Foot & Ankle

Foot & Ankle Anatomy

The foot and ankle are a complex joint involved in movement and providing stability and balance to the body. The foot and ankle consist of 26 bones, 33 joints, and many muscles, tendons and ligaments.

Bones of the Ankle

The ankle joint connects the leg with the foot, and is composed of three bones: tibia, fibula and talus. The tibia or shin bone and fibula or calf bone are bones of the lower leg which articulate with the talus or ankle bone, enabling up and down movement of the foot.

Conditions

Achilles Tendon Bursitis

Achilles tendon bursitis or retrocalcaneal bursitis is a condition that commonly occurs in athletes. It is a painful condition caused by swelling of bursa, a fluid-filled sac which is located at the back of the heel under the Achilles tendon. This retrocalcaneal bursa contains a lubricating fluid that acts as a cushion to reduce friction between muscle and bones. Achilles tendon is the large tendon that connects the calf muscles to the heel bone (calcaneous) and is used when you walk, run, and jump.

Achilles Tendon Rupture

Achilles Tendon or heel cord is one of the most powerful tendon which helps to do heel raise when we are walking, running, jumping or standing on tip toe. This tendon is formed by the confluence of calf muscles, which inserts to back of your heel. This is the strongest and thickest tendon in the body and generates lot of forces, which can be several times your body weight during activities.

Ankle Fractures

The ankle joint is composed of three bones: the tibia, fibula, and talus which are articulated together. The ends of the fibula and tibia (lower leg bones) form the inner and outer malleolus, which are the bony protrusions of the ankle joint that you can feel and see on either side of the ankle. The joint is protected by a fibrous membrane called a joint capsule and filled with synovial fluid to enable smooth movement.

Ankle Injury

Osteochondral injuries are one of the most common causes of ankle pain. Though in most cases there is a history of injury or trauma to the ankle joint, a few cases may not have any previous history of ankle injury. A condition known as osteochondritis dissecans is commonly seen in the knee and ankle joint and is characterised by the damage and separation of a piece of bone and cartilage, within the joint, from the underlying bone. In the ankle joint, it mainly affects the talus bone and sometimes the lower end of the tibia or shin bone may also be affected.

Ankle Instability

Ankle instability is a chronic condition characterised by a recurrent slipping of the outer side of the ankle. It usually results from repeated ankle sprains. It is generally noticed during movement of the ankle joint but can also occur during standing as well.

Ankle Ligament Injury

Ankle ligament injury, also known as ankle sprain, can be caused by a sudden twisting movement of the foot during any athletic event or during daily activities. It is one of the most common orthopaedic injuries and can also be caused by walking down a slope or over any uneven surface. The injury can range from mild to severe, depending on the condition of the injured ligament and the number of ligaments involved.

Ankle Sprain

A sprain is the stretching or tearing of ligaments, which connect adjacent bones and provide stability to a joint. An ankle sprain is a common injury that occurs when you suddenly fall or twist the joint or when you land your foot in an awkward position after a jump. Most commonly it occurs when you participate in sports or when you jump or run on a surface that is irregular. Ankle sprains can cause pain, swelling, tenderness, bruising, stiffness, and inability to walk or bear weight on the ankle.

Athlete's Foot

Athlete's foot also known as tinea pedis, is a fungal infection on the skin of the foot. It is characterised by itchy, moist, white, scaly lesions between the toes that can spread to the sole of the foot. Athlete’s foot is contagious and spreads through contact with infected skin scales or fungi in moist areas such as swimming pools and bathrooms, or from sharing shoes of an infected person or having contact with pets carrying the fungi.

Bunion

A bunion is a bony protuberance that appears on the external surface of the big toe when it angles toward the adjacent toe. It is an extra bone and a fluid-filled sac that grows at the base of the big toe.

Claw Toe

Claw toe is a deformity, where a toe bends and appears like a bird’s claw. The affected toe is bent upward from the joint at the ball of foot, and downward at the joints in the middle and tip of the toe to curl under the foot. Hard thick skin called corns may develop under the ball of the foot or on the top of the affected toe, causing pain while walking.

Club foot and Congenital Deformity

Congenital deformities of the lower limbs are developmental disorders that are present at birth, causing alterations in the shape and appearance of the legs. Several factors such as genetics, teratogenic drugs and chemicals can cause congenital deformities.

