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MarkerOther Common Orthopaedic Conditions

Below are listed some common orthopaedic conditions offered within our orthopaedic surgery department. Please enquire if the surgery you seek is not listed.


Bakers Knee Cyst

What is a Bakers Knee Cyst?

You notice a bulge behind your knee, and you feel tightness there, too. The pain gets worse when you fully extend your knee or when you're active. What could be the cause?

A likely explanation is that you have a Baker's cyst, also called a popliteal cyst. A Baker's cyst is usually the result of a problem with your knee joint, such as arthritis or a cartilage tear. Both conditions can cause your knee to produce too much fluid, which can lead to a Baker's cyst. Treating the probable underlying problem usually relieves the swelling and discomfort of a Baker's cyst.

These cysts occur most often in adults between 55 and 70 and in children between 4 and 7 years old. Up to one in five people with other knee problems may develop a Baker's cyst.


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Signs & Symptoms

In some cases, a Baker's cyst causes no pain and goes unnoticed. The signs and symptoms you may notice can include:

  • Swelling behind your knee, and sometimes in your leg or foot
  • Knee pain
  •  Tightness in the back of your knee
  • Stiffness


A door hinge needs oil to swing smoothly, to reduce the friction between its moving parts and to minimize wear and tear. Similarly, the cartilage and tendons in your knees rely on a lubricating fluid called synovial (si-NO-vee-ul) fluid. This fluid helps your legs swing smoothly and reduces friction between the moving parts of your knees.

Synovial fluid circulates throughout your knee and passes in and out of various tissue pouches (bursae) throughout your knee. A valve-like system exists between your knee joint and the bursa on the back of your knee (popliteal bursa). This regulates the amount of synovial fluid going in and out of the bursa.

But sometimes the knee produces too much synovial fluid. Most commonly this is caused by an inflammation of the knee joint, such as occurs with various types of arthritis or a knee injury, especially a cartilage tear.

When the popliteal bursa fills with fluid and expands, the result is a bulge called a Baker's cyst. In texture, it's similar to a balloon filled with water.

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When to seek medical advice

If you're experiencing pain and swelling behind your knee, see your doctor to determine the cause. Treating the underlying condition, such as arthritis or a cartilage tear, usually relieves the swelling and discomfort of a Baker's cyst. In rare cases, a bulge behind your knee may be a tumor or a popliteal artery aneurysm rather than a fluid-filled cyst.

Screening & Diagnosis

A noninvasive imaging test, such as an ultrasound or a magnetic resonance imaging (MRI), scan can help distinguish a simple cyst. If your doctor suspects a blood clot in your leg (deep vein thrombosis) or an aneurysm, he or she may suggest an ultrasound of your leg or other tests.


Rarely, a Baker's cyst bursts and synovial fluid leaks into the calf region, causing sharp pain in the knee, swelling and sometimes redness of the calf. These signs and symptoms closely resemble those of a blood clot in your leg. If you have swelling and redness of your calf, you'll need prompt medical evaluation, because a blood clot may require urgent treatment.

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If the cyst is very large and causes a lot of pain, your doctor may use the following treatments:

Physical therapy: Applying ice packs, a compression wrap, and crutches may help reduce pain and swelling. Gentle range of motion and strengthening exercises for the muscles around your knee may also help to reduce your symptoms and preserve knee function.

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Fluid drainage. Your doctor may drain the fluid from the knee joint using a needle. This is called needle aspiration.

Medication. Your doctor may inject a corticosteroid medication, such as cortisone, into your knee to reduce the volume of fluid being produced. This may relieve pain, but it doesn't always prevent recurrence of the cyst.

Typically though, doctors treat the underlying cause rather than the Baker's cyst itself.

If your doctor determines that a cartilage tear is causing the overproduction of synovial fluid, he or she may recommend surgery to remove or repair the torn cartilage.

In some instances, particularly if you have osteoarthritis, the cyst may not go away even after your doctor treats the underlying cause. If the cyst doesn't get better, causes pain and interferes with your ability to bend your knee, or if — in spite of aspirations — fluid in the cyst hinders knee function, you may need to be evaluated for surgery to remove the cyst.

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Bunion Removal

What is Bunion Removal (Bunionectomy, Hallux Valgus Correction)

Bunion removal is the surgical treatment of a deformity of the bones of the big toe and foot (bunion).


