Bunion treatment

Women are particularly likely to get them: bunions, also known as hallux valgus or crooked toe. A bunion is a misalignment of the big toe in which it bends further and further outwards, crowding the little toes. Over the long term, this painful condition can cause arthritis of the big toe (hallux rigidus). People with this condition will notice that the big toe joint becomes swollen. Not only will the big toe itself be painful, but by crowding the little toes, it leads to corns, calluses and irritated skin throughout the toe area. Shoes exert pressure on the resulting ganglion cyst, creating calluses. The pressure may also result in bursitis. Other possible consequences include pain in the midfoot and forefoot areas, and the deformation of little toes into hammer toes or claw toes. How do we deal with this? As a first step, conservative treatments and measures can help to alleviate the pain: wide shoes, orthotics (shoe inlays) and foot exercises can stop the misalignment from becoming worse. If this does not help, an operation is usually called for to prevent the big toe from becoming stiff and causing other problems as a result. The surgery should not only eliminate the pain, but also achieve the best results aesthetically, so that our patients can enjoy a healthy sense of well-being. The goal is to lastingly straighten the big toe and retain the health of the joint before it is destroyed by arthritis. We correct the muscles and tendons so that they will no longer be subjected to the immense pressure caused by the misalignment. There are various procedures available for doing this, depending on how far the illness has progressed. We talk with our patients to determine which method best suits their needs, whether a minimally invasive procedure or a more extensive operation might be required, and the location on the foot where we should operate. Patients can walk immediately after the operation thanks to special postoperative shoes. The full healing process takes between six and eight weeks.

Treating arthritis of the big toe using arthrodesis (immobilisation of the joint)

If arthritis has already spread widely in the big toe joint, the toe will slowly become rigid. We refer to this painful ossification of the joint as hallux rigidus. When this reaches an advanced stage, the problem makes it impossible for patients to properly roll their toe. We begin treatment with the use of orthotics (shoe inlays) and infiltrations (injections). If these conservative treatments do not have the desired result, we recommend that an operation be performed. If the stiffness is already at an advanced stage, we have to resort to arthrodesis, a procedure that stiffens the joint. This involves removing the areas of bone and cartilage that have already been destroyed and then using screws and plates to fuse neighbouring bones in place, so that they can grow together. The goal of this procedure is to provide the patient with a pain-free life, so that they can regain their desired quality of life, practice their profession, do sports, and wear normal shoes. Depending on the scale of the intervention required, the healing phase can take between two and eight weeks. During this time, patients must wear supportive post-operative shoes and may require walking aids. Sometimes supportive orthotics may be required after this time.

Bunionette treatment

Sometimes changes occur near the small toe that are similar to what can happen to the big toe – in each case, the result can be painful pressure on the outside of the foot. Unfortunately, the range of treatments available when symptoms occur here are rather limited. Inlays that ‘raise’ the transverse arch generally result in further decreasing the space available in the shoe. That is why we begin with conventional measures that reduce inflammation and relieve pressure, coupled with the use of wide shoes with soft uppers. If these measures do not result in improvement or are unacceptable over the long term, an operation may bring relief. As when treating the big toe bunion, an operative correction of the fifth metatarsal bone is undertaken. This minimally invasive procedure is performed in our podiatry centre and follow-up treatment is provided functionally through the use of special shoes over a period of four to six weeks.

Hammer toe treatment

A hammer toe is a misalignment of the toes with an abnormal bend in the middle joint of the toe and a changing position in the base and end joint. The pressure from the bone beneath the skin results in painful corns, calluses and temporary bursitis (inflammation of the bursa) above the affected joints. Hammer toes are often found in combination with bunions. The operative procedure involves correcting the positioning by fusing the middle joint of the toe in question to immobilise it. The new position is kept stable by a wire for six weeks, after which time it is removed in a pain-free procedure. Depending on the type of misalignment (claw toe), it may also be necessary to correct the end joint and base joint as well. After the procedure has been performed, patients can once again walk normally. With flexible deformities, we employ a special, minimally invasive technique that allows for follow-up treatment that is both pain-free and significantly faster.

Flat foot treatment

A flatfoot is an abnormal deformation of the foot bones with a fallen arch, whereby the entire bottom of the foot touches the ground even when there is no stress placed on it. This makes every step painful, because the foot is no longer able to absorb the impact. Fallen arches / flat feet may be caused by weakened tendons or obesity. Other reasons can include injuries, rheumatoid arthritis, and neuromuscular disorders. Pain usually develops within the instep at the level where shoelaces would be tied and/or within the ankle where the main tendon supporting the foot is located. This disorder may result in pain appearing in the ankle region, calf muscles, hips, or lower back on account of the improper alignment of the feet, legs and hips. The objective is to restore the normal position and function of the foot. There are numerous ways to treat this condition, depending on the specifics of each case. If the joints are healthy, corrective osteotomies and tendon transfers can be conducted in order to correct the deformity and improve the function of the foot. When the joints are damaged, a corrective arthrodesis (immobilisation of the joint) is performed in order to retain the foot's function and alleviate pain.