Corns

A corn is a circular area of thickened skin developed because of continuous friction or pressure. They usually develop on the soles of feet, or on the top or sides of toes, and appear as yellowish dead tissue surrounding an area of tenderness. Pain and discomfort may be present with walking, which can get more painful without treatment.

Cavus Foot

A cavus foot or a high-arched foot refers to a condition that can vary from a slightly high arch to a severe deformity. Cavus foot can lead to symptoms such as pain and instability. The condition may be inherited or associated with neurological disorders or other conditions.

Diabetic Foot

Diabetes is a chronic condition that is characterised by high blood glucose (sugar) levels. Diabetic patients are at a high risk for developing chronic wounds, especially in the feet. If left untreated, these wounds can cause serious problems that can lead to infections and eventually gangrene, which may require amputation.

Flatfoot

Flatfoot, also known as “fallen arches” or Pes planus, is a deformity in children’s feet in which the arch that runs lengthwise along the sole of the foot has collapsed to the ground or not formed at all. Flatfoot is normal in the first few years of life as the arch of the foot usually develops between the age of 3 and 5 years. Flatfoot can be rigid or flexible.

Foot and Ankle Osteoarthritis

Arthritis is inflammation resulting from the degeneration of cartilage in the joint causing pain, swelling, and stiffness in the joints resulting in restricted movements. Arthritis of the foot and ankle joint can occur due to fracture, dislocation, inflammatory disease, or congenital deformity.

Foot and Ankle Trauma

Foot and ankle trauma refers to the injuries that most commonly occur during sports, exercise or any other physical activity. Trauma may be a result of accidents, poor training practices or use of improper gear. Injuries may also be caused when an individual is not medically fit or because of insufficient warm up and stretching exercises.

Foot Dislocation

A dislocation refers to an injury in which bones of a joint get separated. It may occasionally occur in one of the foot joints due to a fall or motor vehicle accident.

Foot Drop

Foot drop also known as drop foot, is a sign of an underlying muscular, neurological or anatomical condition, where you are unable to lift the front part of your foot, resulting in foot dragging. To avoid dragging your foot, you may lift your knee higher than usual as if you were climbing stairs or swing your leg in a wide arc, causing you to slap your foot on the ground every time you step forward. Foot drop may also produce numbness.

Foot Fracture

The hind foot is separated from the midfoot by the medio tarsal joint and the midfoot is separated from the forefoot by the lisfranc joint. Muscles, tendons and ligaments support the bones and joints of the feet enabling them to withstand the entire body’s weight while walking, running and jumping. Despite this, trauma and stress can cause fractures in the foot. Extreme force is required to fracture the bones in the hind foot. The most common type of foot fracture is a stress fracture, which occurs when repeated activities produce small cracks in the bones.

Foot Infections

Foot infections may occur after trauma to the foot or loss of tissue because of contamination from foreign material and/or bacteria or fungus. Infections can occur in healthy individuals as well as in those whose health is compromised.

Foot Pain

Foot pain occurs from distress induced by certain factors in the foot. Foot pain is a common problem experienced by young athletes involved in different activities such as running and jumping.

Forefoot Pain

Forefoot pain, also referred to as metatarsalgia, is a type of pain that occurs in the ball of the foot (around the tip of the metatarsal bones). Generally, forefoot pain is associated with aging. Individuals with metatarsalgia experience pain of varied intensity and discomfort and find difficulty in activities like walking, running, playing, and several others.

Fungal Nails

Fungal infections are common in nails, and occur most often in toe nails. Termed as onychomycosis, nail fungus affects the keratin, the hard material that makes up the nail and can include the entire nail or a portion of the nail, along with the nail root, plate or bed. It gradually leads to thickening, distortion and discolouration of the nails.

Hammertoe

A hammertoe is a deformity of a lesser toe (second through fifth toes), where the toe gets bent upward at the toe’s middle joint, resembling a hammer. The bent portion may rub against a shoe causing pain, irritation and development of corns. It is caused by wearing shoes that are too tight or narrow near the toes, when the second toe is larger than the first, and as a complication of arthritis and certain neuromuscular conditions.