A bunion is a painful deformity of the bones and joint between the foot and the big toe. Long-term irritation (chronic inflammation) caused by poorly fitting and/or high-heeled shoes, arthritis, or heredity reasons causes the joint to thicken and enlarge. This causes the big toe to angle in toward and over the second toe, the foot bone (metatarsal) to angle out toward the other foot, and the skin to thicken (callus formation).

The initial treatment for a bunion is changing from narrow and/or high-heeled shoes to wide shoes without a heel. When this does not work, surgery may be recommended.

Bunion Removal

Surgical Correction

Surgical removal of a bunion is carried out under general anesthesia. Surgery is recommended to correct the deformity, reconstruct the bones and joint, and restore normal, pain-free function. An incision is made along the bones of the big toe into the foot. The deformed joint and bones are repaired, and the bones are stabilized with a pin and/or cast.

After surgery

The patient is advised to keep the foot propped up and protected from pressure, weight, and injury while it heals. Complete recovery may require 3 to 5 weeks. The surgeon can fit a cast with a hard walking sole attached to enable the patient to walk during the healing and recovery period.

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Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome ?

Carpal tunnel syndrome affects about 1 in 100 people at some point in their life. Men and women of any age can develop it, but it is most common in women in their 30s, 40s and 50s.
carpal tunnel syndrome may be caused as a result of the patients occupation, it can lead to the person being unable to work. In Most cases the syndrome can be prevented by stopping or reducing the activity that stresses the fingers, hand, or wrist, or by changing the way in which activities are done.
Carpal Tunnel Syndrome is a condition where there is excessive pressure on the median nerve. This can be caused by swelling in the carpal tunnel and/or thickening of the transverse carpal ligament, which forms the roof of the carpal tunnel.
Pinching or compression of this nerve by the transverse carpal ligament sets into motion a progressively crippling disorder which eventually results in wrist pain, numbness and tingling in the hand, pain combined with a “pins and needles” feeling at night, loss of grip strength and a loss in the feeling of coordination.

What are the Symptoms?

Patients with carpal tunnel syndrome initially feel numbness and tingling of the hand in the distribution of the median nerve (the thumb, index, middle, and part of the fourth fingers). These sensations are often more pronounced at night and can prevent sleep. The reason symptoms increase at night are possibly due to fluid accumulating around the wrist and hand whilst lying flat or in the flexed-wrist sleeping position. Carpal tunnel syndrome may be a temporary condition that completely resolves or it can persist and progress.
As the disease progresses, patients can develop a burning sensation, cramping and weakness of the hand. Decreased grip strength can lead to frequently dropping objects. Occasionally, sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also lead to wasting (atrophy) of the hand muscles, particularly those near the base of the thumb in the palm of the hand.

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What are the Causes?

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition - the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. In some cases no cause can be identified.

There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis. Writer's cramp - a condition in which a lack of fine motor skill coordination and ache and pressure in the fingers, wrist, or forearm is brought on by repetitive activity - is not a symptom of carpal tunnel syndrome.

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Who is at Risk of Developing Carpal Tunnel Syndrome?

Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body's nerves and make them more susceptible to compression are also at high risk. Carpal tunnel syndrome usually occurs only in adults.

The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work - manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel.

During 1998, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about $30,000 for each injured worker.

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How is Carpal Tunnel Syndrome Diagnosed?

Early diagnosis and treatment are important to avoid permanent damage to the median nerve. A physical examination of the hands, arms, shoulders, and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy. Routine laboratory tests and X-rays can reveal diabetes, arthritis, and fractures.

Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. In the Tinel test, the doctor taps on or presses on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute. Doctors may also ask patients to try to make a movement that brings on symptoms.

How is Carpal Tunnel Syndrome Treated?

Carpal tunnel syndrome treatment usually begins conservatively, and moves to more aggressive and invasive techniques if the symptoms of carpal tunnel syndrome persist.

The initial carpal tunnel syndrome treatment steps include some medications and splints

Your doctor may ask you to rest your wrist or change how you use your hand and may also ask you to wear a splint on your wrist. The splint keeps your wrist from moving but lets your hand do most of what it normally does. A splint can help ease the pain of carpal tunnel syndrome, especially at night.

