CQ ORTHOPAEDICS
Dr James Roche
Orthopaedic Surgeon
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FOOT AND ANKLE SURGERY
FOOT SURGERY
Dr Roche performs the following operations on the foot.
BUNION SURGERY
Bunions have a variety of causes such as a family history, ligamentous laxity, footwear and inflammatory arthritis. It is a progressive condition that becomes worse and can reoccur. It is most common in women but can occur in men or girls.
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Treatment for mild disease includes padding and accommodative footwear. As the condition becomes more advanced surgery can be indicated. The exact nature of surgery depends on many things including - severity of the deformity, congruence of the joint, presence of osteoarthritis or ligamentous laxity.
The best surgery for you will be determined after careful clinical assessment and discussed with you in detail at your consultation and will usually be a Chevron osteotomy for milder cases and a Scarf osteotomy for more severe disease.
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Following surgery you may need a small plaster cast and you will need to wear a special shoe that takes the weight off the toe. It takes approximately 6 weeks before a normal shoe can be worn.
HALLUX RIGIDIS
This condition is due to osteoarthritis at the base of the big toe. Over time it becomes painful and stiff. If it becomes severe and fails to respond to non-operative treatment then surgery is indicated in the form of a joint fusion.
The bone ends are shaped and the articular cartilage is removed, these two bones are then joined with either screws or a plate.
LESSER TOE DEFORMITIES
Some people suffer with a variety of lesser toe abnormalities such as a mallet, hammer or claw toe. These can cause pain by rubbing of footwear. These can be corrected by soft tissue procedures or by fusing joints in a straightened position.
PLANTAR FASCIA RELEASE
Most cases of plantar fascitis respond to non-operative treatment that includes physiotherapy, splints and injections.
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Occasionally surgery is required to excise the diseased tissue and remove any spurs that may be present causing problems.
CORRECTION OF FLAT FOOT DEFORMITY
Some people who have flat feet put excessive load on the posterior tibial tendon on the inside of the foot. This can be an extremely painful condition.
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Treatment involves debridement of this tendon (an occasionally a tendon transfer) cutting the heel bone and moving it medially to take the pressure off the tendon. The bone is fixed with special screws that sit entirely within the bone and often allow weight bearing as soon as the wound is healed.
ANKLE SURGERY
Dr Roche performs the following procedures on the ankle:
ACHILLES TENDON SURGERY
Achilles tendinopathy can require surgical treatment. It often occurs in conjunction with heel spurs.
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The procedure involves debridement of the tendon which may involve detachment from the calcaneus. Any inflamed bursa is then removed along with any heel spurs. The tendon is then reattached to the new bone surface with bone anchors. Immobilisation is required for 6 weeks following surgery.
ANKLE ARTHROSCOPY
Ankle arthroscopy can be used as either a diagnostic procedure to look inside the joint or to treat specific problems such as loose bodies or anterior ankle impingement.
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Surgery is performed in a similar way to knee arthroscopy with 2 small incisions to allow passage of a camera and instrument. You can usually go home the same day.
ANKLE FUSION
Arthritic ankles become painful and stiff. Ankle replacements are not as advanced as hip and knee replacements and do not last as long therefore the main operation for this condition in most people is an ankle fusion. This exchanges a painful and stiff ankle for one that is painless and completely stiff.
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The articular cartilage is removed and the bones are joined together with a plate, screws or occasionally both. It takes approximately 3 months for an ankle to fuse but weight bearing can begin sooner than this.
ANKLE INSTABILITY
Most ankle injuries settle down without surgery but when recurrent instability occurs then surgery may be indicated.
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This is often combined with an arthroscopy to asses the ankle and involves repairing the ligament, reinforcing it with additional tissue or reconstructing it with an artificial ligament.