Hallux Rigidus (Big Toe)

Hallux rigidus is an arthritic condition characterised by stiffness and rigidity of the big toe. Arthritis of the foot commonly occurs at the big toe base. The condition can be quite painful as the big toe has to bend with every step you take.

Heel Fractures

The calcaneus or heel bone is a large bone found at the rear of the foot. A fracture is a break in a bone from trauma or various disease conditions. The types of fracture to the calcaneus depend on the severity and include stable fractures, displaced fractures, open fractures, closed fractures and comminuted fractures.

Heel Pain

The heel is made up of the calcaneus bone and supported by a network of muscles, tendons, ligaments and soft tissues, which together support the weight of the body and stress during movement. Heel pain is a common symptom of excessive strain placed on these structures.

Ingrown toenail

An ingrown toenail is a common and painful condition of the toe. It occurs when the sides or corner of the nail grow inwards and penetrates the skin of the toe. Pain is often accompanied by swelling and redness. The big toe is affected most often.

Intoeing

In toeing also called “pigeon-toed”, is an abnormal condition characterised by inward facing of the toe or feet instead of being straight. Parents may observe their children having intoeing at an early age when they start walking. But usually intoeing corrects itself without any specific treatment as the child grows up to around 8 years of age.

Limb Deformities

Limb deformities can be congenital (present at birth) or develop at a later stage because of fracture, infection, arthritis or tumour. Congenital deformities of the lower limbs are developmental disorders that cause alterations in the shape and appearance of the legs. Several factors including genetics influence the foetal growth in the womb, and exposure to teratogenic drugs and chemicals can increase the risk of congenital deformities.

Lisfranc (Midfoot) Fracture

The Lisfranc joint or tarsometatarsal joint refers to the region in the middle of the foot. It is a junction between the tarsal bones (seven bones in the foot arch) and metatarsal bones (five long bones in the foot). Lisfranc fracture scan occur due to a fall from a height or traumatic motor accidents.

Mallet Toe

Mallet finger is a condition where the end of the finger is bent and does not straighten. It occurs when the extensor tendon on the back of the finger is damaged. The finger joint is a hinge-joint that allows bending and straightening of the fingers. Each finger is composed of 3 phalanges bones, joined by 2 interphalangeal joints (IP joints). The joint near the base of the finger is called the proximal IP joint or PIP joint, and the joint near the tip of the finger is called the distal IP joint or DIP joint.

Morton's Neuroma

Morton’s neuroma refers to a nerve injury between the toes, usually the third and fourth toes, which causes pain and thickening of the nerve tissue. Compression or chronic irritation of this interdigital nerve is the main cause of Morton’s Neuroma. Excess pressure is exerted on the nerves due to narrowing of the gap between the toe bones causing thickening of the nerve tissue from scar tissue formation. This causes swelling of the nerve and the surrounding tissue.

Nail Bed Injuries

The nail is composed of a nail plate, nail matrix and nail bed. The nail bed is the soft tissue that lies below the nail and is essential for the growth of the nail. Nail bed injuries such as crush and avulsion injuries are commonly associated with injuries to the hands or fingertips.

Osteochondral Injuries of the Ankle

The ankle joint is an articulation of the end of the tibia and fibula (shin bones) with the talus (heel bone). Osteochondral injuries, also called osteochondritis dissecans, are injuries to the talus bone, characterised by damage to the bone as well as the cartilage covering it. Sometimes the lower end of the tibia or shin bone may also be affected.

Plantar Fasciitis

Plantar fasciitis refers to inflammation of the plantar fascia, a thick band of tissue that lies at the bottom of the foot. It runs from the heel bone to the toe and forms the arch of your foot. Plantar fasciitis is one of the most common causes of heel pain. It is most often seen in middle-aged men and women but may also occur in those who are constantly on their feet such as soldiers.

Shin Splints

Shin splints or medial tibial stress syndrome (MTSS) is pain around the tibia or shin bone due to inflammation of the tendons, muscles and bone tissue. It occurs because of vigorous physical activity such as with exercise or sports.

Stress Fracture of the Foot

A stress fracture is a small crack in the bone which occurs from overuse injury. It commonly develops in the weight-bearing bones of the lower leg and foot. When the muscles of the foot are overworked, or stressed, they are unable to absorb the stress and transfer it onto the bone, which cracks under the pressure.

