Surgery can offer solutions to many foot problems. It is the aim of this practice to explore all conservative and non-invasive ways of managing your foot problems before considering a surgical intervention. We will tailor your treatment plan to your specific needs, as discussed at your initial assessment with your podiatrist.

Your podiatrist may suggest referring you to Ernest Barlow-Kearsley, our consultant podiatric surgeon for a consultation, however you may self refer yourself for a consultant consultation at any time.

A Podiatric Surgeon is a podiatrist who has undertaken extensive post graduate training in foot surgery. It is important for the public to note that Podiatric Surgeons are non-medically qualified specialists in the treatment of all foot problems. The scope of practice as determined by the higher training authority (The Society of Chiropodists and Podiatrists) is that of the foot and its associated structures.

Training
A podiatrist has specialist training to diagnose and treat all aspects of foot pathology as an autonomous practitioner. Podiatric Surgeons are highly specialised, only operating on the foot (rather like a dental surgeon who will only treat your mouth). Podiatric surgery is a proven and effective aspect of foot health care with thousands of foot operations performed each year.

The training involves:

• 3 year full time degree in Podiatry
• 2 years general Podiatric Practice
• 2 year primary fellowship – Postgraduate Certificate in Podiatry
• 2 year surgical training programme – Postgraduate Diploma in Podiatry
• Final Fellowship examination
• 3 year specialist training (Clinical Fellow in Podiatric Surgery)
• Accreditation with the Faculty of Podiatric Surgery
• Consultant Podiatric Surgeon

All Podiatric Surgeon’s are required to be registered with the Health Professions Council with the award of Fellowship and training provided by the Faculty of Surgery, The Society of Chiropodists & Podiatrists

Below is a brief description of the more common surgical procedures that are surgically managed by Podiatric surgeons.

Hallux Valgus (Bunion)

Podiatric surgeon Ernest Barlow-Kearsley discusses foot surgery, bunion removal and the discomfort of hammertoe deformity. See a video of a surgical procedure to remove a bunion.

Bunions are caused by the separation of the metatarsals that the first and second toes are attached to (these are the long bones in your foot). This results in a widening of the angle between these two long bones and a bump or ‘bunion’ on the side or the foot as the big toe migrates towards the second toe. This is due to the influence of tendons, resulting in a ‘kink’ in the shape of the big toe joint. The condition is often hereditary and is progressive and can deteriorate with time therefore it is important to also discuss footwear and biomechanical influences with your podiatrist.

Correction of this very common foot deformity is achieved by reducing the angle between the metatarsals. This is done by cutting the bones and moving them into the corrected position and maintaining this position by way of screws Fig 1. For larger angles between the 1st and 2nd long bones the Lapidus procedure is preferred see figure 2.

Fig. 1 Scarf and Akin osteotomy where the bone is cut in three places.

Fig. 2 Lapidus procedure for large angles between the 1st and 2nd long bones.

Hammer toes
This conditions results from the imbalance in power between the small finer muscles of the foot and the more powerful muscles that have their origin in the lower leg. The cause of this imbalance can be multi-factorial. One possible influence is abnormal biomechanics, therefore discuss this with your podiatrist. The toes start to buckle at the “knuckles” and are then irritated by footwear with resultant corns over the “knuckles” or interphalangeal joints. See Figure 3 for a picture of claw toe deformity. The correction of these toe deformities will depend on the cause and the procedures used are an arthroplasty (excision of part of the knuckle joint) or an arthrodesis (fusion of the knuckle joint) . In toes that require a fusion a surgical steel wire will be used to stabilise the fusion site.

Fig. 3 Claw Toes

Morton’s Neuroma
This condition affects the nerve on the sole of the foot that lies between the 3rd and 4th long bones This is one of the smaller branches of the larger nerves that enter the foot. At the ankle the Tibial Nerve divides into three branches before it courses deep to the skin and divides into smaller nerves that supply the toes. The cause of this nerve pain is caused by prolonged irritation of the nerve as it is stretched and rolled over the heads of the 3rd and 4th long bones of the foot. This mechanical irritation of the nerve is often associated with abnormal biomechanics. A thickening of the nerve occurs which then results in impaired signals being sent to the 3rd and 4th toes. The pains often experienced is described by patients as ‘sharpness’, ‘shooting’, the sensation of ‘walking on a stone’ ‘cramp-like’ or sometimes ‘numbness’. The treatment for this condition is by correcting any abnormal biomechanical anomaly often with orthoses, possible injection with corticosteroid and local anaesthetic or if persistent pain is experienced excision of the nerve that is thickened.

Fig.4  Arrow pointing to Neuroma / thickened nerve

Contact us today to book an appointment or to find out more about the treatments we offer.