High arch treatment

With a high arch, the most troublesome cases are those in which the longitudinal arch is raised primarily or solely on the inside. This results in the foot being pushed outward at the ankle, placing increased stress on the ankle and finally leading to instability and arthritis in the joint. With such high arch cases, a joint-preserving correction is generally performed. This involves moving the heel towards the outside and upwards, and results in a flattening of the longitudinal arch and the correction of the rearfoot varus. This is followed by a corrective osteotomy of the first metatarsal bone, whereby the longitudinal arch of the foot is further flattened and the Peroneus Longus tendon is joined to the Peroneus Brevis tendon (tenodesis).

Achilles tendon disorders (Haglund’s heel)

Depending on the severity, the resection of a Haglund deformity can be achieved using a minimally invasive procedure. A small incision (‘keyhole’) is made through which precision instruments are able to reach the Achilles tendon. These instruments are then used to smooth / remove the Haglund’s heel and bursa. This does not affect the Achilles tendon. When this operative method is used for the removal of Haglund’s exostosis, there is no need to immobilise the area. Even so, it is advisable to use walking aids that partially relieve the strain for about two weeks in order to protect the area and help it to heal and regenerate. If a more serious, advanced pathology is the diagnosis, the operation will be performed through an open incision. In some cases it is necessary to partially detach the Achilles tendon from the heel bone. Once the bone has been smoothed, the tendon is reattached to the correct position. Today there are very good techniques and implants available that allow the Achilles tendon to be very securely attached. Following an operation with an open incision, the area must be immobilised in a walking boot for six to eight weeks. This is necessary to optimise the healing process for the Achilles tendon after it has been partially detached. In addition, forearm crutches can help offer relief by bearing part of the load.

Arthritis of the upper and lower ankle joint

In cases of severe arthritis of the upper and lower ankle joint, the joint can be surgically stiffened (arthrodesis). The aim of this procedure is to eliminate pain and to stabilise the joint in the best possible position (functional position). In order to achieve the ideal position and function while guaranteeing the best conditions for bone healing, it is sometimes necessary to use the patient’s own bone. This is taken from the patient's iliac crest or tibial plateau.

Paediatric foot deformities (treatment of flexible flat feet, sinus tarsi screw, arthroereisis)

In cases of flexible flatfoot in children, the most common treatment is a minor intervention involving a mini-titanium implant that can remain in the foot throughout their lifetime. Arthroereisis is frequently conducted for young patients with flexible flatfoot for whom conservative treatments have not been successful (subtalar arthroereisis). The malposition of the foot and misalignment of the heel bone (calcaneus) and ankle bone (talus) are corrected by blocking the lower ankle joint and making an insertion outside the articular capsule – usually in the sinus tarsi. For a patient to be eligible for this procedure, they must still have multiple years of their growth phase ahead of them so that the surrounding tendons and ligaments have time to develop properly.

Ligament instability and injuries

Ligament instability can be a problem for athletes in particular. An unstable ligament structure increases the risk of injuries or pain that can have a negative impact on athletic performance. Here at our podiatry centre in Cologne we offer effective solutions for ligament instability and injuries so that we can help to restore your athletic performance. The possibilities range from conservative treatments like physical therapy and special shoes to minimally invasive operations – we offer numerous options that help you to return to your favourite sports and athletic activities quickly and safely.

Cartilage injuries (osteochondrosis)

Cartilage injuries, also known as osteochondrosis, can be painful and limiting. At the Foot and Ankle Surgery Center Cologne, we offer a range of treatment options to alleviate pain and correct functional problems. Untreated cartilage injuries can result in joint wear and arthritis. That is why it is important that a diagnosis be made and treatment commenced as soon as possible. As experienced foot specialists, our podiatry centre here in Cologne specialises in the treatment of cartilage injuries. The treatment possibilities range from conservative treatments like physiotherapy and pain management to surgical interventions that include arthroscopy and cartilage transplants. We create a personalised treatment plan for you to ensure that the health of your feet is quickly restored.

Morton’s neuroma

Morton’s neuroma is a painful ailment that involves a thickening and inflammation of the tissue surrounding the nerves between the toes. This most commonly afflicts the area between the third and fourth toes and causes pain, numbness or a tingling feeling in the affected area. Although the exact cause of this disorder is unknown, it is believed that it occurs as a result of pressure on the nerve or irritation thereof. Various treatment options are available, ranging from conservative treatments like shoe inlays and pain medication to more invasive options such as injections or surgical interventions, depending on the severity of the ailment.