Sesamoid Fractures and Sesamoiditis

Sesamoiditis is an inflammation of the sesamoid bone and the associated tendons. It is commonly seen in ballet dancers, sprinters and basketball players. It is an overuse injury caused by an increased pressure over the sesamoid bones resulting in a chronic inflammation.

Talus Fractures

The talus is a small bone at the ankle joint that connects the heel bone and the shin bones, enabling the up and down movement of the foot. Fractures in the talus bone may occur due to a fall from great heights, motor vehicle accidents or sports injuries. Symptoms include severe ankle pain, inability to walk, swelling and tenderness.

Toe & Forefoot Fractures

The forefoot is the front of the foot that includes the toes. Fractures occurring in this part of the foot are painful, but very often not disabling. There are 2 types of fractures namely, traumatic fracture and stress fracture. Traumatic fractures occur when there is a direct impact of your foot on a hard surface.

Turf Toe

Turf toe is an injury to the ligament at the base of the big toe. It is a painful condition which usually results from jamming of the toe into the ground or excessive backward bending of the toe. As it is more common in athletes playing on artificial turf, especially those involved in field sports such as football, baseball and soccer, it is known as turf toe.

Procedures

Non-Surgical Treatments

Ankle-Brachial Index

The Ankle-Brachial Index (ABI) is a noninvasive diagnostic test performed to determine your risk of peripheral artery disease (PAD), a condition of narrowing or blocking of the arteries in your legs or arms. This condition increases the risk of stroke, leads to poor blood circulation, and may cause heart attack and leg pain.

Custom Foot Orthotic Fitting

Custom foot orthotics are specially designed corrective devices to restore the natural position of the feet. The orthotics acts as an interface between the feet, the shoe and the ground. The purpose of the device is to support the bones and joints of the feet to maintain optimal neutral position and to eliminate or compensate any misalignments or structural problems of the feet.

Chronic Wound Care

An injury or small wound over the skin will normally heal within a week or two. However, sometimes due to an underlying medical condition, a small wound on the leg may take months to heal and may even increase in size. Such a wound on the leg that takes more than six weeks to heal is called a chronic leg wound. Chronic leg wounds can become infected and threaten the functionality of the patient’s limb and even life.

Foot Activity and Exercise Guide

A foot injury or foot surgery may leave you immobile for a period. To return to your regular activities and more strenuous recreational activities, it is necessary for you to follow a well-planned activity and exercise program.

Foot Care

Feet support your body weight, help maintain proper posture and help in movement. As the feet bear the entire weight of the body and are involved in most activities, they are more prone to problems such as calluses, corns, cracks, infections and traumatic injuries. To maintain good health of your feet, you should always wear comfortable, good quality and proper fitting footwear.

Platelet Rich Plasma Therapy

Our blood consists of a liquid component known as plasma. It also consists of three main solid components which include the red blood cells (RBCs), white blood cells (WBCs), and platelets. Platelets play an important role in forming blood clots. They also consist of special proteins, known as growth factors, which help with our body’s healing process.

Nail Care

Nails are made of hard keratin tissue that helps protect the underlying tissue of your fingers and toes. They can reveal a lot about your overall health. Healthy nails are uniform in colour and consistency, and smooth, without grooves or pits. Changes in colour and growth rate can indicate various diseases.

Surgical Treatments

Achilles Tendon Repair for an Acute Rupture

This procedure is generally performed as a day case operation. You will be coming to the day case reception lounge on the day of operation.

Ankle Arthrodesis

Ankle arthrodesis is the surgical fusion of bones that form the ankle joint. The ankle joint is formed by the tibia, talus, and the fibula bones.

Ankle Arthroscopy

Ankle arthroscopy is a minimally invasive surgical procedure in which an arthroscope, a small, soft, flexible tube with a light and video camera at the end, is inserted into the ankle joint to evaluate and treat a variety of conditions.

Ankle Fusion Surgery

This procedure is generally performed as a day case operation. Usually it is an arthroscopic procedure unless it is a revision or complex case where we do open fusion. You will be coming to the day case reception lounge on the day of operation. You will be checked into preoperative lounge and will be met by the surgeon and the Anaesthetist who will go through all the benefits and risks of the surgery again.

