londonfootanklesurgeon

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@dr.caleb.burgess a physiotherapist, recently posted a picture (swipe right), which I have to admit, I didn’t find particularly accurate or helpful 😏 The body of his message was very reasonable however, that one should always try and exhaust non operative management whenever possible. I liked the way he also said “surgery can definitely be appropriate in a variety of cases, but it should be viewed as the last option unless the individual is in immediate harm, or in danger of the injury quickly worsening”. I would also add to this, some conditions left unoperated on will lead to deformity, pain and loss of function, and any surgery later on will not result in as high a success rate or outcome compared to earlier intervention. For example Cauda Equina syndrome, carpal tunnel syndrome, Lis franc injury, severe achilles tendon rupture. The issue that I have with Calebs picture is that it suggests that physiotherapy is saving a patient from surgery, as if surgery is a catastrophic outcome 😔, it isn't, and I say this as someone who has undergone 6 different successful operations myself. Chronic pain, disability, loss of function, loss of independence, inability to do sports and enjoy life, THAT is the catastrophic outcome from an injury or illness! 😩 As a surgeon, my job isn’t to just operate (only about 8% of my patients go under the knife), it is to diagnose the patient, make sense of imaging, help put a treatment plan together and like a conductor get all members of the orchestra playing in synch to help the patient. And yes sometimes surgery is necessary. Sadly there is a huge drive for non operative management, and I see the result of that in my clinic every day with injuries inappropriately managed non surgically, resulting in severe complications 🥺😭 Let us all work together to help our patients, both non operatively and where necessary surgically 🙏🏻 selflessly like Ali in squid games played by the wonderful @sangipaiya Please like, follow, tag, share and spread the message 🤜🏼

“I feel so old!” is something I hear from patients all the time. Or something along those lines, “it’s been all downhill since I turned 40”, “I hate growing old”, “growing old sucks”, “I feel like such an old person, my body just aches everywhere” etc etc

It makes me really sad to hear this. Aging is a natural process, but feeling old isn’t.

I am 45 soon to turn 46 and I can put my hand on my heart and truthfully say I have never felt fitter, stronger and healthier than at any point in my life.

Ok something are out of our control such as chronic illness etc, however there is SO much we can do to look after our bodies. And that’s ultimately what it is all about when growing older.

If we think of our bodies as cars, the question is how are you looking after it? There are classic cars over 50 years old that are immaculately looked after and maintained, and cars less than a decade old that are simply neglected.

The older we get, the more important it is to look after our bodies. And much of it is free and very simple.

Quality sleep, healthy eating, minimal alcohol, avoidance of smoking, regular balanced exercise, fresh air in the great outdoors, looking after your mental health, and identifying and treating any illness early cannot be understated.

Grow old, but don’t feel old 🙏🏼

At the 6 week mark I show my patients their X-rays and take them through the correction.

I hear a lot of "thank you so much", "my foot looks amazing", "i can't believe it's my foot" etc

But then I ask, "aren't you curious about the persistent bump?"

And quite a few will say... "I was wondering about that" 🤔

Me at that point - 😝

I then explain that while the bump can feel hard, it's actually soft tissue (joint capsule, swelling and excess skin). The bones are straight, the alignment corrected. If you look at the gap between the medial 1st metatarsal head and skin outline on an xray it normally measures 3 to 4mm. For the first few months after a bunion correction it can easily be double that.

The patient - "oh phew!"

Me - 🤭

This is what gives the illusion of a persistent bunion at the 6 week post op check. The good news is, it almost always settles over the coming months. The more you rest and elevate the foot in the early days, the quicker it will settle.

So don't panic, it's all good 😉

Thank you to my patient for letting me share these images 🙏🏼

Happy mother's day!

Miss my mum so much. Haven't seen her since August 2020. Can't wait to hug her and see her.

And happy mother's day to my wife, can't imagine a better mother 💕

I see alot of patients with plantar fasciitis. It's important not to look for quick fixes but sustainable long term relief. Thank you to the for this guest post 🙏🏼👇🏼

References: Rathleff et al., 2015; Trojian, and Tucker, 2019; Luffy et al., 2018.

Plantar fasciitis is the most common cause of heel pain and is prevalent in both sedentary and sporting populations. Common therapeutic treatments involve insoles or gentle stretching exercises.

Others are NSAID’s, and corticosteroid injections, which only provide temporary relief
With individuals reporting symptoms several years after onset, maybe these treatment strategies could be improved upon.

Strength training could be the answer.

In one long term study they looked at just this. Both groups had shoe insoles but were either randomised to daily plantar specific stretching and the other strength training. They were reviewed at 1, 3, 6 and 12 months.

It is important to note that after 12 months both groups improved, however After 3 months the strength training group had superior improvements in their foot functional index scores and after both 3- and 12-months intervals were more satisfied with their treatment.

Research likes to compare one thing to another which is great, but in the real world you should probably offer both treatment options for different reasons.

Stretching is great for providing relief if there is any tightness, however strength training promotes tissue healing and the normalisation of tendon structure and function.

My heart sinks when a patient tells me that they have been previously told they "overpronate". It can be an incredibly difficult idea to dislodge once embedded.