Putting ice on your wrist, massaging the area and doing stretching exercises may also help.

Cortisone injections decrease inflammation around the nerve providing temporary relief to the affected area.

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Surgical treatment

Surgical correction known as the carpal tunnel release is effective in the treatment of carpal tunnel syndrome. This procedure involves making an incision in the fibrous sheath around the carpal tunnel. By releasing tension in the carpal tunnel, the pressure is removed from the nerve.

Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations. Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two small incisions (about ½" each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. One-portal endoscopic surgery for carpal tunnel syndrome is also available.

After Surgery

Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may need to adjust job duties or even change jobs after recovery from surgery.

Recurrence of carpal tunnel syndrome following treatment is rare.

The majority of patients recover completely.

Tendonitis - Wrist


What is Wrist Tendonitis ?

Wrist tendonitis, also called tenosynovitis, is a common condition characterized by irritation and inflammation of the tendons around the wrist joint. Many tendons surround the wrist joint. Wrist tendonitis usually affect one of the tendons, but it may also involve two or more. Often wrist tendonitis occurs at points where the tendons cross eachother or pass over a bony prominence.
The wrist tendons slide through smooth sheaths as they pass by the wrist joint. These tendon sheaths, called the tenosynovium, allow the tendons to glide smoothly in a low-friction manner.

When wrist tendonitis becomes a problem, the tendon sheath or tenosynovium, becomes thickened and constricts the gliding motion of the tendons. The inflammation also makes movements of the tendon painful and difficult.

Wrist Tendonitis

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What are the Symptoms of Wrist Tendonitis?

The most common and consistent complaint of patients diagnosed with wrist tendonitis is pain over the area of inflammation. Swelling of the surrounding soft-tissues is also quite common.

How is the Diagnosis of Wrist Tendonitis Made ?

Diagnosis of wrist tendonitis is a made by looking for the characteristic signs of this problem. In addition, depending on the tendon that is inflamed, the physician can perform tests that stretch the area of concern to locate the precise source of inflammation.

For example, one type of wrist tendonitis is called DeQuervain's tenosynovitis. This is inflammation of the tendon at the base of the thumb. Often seen in new mothers, DeQuervain's tenosynovitis is diagnosed by a specific test called 'Finkelstein's test' where the patient makes a fist and the wrist is pulled away from the thumb. Pain from this maneuver is diagnostic of this type of wrist tendonitis.

Rehabilitation Exercises

The exercises below will help to strengthen the wrist. Please note that these should only be attempted when the initial tendonitis has subsided and you wish to strengthen the wrist. If any pain is initiated from these exercises then you should immediately cease the exercises.


Wrist Tendonitis

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Tennis - Elbow Repair

Tennis Elbow

Tennis elbow (medical term lateral epicondylitisis) is where the outer part of the elbow becomes painful and tender, usually as a result of a specific strain or overuse. Although it is called "tennis elbow", it is not restricted to tennis players.

Anyone who does a lot of work involving lifting at the elbow or repetitive movements at the wrist is susceptible to tennis elbow particularly with heavy vibration such as constant use of road drills, plumbers, painters, gardeners, carpenters, motorcyclists etc.


  •  Pain on the outer part of elbow.
  •  Gripping and movements of the wrist hurt, especially wrist extension and lifting movements.
  •  Tenderness to touch, and elbow pain on simple actions such as lifting a cup of coffee or throwing a ball.
  • Pain radiating down the forearm.
  •  Pain usually subsides overnight.
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Non Surgical Treatments

  •  Rest, ice, and cold compression therapy are the first initial treatments.
  •  Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain, and inflammation.
  •  Applying heat and cold (ice packs) in combination works extremely well, as ice controls swelling and heat heals and promotes blood flow and also relieves the tightness and pain.
  •  Anti-inflammatory pain-killers, such as ibuprofen can help
  •  A brace might also be recommended by a doctor to reduce the range of movement in the elbow and thus reduce the use and pain.
  •  Stretches and strengthening exercises help prevent re-irritation of the tendon
  •  Sports players may be advised to strengthen shoulder and abdominal muscles to reduce overcompensation in the wrist during shoulder and arm movements.
  •  Local steroid injections can relieve symptoms sometimes for several months, but there is a risk of later recurrence. Following an injection, the patient may experience pain for a while before the steroid starts to act. Most doctors will limit treatment to two injections. Steroid injections have little impact in the chronic stages of the condition.
  • ultrasound can be used to reduce the inflammation and promote collagen production.

