatment of all aspects of problems relating to pain and discomfort in the foot.

Hallux Valgus (Bunion)

Hallux valgus, often referred to as a " bunion" is a deformity of the big toe. The toe tilts over towards the smaller toes and a bony lump appears on the inside of the foot. Sometimes a soft fluid swelling develops over the bony lump. The bony lump is the end of the "knuckle-bone" of the big toe (the first metatarsal bone) which becomes exposed as the toe tilts out of place.

The main problem is usually the pressure of the shoe over the bony prominence, which causes discomfort or pain. The big toe sometimes tilts over so much that it rubs on the second toe, or pushes it up out of place so it presses on the shoe. One can also get pain under the ball of the foot due to the bunion("metatarsalgia").

Management begins with advice on footwear and Orthotics if necessary. Mr Ray refers his patients for orthotics, footwear management and gait analysis to Consultant Podiatrist Mr Livingstone.

Mr Ray specialises in Bunion surgery. He uses the latest and most modern techniques. At surgery specialised hardware is used to stabilise the osteotomies ( bony breaks). He uses internal screw fixation for all cases. Patients therefore do not need a post operative plaster and can start mobilising on special wedge shoes (provided by hospital) immediately after the operation. He works closely with his Consultant Anaesthetist who makes sure that all patients get intraoperative nerve blocks to reduce post op pain.

Patients go home the same day or the next morning. Wounds are checked in a week, 2 weeks and 6 weeks. Patients can start wearing broader shoes by 4 weeks and own shoes by 3 months.

Hallux Rigidus

Hallux rigidus refers to arthritis of the main joint of the big toe in the ball of the foot. The joint surfaces wear out and the joint becomes stiff (rigid). The cause is multiple and can affect the big toe at any age.

Patients usually complain of pain in the big toe joint. They also complain of stiffness and inability to push off while running or walking. Sometimes a bony lump develops over the big toe ( due to osteophytes). Because the big toe is rigid one tend to walk on the outer surface of the foot resulting in metatarsalgia and lateral foot and ankle pain.

Mr Ray believes that the first course of treatment is footwear modification and orthotics. However if all else fails then intervention is necessary

A "Durolane" injection into the joint may be all that is necessary in the initial stages.

A "Chilectomy" is preferred when the main problem is due to the development of bony lumps and mechanical obstruction of dorsiflexion. This involves excision of the osteophytes and restoring dorsiflexion( upward movement ) of the big toe. Recovery takes about 6 weeks with concurrent physiotherapy.

Mr Ray also offers Toe Joint Replacement service for carefully chosen arthritic big toe joints. This is joint replacement surgery. This is offered to maintain some painfree movement of the joint. He uses modern techniques to either replace the proximal phalanx or the metatarsal head.

Post operative recovery is usually 6-12 weeks with concurrent physiotherapy.

"Fusion" of the big toe joint is the gold standard surgery for an arthritic big toe joint. Mr Ray usually offers this for patients with joints that are very arthritic and have no movement at all. He uses titanium plates and screws to fuse the joint. Usually he does not use a plaster cast post operatively and gets the patients to mobilise on wedge shoes immediately. Total time to recovery is usually 12 weeks.

Metatarsalgia

Metarsalgia is referred to pain in the balls of the foot. It is usually felt in the sole of the foot and can feel like "walking on pebbles".

Anything that puts extra pressure on the balls of the foot can cause metarsalgia. This could be being overweight, wearing high heeled shoes, hammer or claw toes. A stiff big toe (Hallux Rigidus) or a stiff ankle can cause metatarsalgia. A interdigital neuroma (Mortons Neuroma) can cause pain in the sole of the foot. Athletes can have a stress fracture that can cause pain. Arthritic changes locally in the joints of the ball of the foot can cause a similar pain.

Solutions usually involves keeping weight under control, wearing comfortable shoes, orthotics and treatment of systemic causes ( rheumatoid arthritis, gout, diabetes).

Mr Ray offers simple and specialised investigations for a diagnosis and subsequently surgeries involving correction of hammer toe or claw toe deformity, excision of a trapped nerve or reshaping and shortening of the metatarsals.

Lesser Toes

The smaller toes are very important for walking. They help in distributing the forces and share the pressure with the big toe.

The lesser toes can get deformed because of several reasons. A claw toe or hammer toe can become symptomatic because of rubbing in the shoe.

Simple solutions are strapping the toe, altering the shoe, avoiding high heeled shoe, small pads on top and the end of the toe.

Mr Ray offers the latest surgical solutions for these problems. He offers fusions of joints to correct the deformities. He offers shortening and corrections of the metatarsals. He uses the most modern "all inside" screw system for the fusions. This is different to the "K" wires normally used for these fusions ( therefore no need for removal of wires). Usual recovery time is about 4 weeks.

Mortons Neuroma

Morton's neuroma is a common, painful condition affecting the base of the toes, usually the third and fourth toes. The pain, which is sharp and severe (often described as like a red-hot needle), suddenly occurs while walking.

Anyone can develop Morton's neuroma, but the condition is much more common in women. It tends to occur in women who wear high-heeled shoes, people who regularly do sports or those who have a particular foot shape, such as a high arch or a flattened arch.

Morton's neuroma causes sharp or dull pain between the toes (usually the third and fourth toes). The pain occurs while you are walking and will cause you to stop and remove your shoe. It makes some people with the condition anxious about walking or even placing their foot on the ground. Keeping the weight off your feet or rubbing your foot can lessen the pain, which is made worse by wearing tight shoes. Other symptoms are numbness and tingling or burning sensation in the toes.

Diagnostic test of choice is usually an Ultrasound scan. An X-ray will also be taken. An MRI scan is rarely necessary.

Early treatment involves a change of shoe to reduce pressure, padding in the sole of the foot and orthotics. Mr Ray offers an Ultrasound guided injection of the neuroma performed by the radiologist.

Most patients will need a surgical excision. This is a day case surgery. Mr Ray uses a dorsal incision (top of the toe) to excise the neuroma. Post operatively patients walk on a special flat soled shoe for 2 weeks. Total time for recovery is usually 3 weeks.

Flat Feet

Some people's feet have a low arch or no arch at all, which is referred to as flat feet or fallen arches. When someone with flat feet stands, their inner foot or arch flattens, and the foot may roll over to the inner side (known as over-pronation).

People with flat feet may have stiffness in the foot and pain in any of the following areas-the inner side of the ankle, the arch of the foot, the calf, the knee, the hip and the back.

Flat feet can run in families. If a flat foot did not exist before but develops later in life, this can be due to, arthritis ,a ruptured tendon (Tibialis posterior tendon dysfunction) , a disease of the nervous system or muscles, such as cerebral palsy, spina bifida or muscular dystrophy, where the muscles are weakened.

Very rarely, the flat foot shape is caused by a condition called tarsal coalition. This results in the bones of the foot joining together abnormally, causing stiff, flat feet. This condition is usually obvious, and normally diagnosed in childhood.

Most people need no treatment for a flat foot. A symptomatic flat foot however will need treatment. Usually arch supports, achilles tendon stretches and change of footwear will suffice.

Patients who have developed flat foot deformity with age due to tendon dysfunction (Tibialis posterior tendon dysfunction) are initially treated with orthotics, an aircast boot, physiotherapy and if necessary a ultrasound guided injection.

Mr Ray offers surgery for flat feet only when all non-surgical treatments have been tried. Patients undergo tendon transfers, heel and midfoot osteotomies to correct deformity and restore the medial arch. Mr Ray also offers flat feet corrective surgery for children to excise tarsal coalitions (a cause of congenital rigid flat feet).