Ankle Joint Replacement

The ankle joint connects the leg with the foot and provides free movement to the foot. It is formed by connecting the bones of the lower leg, tibia and fibula, with the talus, or ankle bone.

Ankle Ligament Reconstruction Surgery

This procedure is generally performed as a day case operation. You will be coming to the day case reception lounge on the day of operation. You will be checked into preoperative lounge and will be met by the surgeon and the anaesthetist who will go through all the benefits and risks of the surgery again

Ankle or Subtalar Joint Arthroscopy: A Guide

This leaflet aims to answer your questions about having an ankle arthroscopy under the care of Mr Rajiv Limaye. It explains the benefits, risks and alternatives, as well as what you can expect when you come to hospital.

Ankle Tenotomy

Ankle tenotomy is a surgical procedure to lengthen the Achilles tendon enabling the ankle to flex upward and allowing the heel to be placed flat on the floor. It is indicated in patients that have an abnormally developed Achilles tendon or one that has become shortened and difficult to stretch. The surgery is done to restore the normal range of motion of the ankle.

Ankle Instability Surgery

Ankle instability surgery is performed to treat an unstable ankle and involves the repair or replacement of a torn or stretched ligament.

Ankle Ligament Reconstruction

A sprain is stretching or tearing of a ligament. Ligaments connect adjacent bones in a joint and provide stability to the joint.

Big Toe Joint Replacement

Introduction

Metatarsophalangeal joint (MTPJ) is a junction between the metatarsal bones (long bone in the foot) and proximal bones (bone in toes). 1st MTPJ refers to the joint in the big toe of the foot. Cheilectomy is a surgery to remove excessive bone from the 1st MTPJ. The operation is performed through a very small incision which is why it is referred to as minimally invasive. This surgery is intended to treat pain and stiffness and to increase the motion in the joint of the big toe.

Broström Lateral Ligament Reconstruction

This leaflet aims to answer your questions about having a broström lateral ligament reconstruction of ankle under the care of Mr Rajiv Limaye. It explains the benefits, risks and alternatives, as well as what you can expect when you come to hospital.

Bunion Surgery

This procedure is generally performed as a day case operation. You will be coming to the day case reception lounge on the day of operation. You will be checked into preoperative lounge and will be met by the surgeon and the anaesthetist who will go through all the benefits and risks of the surgery again. Surgery is performed under general anesthetic, usually as a day case. The procedure takes approximately 30-60 minutes. The aim of surgery is to improve pain and function as well as the appearance of the toe.

Cavovarus Foot Correction

To support the entire body’s weight on your two feet, the inner middle portion of each foot (midfoot) is raised off the ground to form an arch. A cavovarus foot deformity is characterised by a higher-than-normal arch of the inner midfoot. This results as the two ends of the foot - the heel and toes - abnormally draw towards the inside of the foot, causing the foot to rest on its outer side.

Cheilectomy

This leaflet aims to answer your questions about having surgery for a Cheilectomy procedure under the care of Mr Rajiv Limaye. It explains the benefits, risks and alternatives, as well as what you can expect when you come to hospital.

Corticosteroid Injections

The aim of this information sheet is to help answer some of the questions you may have about having a corticosteroid injection. It explains the benefits, risks and alternatives of the procedure as well as what you can expect when you come to hospital.

Excision of Morton’s Neuroma

This procedure is generally performed as a day case operation. You will be coming to the day case reception lounge on the day of operation. You will be checked into preoperative lounge and will be met by the surgeon and the anaesthetist who will go through all the benefits and risks of the surgery again.

FDL Tendon Transfer

Coming Soon

Flatfoot Reconstruction

Foot reconstruction is a surgery performed to correct the structures of the foot and restore the natural functionality of the foot that has been lost due to injury or illness.

Foot Reconstruction

Foot reconstruction is a surgery performed to correct the structures of the foot and restore the natural functionality of the foot that has been lost due to injury or illness. Ideally, any foot surgery for reconstruction is done to improve the appearance and function of the foot so that patients can maintain their quality of life.

Forefoot Deformity Correction

Most forefoot deformity surgery is to treat bunions (hallux valgus) and/or lesser/smaller toe deformities.