Without early treatment this condition can become chronic and more difficult to eradicate.

Surgical Treatments

Where the Tennis elbow condition has not responded to conservative treatment surgery is then deemed necessary.

The surgeon will conduct a physical examination and may take X-rays or CT Scans to determine the exact cause of the problem.

Surgery is usually carried out under general anaesthesia.

The surgeon will make a 3cm incision after which there are several possible surgical treatments that the surgeon may adopt, including removing a portion of the damaged tendon or releasing the attachment of the affected tendon. A repair of the healthy portion of tendon is sometimes carried out as well.

Surgery to release the damaged tendon is usually successful.

The patient will normally stay overnight as a precautionary measure and leave the next day.

Rehabilitation after Tennis Elbow Surgery?

Within several weeks of surgery, patients should begin light exercises and begin strengthening their muscles after about six weeks. Patients who wish to return to athletic activities can begin to do so about 12 weeks after surgery.

Trigger finger

A trigger finger occurs when the motion of the tendon that opens and closes the finger is limited, causing the finger to lock or catch as the finger is extended.

The tendons that control the movements of the fingers and thumb slide through a snug tunnel of tissue, created by a series of pulleys which keep the tendons in place. The tendon can become irritated as it slips through the tunnel. As it becomes more and more irritated, the tendon may thicken, making its passage through the tunnel more difficult. The tissues that hold the tendon in place may thicken, causing the opening of the tunnel to become smaller. As a result, the tendon becomes momentarily stuck at the mouth of the tunnel as the finger is extended. A pop may be felt as the tendon slips past the tight area. This why pain and catching may be felt as the finger is moved.

The goal of surgery is to widen the opening of the tunnel so that the tendon can slide through it more easily. The surgery is performed through a small incision in the palm. Usually, the fingers can be moved immediately after surgery. Some soreness in the palm is common, but elevating the hand after surgery can help reduce swelling and pain. Recovery is usually complete within 6 - 8 weeks.


An ankle fusion is a surgical procedure that is usually done when an ankle joint becomes worn out and painful, a condition called degenerative arthritis.

An ankle fusion actually removes the surfaces of the ankle joint and allows the tibia to grow together, or fuse, with the talus. For the ankle, a fusion is a very good operation for treating a worn-out joint. This is especially true if the patient is young and very active. An ankle fusion, if successful, is not in danger of wearing out like an artificial ankle. A fusion keeps the ankle joint from moving during walking and other activities, so the other foot joints will need good mobility.

You can expect a great deal of swelling in your ankle, and will need to keep your foot elevated to help reduce the swelling. Once the swelling goes down and the incisions on your foot are healing, you will be put in a plaster cast from your knee to your toes. You will need to wear the cast until the ankle has fused — usually 3-4 months. For the first 6 weeks you should not put any weight on your foot as it may disturb the healing joint. While in the hospital, a physical therapist will teach you how to walk with crutches without putting weight on your foot.

Over the next few weeks, you will have x-rays taken to monitor the healing of your fused ankle joint. When the x-rays show that the joint is fused enough to take your weight, the cast will be removed and you will be given a brace to wear that will support you as you begin walking with weight on your foot again. The brace is usually worn for about a month.

Ankle Arthroscopy


    Ankle Arthroscopy is a minimally invasive surgical procedure used to investigate, diagnose and treat an ankle disorder that fails to respond to physiotherapy, medication or other non-surgical treatments. This procedure involves using very small incisions to enables the Surgeon have a quick easy and clear view of the inside of the ankle through a pencil slim camera known as an Arthroscope Each incision is less than 1cm and usually two incisions are required. There are two types of Ankle Arthroscopy a) Diagnostic Arthroscopy (investigation to find out what is wrong with an ankle joint) b) Therapeutic Arthroscopy (correction of an injury or fault within the ankle joint). It is most common for these procedures to be provided at the same time.

