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.
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.
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.
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.
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.