Hallux valgus/bunions

Hallux valgus or 'bunion' deformities are common conditions affecting the big toe joint of the foot and are predominantly familial in nature. Cosmetic aspects aside, they make wearing shoes difficult and usually cause pain from arthritic joint changes or from rubbing on shoes.

The definitive treatment to correct a bunion deformity is surgery. Modern surgical procedures cause minimal postoperative discomfort and usually provide long-term correction of the deformity. Although bunions are best treated in the earlier stages of their development, effective treatment for advanced cases is still possible. It may be possible to have both feet corrected at the same time and patients are normally able to ambulate in relative comfort in protective post-operative shoes immediately following surgery.

Hallux limitus/rigidus

Hallux limitus or rigidus is the result of arthritic degeneration of the big toe joint that has reduced movement and is usually quite painful. It can develop due to a systemic arthritic condition, a long-standing bunion deformity, or more often from direct trauma to the joint that may have occurred many years before the onset of pain and stiffness.

The condition is usually progressive in nature and is often best treated earlier rather than later. There are some very reliable surgical procedures available that can be performed for hallux limitus with good symptomatic effect.

Flat feet 

Flat-looking feet is quite normal in infants and toddlers but by the time a child reaches school age their feet should look and function like small versions of adult's feet.

Flat or ‘pronated’ feet that persist beyond 6-7 years of age is not normal and is the cause of a great many adult foot and leg complaints that podiatrist's routinely see. 

If you are concerned about your child's feet a podiatric examination is recommended. Postural foot problems can often be significantly improved with the right prescription foot orthoses.

Sometimes surgery is required to correct a flat-foot deformity in adolescents and adults that has been resistant to conservative treatment. A minimally invasive surgical technique is now available for appropriate patients that involves inserting a small titanium implant into the sinus tarsi of the foot to realign the hind-foot into a more stable position. This relatively new technique often allows patients to cease wearing foot orthoses altogether!
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Fungal Infected Nails

Toenails infected with fungi appear thickened, distorted, discoloured and are often a source of unnecessary embarrassment.
There are numerous ways to treat fungal infections of the nail, including the use of topical  or oral anti-fungal medications, or if necessary, by surgical removal of the affected nail.

Hammer Toes

Hammer toes are usually the result of tendon imbalances and often develop painful corns as a result of rubbing on shoes and are often associated with bunion deformities. 
These may be treated conservatively by paring down the thickened skin over the bony prominences for temporary relief, or surgically by straightening the involved toes. Early deformities may often be corrected with a simple soft tissue procedure that can be performed in the office. Long-standing deformities usually require corrective bone surgery that needs to be carried out in hospital as a day-case procedure.

​Heel Pain

The most common causes of heel pain include plantar fasciitis or heel spurs, achilles tendonitis in adults, and osteochondritis (Sever’s disease) of the heel in children. Each condition needs to be accurately diagnosed and treated appropriately.
Treatment is usually very successful and may include strapping, stretching exercises, oral  anti-inflammatory drugs, injection of a corticosteroid and/or the use of prescription foot orthoses. On occasions, surgery may be indicated when the heel pain fails to respond to conservative care. 

Ingrown Toenail

The initial podiatric treatment often includes the simple removal of the ingrowing section of nail under local anaesthetic. Sometimes a short course of antibiotics is required and permanent correction of the condition can be painlessly performed as an office-based procedure once the infection has settled. 
Dr Bryant was invited to write an article for the Australian Family Physician on the management of ingrown toenail. See: ​https://www.racgp.org.au/afp/2015/march/ingrown-toenails-the-role-of-the-gp/ 

Morton's Neuromas

Neuromas are painful thickenings of tissue in and around sensory nerves, usually present between the second and third or the third and fourth toes of the foot.
Patients often report early symptoms of numbness and as the condition progresses,  a sharp, burning pain develops between the toes. The conservative treatment of neuromas usually includes injections of corticosteroids or the use of specially designed foot orthoses. However, surgical removal of the thickened nerve section is sometimes necessary and is usually very successful..

Warts

Warts or verrucas are the result of a viral infection in the superficial layers of the skin and are thought to be transmitted through direct contact or from using communal change rooms  or showers. Plantar warts may spread and grow to press on nerve endings in the skin and become quite painful. Verrucae are best treated by the use of specially compounded ‘wart-paints’  or by surgically removing the lesions as an office-based procedure.