Great Toe Cheilectomy

Surgery is performed as a day case under general anesthetic. The procedure takes 30 minutes

Great Toe Fusion

This procedure is generally performed as a day case operation. You will be coming to the day case reception lounge on the day of operation. You will be checked into preoperative lounge and will be met by the surgeon and the anaesthetist who will go through all the benefits and risks of the surgery again.

Hindfoot ‘Triple’ Fusion Surgery

Surgery is performed under general anesthetic as an inpatient. The stay is usually 2-3nights. The procedure takes 2 hours. The aim of surgery is to improve the position of the joints at the back of the foot and stop them moving so removing the pain.

Minimal Invasive Bunion Surgery

A bunion, also known as hallux valgus, is bony prominence at the base of the big toe, which often results in pain, redness and rubbing in footwear. The 1st metatarsal bone abnormally angles outward towards the other foot from its joint in the midfoot. A bunion can change the shape of your foot, make it difficult for you to find shoes that fit correctly and worsen the symptoms if left untreated.

Midfoot Fusion

Introduction

Tarsometatarsal joints are the small joints in the middle foot. Osteoarthritis, rheumatoid arthritis or some unknown conditions may damage the tarsometatarsal joints. The joints may wear out, collapse, cause severe foot deformity and affect the function of the foot. Tarsometatarsal joint fusion is a surgical procedure that fuses the bones of the middle foot and stiffens it to correct deformities in the tarsometatarsal region.

Minimally Invasive Foot Surgery

Minimally Invasive Foot Surgery (MIFS) uses the latest advanced technology to treat foot and ankle pain caused by a variety of conditions. Special surgical instruments, devices and advanced imaging techniques are used to visualise and perform the surgery through small incisions. The aim of MIFS is to minimise damage to the muscles and surrounding structures enabling faster recovery and less pain.

Peroneal Tendon Surgery

This procedure is generally performed as a day case operation. You will be coming to the day case reception lounge on the day of operation. You will be checked into preoperative lounge and will be met by the surgeon and the anaesthetist who will go through all the benefits and risks of the surgery again. Surgery is performed under general anesthetic, usually as a day case.

Small Toe Surgery

There are several operations that are performed to correct small toe deformities. The choice of operation will depend on several factors but will the one most suitable to treat your particular problem. This procedure is generally performed as a day case operation.

Surgery for Achilles Tendon Pain

Surgery is performed under general anesthetic and it is usually necessary to stay for one night after the operation. The procedure takes 60-120 minutes depending on the severity of the condition and the need to transfer tendons.

Surgery on the Rheumatoid Forefoot

Surgery is performed under general anesthetic. The stay is usually 1 to 2 nights. The procedure takes about 90-120 minutes. The aim of surgery is to realign the toes, remove the pain and so allow improved function. It is not possible to make the foot look completely normal again.

Tibialis Posterior Tendon Decompression

Surgery is performed under general anesthetic. The stay is usually 1-2 nights. The procedure takes 1hour. The aim of surgery is to remove the inflamed tissue and repair any damage to the tendon.

Tibialis Posterior Tendon Reconstruction Surgery

Surgery is performed under general anesthetic. The stay is usually 2 nights. The procedure takes 2 hours. The aim of surgery is to realign the heel and midfoot and to replace the function of the tibialis posterior tendon that is not working.This involves a tendon transfer and bony realignment procedure.

Others

Footwear Guide

Comfort and durability are important when selecting footwear. A shoe must conform to the shape of your foot and not vice versa. If your activities include walking long distances or standing for a long time, you must purchase shoes appropriate to those activities. Ill-fitting shoes that lack support can stress the feet, ankles, hip and spine, and lead to pain and deformities that prevent you from participating in your regular activities.

ROTO Glide

Coming soon

Swanson’s Toe Joint Replacement

Coming soon

Subtalar Arthrodesis

Subtalar arthrodesis is the surgical fusion of bones that form the subtalar joint. The subtalar joint is a complex joint located below the ankle joint and is formed by the union of the heel (calcaneus) and the talus (ankle) bone. The subtalar joint allows side-side movement of the foot.

Treatment of Foot & Ankle Sports Injuries

Injuries during sports are common. They can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises. Injuries to the foot and ankle are common while playing sports such as football, hockey, skating and in weekend athletes. Common sports injuries include sprains and strains, ankle fractures, and Achilles tendinitis.