    Ankle Arthroscopy is usually performed in order to investigate and relieve persistent ankle pain, swelling, clicking, catching, instability or 'giving way' of the joint. This is an increasingly more common orthopaedic procedures today than it has ever been because the ankle joint is so easily injured through sport injuries, work related injury, arthritis or general inflammation or 'wear and tear'. The majority of Ankle Arthroscopies are performed on patients between the age range of 20 and 60 years, although much younger and older patients can also benefit from this procedure.

    The very small incisions used result in minimal soft tissue disruption and trauma. This in turn results in:
  •   Significantly lower pain levels than an open approach

  •  The ankle is comfortable to weight bear through on the day of surgery

  •  Most cases can be performed as day cases

  •  Lower infection rates than open surgery

  •  Earlier return to work/function/sports

  •  Little scarring

  •  Minimal effect if further surgery to the ankle is required

  • Once back on the ward the physiotherapist will get the patient up. The patient may put as much weight through the ankle as is comfortable. Crutches maybe needed for a day or so.
    The affected limb will need to be elevated when not weight bearing for the first 48 hours.

    Dupuytren’s Fasciectomy

    The layer of tissue just under the skin in your palm, the fascia, has become abnormal. The fascia has formed a band which is thicker than normal and is shortened. The band prevents you fully straightening your finger. This is known as Dupuytren's contracture.
    Surgery is the most common treatment of Dupuytren's disease. Surgery is usually considered at a relatively late stage of the disease, typically when fingers are already bent by more than 15 to 20 degrees and the use of the hand has become restricted. In a much progressed stage, when the hand is already bent inwards, surgery is the only proven therapy that we know of that can make your hand straight again.

    Surgical procedures:

    There are two main options:

    Open fasciectomy.
    Fasciectomy simply means cutting the thickened tissue. (Another word for the thickened tissue is called fascia.)
    Open fasciectomy means that to get to the thickened tissue, the overlying skin is cut open. This allows the surgeon to see the thickened tissue, and then to cut it. The skin is then stitched back together. It is a relatively minor procedure which can be done under local anesthetic.

    Needle fasciectomy.
    This is sometimes called needle aponeurotomy. The Surgeon pushes a fine needle through the skin over the contracture. He then uses the sharp bevel of the needle to cut the thickened tissue under the skin. The procedure is done under local anesthetic.

    So which is the best option? There are pros and cons of each procedure. For example:

    Needle fasciectomy can be a quick procedure and has shorter healing time. However, the contracture returns in about half of cases within 3-5 years following this procedure.

    If you have an open fasciectomy, (removal of the thickened tissue), the chance of the problem returning is much less than with a needle fasciectomy. However, it is a more extensive operation and it can take some time for the wound to heal and for you to get full function of the hand.

    Hallux Rigidus

    What is Hallux Rigidus?

    Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the big toe, and with time it gets increasingly harder to bend the toe. "Hallux" refers to the big toe, while "rigidus" indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis.
    Early signs and symptoms include:

    •   Pain and stiffness in the big toe during use (walking, standing, bending, etc.)

    •   Pain and stiffness aggravated by cold, damp weather

    •   Difficulty with certain activities (running, squatting)

    •   Swelling and inflammation around the joint

    •  As the disorder gets more serious, additional symptoms may develop, including:

    •  Pain, even during rest

    •  Difficulty wearing shoes because bone spurs (overgrowths) develop. Wearing    high-heeled shoes can be particularly difficult.

    •  Dull pain in the hip, knee, or lower back due to changes in the way you walk

    •  Limping, in severe cases

    What Causes Hallux Rigidus?

    Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis—the kind that results from "wear and tear"—often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus.
    In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse—especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury—even from stubbing your toe. Or it may be caused by certain inflammatory diseases, such as rheumatoid arthritis or gout. Your foot and ankle surgeon can determine the cause of your hallux rigidus and recommend the best treatment.

    Diagnosis of Hallux Rigidus
    The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle surgeon is when you first notice that your big toe feels stiff or hurts when you walk, stand, bend over, or squat. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.
    In diagnosing hallux rigidus, the foot and ankle surgeon will examine your feet and manipulate the toe to determine its range of motion. X-rays are usually required to determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have formed.

    Torn Achilles Tendon

    The Achilles tendon is the tendon that connects the calf muscle (gastrocnemius) to the heel bone (calcaneus). This is the tendon that is just below the skin at the back of the ankle. As with most tendon injuries, this tendon may be injured.