Thank you to Ian Griffiths for the guest post explaining (better than I ever could) why this is the case 👇🏼

If something was unable to be accurately measured, lacked an agreed upon definition, didn't dictate treatment strategies and also had the potential to impact a patient negatively (from a psychological perspective), I'd imagine there'd be no disagreement that it was worthless and had no place in clinical practice. See: OVERPRONATION. 

An incredibly common term which we've been petitioning for the discontinuation of for many years. It is NOT a diagnosis. It demonises movement and human variation (both of which are normal). It promises the correlation between foot posture/dynamics and pain or injury development is straightforward (It isn't). It erroneously simplifies the complexity of foot function (How dare it!).

Health professionals should be more mindful than ever of the power of words, and as such the potential impact the terminology they use within clinical encounters may have. The best time to remove "overpronation" from your lexicon and your clinical discussions was 20 years ago... the second best time is today.

Please like, share and tag 🙏🏼

By

International Women’s Day

I always feel a little bit torn when this comes around. On one hand, I’m proud to be a woman and to celebrate the achievements of those around me and those who have gone before me, but also a bit sad that such a thing is needed.

I’m an orthopaedic surgeon. Orthopaedics, up until very recently was an almost exclusively male speciality, and although now there are many female orthopaedic surgeons, the number of female consultants and women in leadership roles are still comparatively very low.

Colleagues are still often surprised that I have children and am a surgeon. I get lots of “well done” and “how amazing”. But the truth is it isn’t, and I shouldn’t need to be congratulated on doing a job just because I’m a woman with children.

I’ll be honest, there should be no barriers to achieving whatever you want to in any field as a woman or a mother. I don’t feel I’ve ever been actively discriminated against as a female in orthopaedics, but what I do come across is a lot of ignorance and “soft” gender discrimination. Like the need people have to ask me who’s looking after my children while I’m at work. Would I be asked this if I was a man? Or the surprise when I say my husband! Who, by the way is amazing, we share all family duties 50:50 and juggle the childcare between us. Honestly, men are parents too, and should be just as capable of parenting!

I was very lucky. I had female surgical role models in my life to know that this was possible (my amazing Mum….and Dr’s Cordey and Rasgotra 😂) Even today however, I still come across medical students and trainees who’ve been told that its too hard to have a family and be a surgeon. I would say you can absolutely do whatever the hell you want to (within reason, let’s not go crazy here), and don’t let anyone tell you otherwise.

Thanks Geoff for the kind review.

Glad your surgery went well 😊

Hopefully back playing golf when lockdown ends 🤞🏼

People come and see me when there is a problem with their foot and ankle. It might be sports related, an injury, congenital or arthritic in origin.

Sometimes it's because the foot just isn't working.

While I am a foot and ankle specialist, not all foot problems can be remedied by me. If for example the toes are ischaemic due to a vascular blockage, you need to see a vascular surgeon.

This year I have seen two patients with foot drop. They didn't know they had foot drop, they complained of weakness, ankle giving way, problems with balance etc

Both cases involved significant lower leg weakness, no sensory deficit, no hx of trauma. On examination both had involuntary twitches and tremors of their hands which they were unaware of.

Based on the history and examination findings I suspected motor neurone disease and it was confirmed on nerve conduction studies and the patient referred to a neurologist.

Motor neurone disease (MND) is an uncommon condition that affects the brain and nerves. It causes weakness that gets worse over time.

There's no cure for MND, but there are treatments to help reduce the impact it has on a person's daily life. Some people live with the condition for many years.

But sadly MND can significantly shorten life expectancy and, unfortunately, eventually leads to death.

It is not a diagnosis I am happy to make 😭

If you see a patient with gradual hx of ankle weakness, sprains and even foot drop refer urgently to a specialist.

I'll talk about foot drop and its causes in my next post 🙏🏼

Love it when a plan comes together.

Great referral from podiatrist , great mum, great patient 🙏🏼👍🏼

My neighbour is in his 90s and has been smoking since he was 5.

Does that mean it is ok to smoke? That ci******es are safe?

Of course not. For everyone smoker like my neighbour there are many more who suffer adverse effects of smoking.

What has this got to do with orthopaedic surgery? 👇🏼

There are many orthopaedic procedures, novel treatments and implants with relatively high sounding success rates. Take for example some big toe joint replacements, with success rates ranging from 50% to 75%. Clearly SOME patients will find these procedures helpful in reducing pain. HOWEVER, between 1 in 2 to 1 in 4 patients will NOT be happy and possibly require revision surgery. To me that is an unacceptably high complication rate.

My preference is to offer operations with 95 to 99% success rates.

In the unusual circumstance that I do any procedure with a success rate lower than this, it is only because it -

*doesn’t close the door on any further treatment
*doesn’t reduce the success of any further procedure
*doesn’t significantly complicate any further treatment
*and most importantly the patient is aware of the risks and accepts the high risk of undergoing revision surgery

The reality is that the human body has an amazing capacity to compensate and become adjusted to the new normal, so even a “bad” operation will result in some “satisfied” patients.

When offered a treatment ask your surgeon about the success rate, and in the event of failure, what plan B will be.

Back to my neighbour, just because smoking is ok for some people, doesn't mean it's a good thing or safe.

Thanks for the feedback anonymous patient ❤️

Glad you are happy with your bunion surgery 🙏🏼

Wonder who you are? 🤔