Private multidisciplinary fracture clinic
We are currently offering the first multidisciplinary private fracture clinic on the Mornington Peninsula. The aim of this clinic is to see acute and sub-acute trauma within a timely manner. We accept referrals from general practitioners, public and private emergency departments and other medical practitioners. The clinic provides a private facility where patients can be assessed by an orthopaedic surgeon and physiotherapist at the same appointment. Patients have access to onsite imaging, undergo plaster/splint application and removal, and commence a rehabilitation program as appropriate. Patients are then referred back to their primary allied health practitioner and general practitioner with a detailed management plan for ongoing care.
This clinic treats all acute and sub-acute trauma (with the exception of hand and spinal injuries).
We also treat a variety of non-urgent orthopaedic conditions, such as sports injuries and arthritis. For more information on the various elective conditions we treat, please see below:
Ankle arthritis is usually associated with some kind of trauma to the ankle. Many people don't have symptoms and only present for treatment due to deformity or wearing out their shoes. Often, an ankle brace, physiotherapy or an injection into an arthritic ankle can be suitable treatment. If these measures are unsuccessful, an ankle fusion or occasionally an ankle replacement could be considered.
A bunion is soft tissue swelling over an area of bony prominence. In the big toe, sometimes the ligaments on the inside of the toe stretch and the ligaments and tendons on the outside of the toe contract. This causes the toe to drift to the side, causing a bunion. Bunions can be associated with ligamentous laxity, ill-fitting shoewear, inflammatory conditions like rheumatoid arthritis and trauma. They are not always painful and many people just need to make some minor modifications to their shoewear and need no further intervention. Rarely, some people require further investigations and/or surgery.
Ankle instability is a common problem, often occurring in young sportspeople. In 90% of people, an isolated ligament injury to the ankle heals well with rest, intensive physiotherapy and occasionally ankle bracing. A small proportion of people go on to have chronic instability which can lead to arthritis, difficulty playing sport and pain. In these patients, a lateral ligament reconstruction and ankle arthroscopy may be considreed.
Flat feet can be due to an acquired deficiency of the posterior tibialis tendon, a thick tendon that runs around the inside of the ankle. It supports the arch of the foot and if damaged, the arch can collapse. Damage can occur due to ligamentous laxity, obesity and trauma, and in some cases no cause is identified. Flat feet respond very well to an arch support and shoewear modification. If this does not work, surgery to reconstruct the tendon, or a fusion (in the setting of arthritis) may be considered.
Some people have high arches (pes cavus) and present with ankle instability, stress fractures or early arthritis. Occasionally, high arches can be due to neurological disorders such as problems to the nerves in the leg or spine. Depending on the cause of the high arch, some people do very well with orthotics and shoe wear modification to correct the heel bone. In some cases, a tendon transfer combined with a heel shift may be appropriate treatment. If the foot or ankle is very stiff, a fusion may be required to treat the deformity.
BIG TOE ARTHRITIS
Arthritis of the big toe, or hallux rigidus, is a suprisingly common condition. It can be due to trauma, poor shoewear and in many cases has no clear cause. A stiff soled shoe and avoidance of heeled shoes takes the load off the big toe and therefore minimises pain from the arthritis. In some cases, patients may benefit from a fusion to the big toe. Rarely, other surgical options may be considered.
Knee arthritis is very common. It is estimated that over 240 people out of 100,000 are diagnosed with knee arthritis every year. It is associated with previous trauma to the knee, obesity and some inflammatory conditions like rheumatoid arthritis and gout. If the cartilage in the knee wears away, the bone underneath is exposed which can cause pain, deformity and even instability. Non-operative treatment like weight loss, reducing sugar intake, participation in non-weight bearing activities such as swimming and occasionally bracing can limit the force that is put through an arthritic knee and reduce or even eliminate knee pain. In some cases, a knee replacement may be an option.
Hip arthritis is also quite common, although not as common as knee arthritis. Sometimes patients present only with stiffness of their hip and difficulty doing up their shoelaces. Physiotherapy can be very helpful in the setting of hip arthritis. Strong gluteal muscles and addressing any contractures is important as this may help avoid surgery altogether. In some patients, a hip replacement is a suitable operation for hip arthritis and can be very successful in relieving pain.
SUBTALAR JOINT ARTHRITIS
Subtalar joint arthritis is a relatively rare condition where the cartilage in the joint underneath the ankle (the subtalar joint) has worn away. It is commonly associated with fractures of the calcaneum or talus. It can be very painful and patients often report difficult with walking on uneven ground. An injection into the subtalar joint can be quite helpful for both pain relief and also to determine exactly where the pain in the foot is coming from if not apparent in imaging and examination. A subtalar fusion is a reliable operation for relief of pain from the subtalar joint and can be done through keyhole, or arthroscoipc surgery.
LESSER TOE DEFORMITIES
Less toes (or every toe that isn't the big toe) can be notoriously difficult to treat. Every effort is made to treat the toe non-surgically. This can be done with taping, shoewear modifications and calf-stretching exercises to relieve pressure on the ball of the foot. Rarely, surgery may be indicated to treat instability or severe deformity.
Mid foot arthritis, or arthritis of the tarso-metatarsal joints, is a very common condition. It particularly affects middle-aged women. Mid-foot arthritis can be associated with a flat-foot deformity. Often patients present with a bump on top of the foot, caused by osteophytes, a bone reaction to arthritis. Injections of local anaesthetic and steroid can be very helpful in relieving pain and also diagnosing exactly where the arthritis is coming from. A stiff-soled shoe can also relieve the pressure on the foot and spread the distribution of weight more evenly. In some patients, a fusion of the tarso-metatarsal joints may be appropriate surgical treatment.
Moreton's neuroma is a common condition that can cause pain and numbness in the toe. Interestingly, up to 50% of people have evidence of a moreton's neuroma on ultrasound but only a very small proportion of people have symptoms. Changing shoewear and an injection of local anaesthetic and steroid around the neuroma (normally done under ultrasound) can be very effective in relieving symtpoms. Occasionally, surgical intervention may be warranted.
Achilles tendonopathy is a term used to broadly describe problems with the achilles tendon. This can range from actue tendonitis, to rupture, to tendonosis where the tendon fibres themselves become degenerate. Treatment can include extensive physiotherapy and a small heel raise in the shoe to alleviate pressure from the tendon. Occasionally, surgical intervention may be suggested.
We treat a variety of fractures, dislocations and soft tissue injuries and usually have one vacant appointment for emergency review. Please contact the surgery if you think you need to be seen urgently (within 48 hours). You will still need a referral from the emergency department or general practitioner.
Dr Touzell is a qualified Independent Medical Examiner and has collaborated with insurance companies and legal firms to offer expert opinion on complex medicolegal cases. Please let our secretary know if you are an insurance or legal firm requiring an appointment as we allocate a longer appointment time for these complex cases.