    When the gastrocnemius muscle (in the calf) contracts (shortens), the tendon which is attached from the muscle to the heel bone (calcaneus) moves. As the muscle shortens, the tendon moves to point the foot downwards. This is the action that allows a person to stand on one's toes, to run, to jump, to walk normally, and to go up and down stairs.


    Achilles tendonitis is an inflammation of the tendon. It often results from a small stretch injury that causes the tendon to become swollen, painful and less flexibility than the normal tendon. Untreated, this injury may fail to heal, or progress to a chronically painful condition. Of course, in some people, the tear may progress to a complete rupture of the tendon. A ruptured (or torn) tendon may occur when the tendon has been structurally weakened by an ongoing tendonitis, or when a completely healthy tendon is subjected to a sudden, unexpected force. As a result, the tendon tears. When the tendon tears, people often report hearing a pop at the back of the ankle. If they are playing doubles in tennis, the person often thinks that his/her partner has hit them in the back of the ankle. With the injury, pain, swelling, and loss of function occur. Since the calf muscle is no longer attached to the heel bone, people find it difficult to walk normally, and have difficulty doing activities that require any type of significant push off with their toes (such as running, jumping, doing toe raises). Left untreated, the tendon often fails to heal, thereby resulting in a permanent disability.


    For a tendon rupture, the area of the rupture is often swollen, tender, bruised (ecchymotic), and may actually have a palpable gap in the tendon. X-rays, although they do not show the tendon reliably, do show the calcaneus. When doing the x-ray, the physician is checking to see if the bone to which the Achilles tendon attached (calcaneus) has been injured. In some cases, the tendon will not tear; but instead, it will literally pull a piece of calcaneal bone off of the rest of the calcaneus. Although this is repairable, the technique is different then merely sewing the two ends of a ruptured tendon together. If the tendon has not ruptured, then the patient may have sustained only a pulling injury to the tendon. This type of injury results in a stretch injury to the tendon which is called tendonitis. Although this often heals without surgery, until completely healed, the tendon is structurally weaker then normal and is at an increased risk for tearing with continued athletic activity or additional injury producing situations. The most reliable diagnostic study for a suspected rupture of the Achilles' tendon is the Thompson test. This is a test performed during the physical exam. When then test is abnormal, the probability of a ruptured tendon being present is extremely high.


    The treatment options for a complete rupture of the tendon include surgery followed by casting, or casting alone. There are advantages and disadvantages to each technique and the options should be discussed with your physician. With surgery, the tendon is either reattached to the calcaneal bone (if it has been pulled off or avulsed) or the two ends are sewn together is the tendon has been torn in two. In most people, a cast is applied after surgery until healing is complete. Each patient must be considered individually. There are many reasons why a person may not be a suitable candidate for a surgical repair of the injury. These include, but are not limited to: poor circulation, presence of skin problems at the site of the injury, age, a sedentary lifestyle, other medical conditions that make the person a poor candidate for surgery (such as heart or lung problems). If the injury is treated non-operatively, then a cast is applied until healing is complete. The length of time required for healing is highly variable. Often it may take as long as six months for complete healing to occur.


    The Trapezium is one of the eight carpal (wrist) bones and lies at the base of the thumb. Arthritis in the joints is very common and is contributed to by instability of the joint and a natural vulnerablity to wearing of the joint surface. Its is a progressive condition that leads to increasing stiffness and deformity of the thumb. If neglected, the joint tends to stiffen.

    Trapeziectomy involves the complete removal of the trapezium bone. It is mandatory if the joints both above and below the trapezium are arthritic. Some Surgeons fill the gap but there is no evidence that this improves outcome.

    Trapeziectomy with ligaments reconstruction is performed routinely by many surgeons. There is no evidence that this improves outcome and reserve it for instance where the base of the thumb appears too slack to sit securely into the new joint created by removal of the bone

    Hammer Toe

    A hammer toe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. Initially, hammer toes are flexible and can be corrected with simple measures but, if left untreated, they can become fixed and require surgery.
    People with hammer toe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.
    Hammer toe results from shoes that don't fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and cannot stretch out.
    Shoes that narrow toward the toe may make your forefoot look smaller. But they also push the smaller toes into a flexed (bent) position. The toes rub against the shoe, leading to the formation of corns and calluses, which further aggravate the condition.

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