Hallux valgus (bunion)

This is when the base of the big toe starts to move towards the midline causing a painful bony lump.

For early cases a widened shoe box or padding is helpful. However if the pain persists then the bunion can be corrected by breaking and resetting the 1st metatarsal (osteotomy) thus removing the bump.

Mr Cope performs a type of osteotomy called a scarf osteotomy that allows early mobilisation with a surgical shoe. Recovery is typically over four to six weeks.

During surgery an ankle block is performed which numbs the nerves to the foot. This improves pain control after the operation and often enables you to go home the same day.

Hallux rigidus (arthritis big toe)

This is when wear and tear arthritis develops leading to reduced, painful movement at the base of the first (big) toe.

Initial treatments for the early stage involve stiff soled shoes and steroid injections. If this fails then early surgery for stiffness involves removing the bump on the top of the toe to improve the movement. If however pain is the main problem the joint can either be permanently stiffened (arthrodesis) or replaced (1st MTP replacement).

During surgery an ankle block is performed which numbs the nerves to the foot. This improves pain control after the operation and often enables you to go home the same day.

The wound heals by two weeks and recovery can be expected by four to six weeks.

Lesser toe deformities

Hammer and claw toes can develop at any stage in life. They often rub on shoes and cause thickening of the skin (callosities) and pain.

Initial measures involve chiropody and pads to the shoes to alleviate the pressure areas. If this fails then the affected joint can be surgically stiffened to create a straight toe. The toe is often held with a temporary wire through the skin that is removed, in clinic with minimal discomfort, after four weeks.

Following surgery you get to go home the same day and the pain is controlled initially by ‘blocking’ the nerves to the toes to make them numb.

Morton's neuroma

This is when you get numbness in the affected toes or a sharp stabbing pain at the base of the toes. It often affects the 3rd and 4th toes. The nerve supplying them gets trapped as it passes through a tunnel below the ‘transverse ligament’ this causes it to swell and then this causes the pain or numbness felt.

The treatment initially involves rest, ice, elevation or a cortisone injection. If this fails to work then surgical release can be considered. I perform this from the top of the foot so that you can walk on your foot straight away.

Possible Complications
Infection
Continued pain (20%)
Reoccurrence of pain

This is the name given to pain in the balls of the foot. Often it is associated with thickening (callosities) of the sole over the base of the 2nd,3rd or 4th toes.

It is due to one of several conditions either a Morton’s neuroma, fallen metatarsal arch, or Sesamoiditis. This is the inflammation of the soft tissue surrounding the seed-like sesamoid bones in the ball of the foot under the big toe.

Treatment is targeted to the condition and can involve injections or orthotics (inserts to your shoes). Occasionally surgery is required and can involve soft tissue or bony procedures.