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Category: Patient information resources

Patient information resources. Useful links to external websites, organisations and publications.

For example, for patients researching or considering total ankle replacement as a treatment option for ankle arthritis, there are:

    • links to the British Orthopaedic Foot & Ankle Society (BOFAS) website and the American Orthopaedic Foot & Ankle Society (AOFAS) website
    • patient testimonials
    • links to the Corin Zenith manufacturers website, which has a useful patient information section

For example, for patients researching or considering surgery as a treatment option for hallux valgus (bunions), there are:

    • links to the British Orthopaedic Foot & Ankle Society (BOFAS) website and the American Orthopaedic Foot & Ankle Society (AOFAS) website
    • patient testimonials
Morton's neuroma

Investigation and treatment of Morton’s neuroma

The normal foot contains many nerves. The sole of the foot in particular is a very sensitive area due to its dense innervation. The medial and lateral plantar nerves (shown in the diagram below) supply these areas and protect our feet from painful trauma. A Morton’s neuroma occurs when one of the branches to the toes becomes painful and thickened.

 

Morton's neuroma - normal plantar nerve anatomy
Medial and lateral plantar nerves to the sole of the foot (shown in yellow). Morton’s neuroma most commonly affects the nerve supplying the 3rd / 4th toes.

The most common site for this problem is in the lateral branch of the medial plantar nerve that supplies the 3rd and 4th toes. The nerve becomes compressed in the space between the heads of the metatarsal bones and the soft tissue above / below.

Morton's neuroma - sketch of anatomy
Sketch showing thickened Morton’s neuroma between the heads of the metatarsal bones

 

 

 

 

 

 

 

 

 

 

 

 

 

Often the history (description) and examination will allow a foot and ankle specialist to make a diagnosis without the need for further imaging such as ultrasound or MRI scans. A weightbearing xray is essential however to exclude other causes of foot pain. If there is any doubt, then an ultrasound scan (or occasionally an MRI if appropriate) can be helpful. The title image shows an ultrasound picture of a typical neuroma.

There are many other reasons for forefoot pain that can form a differential diagnosis and must be excluded if a neuroma is to be confidently diagnosed. The differential diagnosis for Morton’s neuroma includes:

  • intermetarsal bursitis

  • plantar plate rupture​

  • metatarsophalangeal joint capsulitis

  • metatarsal stress fractures

  • metatarsalgia

  • lumbar radiculopathy

  • tarsal tunnel syndrome

  • Frieberg’s infraction

  • infection

  • tumors (such as synovial sarcoma)

  • painful callosities

  • rheumatoid nodule

  • peripheral neuropathy

Conservative treatment and the help of a good podiatrist can make a big difference to many people with  a painful neuroma.

If this fails to settle the problem, then treatment with an injection can be very helpful. An injection is quick and simple to administer and can be done at the same time as an outpatient appointment.

We have found in Harrogate that about 60% of people who receive an injection in the outpatient clinic for a Morton’s neuroma do not need any additional treatment. We presented these results recently to the SICOT meeting in Rome. See the following links for more information.

SICOT, Rome, 2016: Conservative treatment of intermetatarsal neuroma

American Orthopaedic Foot & Ankle Society: AOFAS Morton’s neuroma information

Surgery is the final option for treatment and in the right circumstances can be a very effective choice, as the following testimonial illustrates:

Outpatient consultation and can be arranged by calling 0113 388 2189 and is available at the following locations:

ankle replacement patient information resources

Ankle replacement patient information resources

For patients with painful ankle arthritis, making the correct choice between treatment options can be difficult.   It is often an intensely personal & individual decision.   Ankle replacement patient information resources may be very helpful.   They should supplement thorough discussions with your clinician.

 

 

Good quality, balanced information about the different surgical treatments is essential.

Adequate time to consider your options and the ability to have all your questions answered before arriving at a decision is essential.

 

The following links may be useful:

Harrogate foot & ankle specialists use the Corin Zenith total ankle replacement. The link below is to the patient information section on the manufacturers website:

Corin Zenith Patient Information

 

The British Orthopaedic Foot & Ankle Society website contains a link to an excellent document prepared on the subject of ankle arthritis by the Royal National Orthopaedic Hospital:

RNOH Total Ankle Replacement Information

 

The American Orthopaedic Foot & Ankle Society website contains links to patient information documents relating to both ankle arthritis and total ankle arthroplasty:

AOFAS Ankle Arthritis Information

AOFAS Total Ankle Replacement Information

 

You can read some patient experiences here:

Arthroscopic Ankle Fusion Testimonial

AP xray 6 weeks after arthroscopic ankle fusion
LAT xray 6 weeks after arthroscopic ankle fusion
bunion (hallux valgus) surgery

Bunion surgery in Leeds & Harrogate

Hallux valgus (bunions) can be extremely painful. A thorough assessment &  discussion of your options, including corrective treatment with bunion surgery in Leeds & Harrogate is available with Mark Farndon privately at the following locations:

Nuffield Health Hospital Leeds (0113 388 2189)

2 Leighton Street, Leeds, LS1 3EB

www.nuffieldhealth.com/consultants/mr-mark-a-farndon

https://www.nuffieldhealth.com/hospitals/leeds

BMI The Duchy Hospital, Harrogate (01423 554411)

Queens Road, Harrogate, HG2 0HF

www.bmihealthcare.co.uk/consultants/Mark-Andrew-Farndon

The Harlow Suite, Harrogate (01423 555430)

Lancaster Park Road, Harrogate, HG2 7SX

NHS treatment is available at Harrogate District Hospital via a referral from your GP.

Weight bearing xrays showing hallux valgus, with increased intermetatarsal angles and uncovering of the sesamoids.

The diagram below shows the normal soft tissue balance around the big toe joint and the imbalanced bone and soft tissues that exist when a bunion is present. A combination of bony and soft tissue surgery is used to achieve correction.

Post-operative xrays showing bilateral (simultaneous) bunion correction using scarf osteotomies to cut and reset the metatarsals. The intermetatarsal angles are corrected to normal range, the sesamoids are reduced beneath the metatarsal heads and the hallux valgus is corrected.

bunion surgery in leeds & harrogate

This surgery is usually undertaken as a day case procedure, under a brief general anaesthetic, with a long acting ankle nerve block to keep the foot comfortable.

After bunion surgery in Leeds & Harrogate undertaken by Mark Farndon, patients are allowed to weight bear in a protective Podalux shoe immediately after surgery, though are advised to elevate the foot / feet as much as possible for the first two weeks to allow wound healing and to let any swelling settle.