Sexy shoes, painful feet? This is not entirely correct but modern shoes, and the hurried lifestyles (cramped, overcrowded, ill designed shoes) do not help. Yes,bunions run in the family and they can affect the big toe as well as the little one (bunionette).

Usually, the forefoot diameter becomes wider than the midfoot one and, pressure on the top and outside, forces the toe to drift off. Irritation and inflammation make the bone grow and the rough surfaces dig into the overlying skin. Taping, night splints and padding can relieve symptoms but after a while you might have had enough and surgery can be offered.

It is crucial to understand that the recovery for fore-and midfoot surgery should not be underestimated - several months are needed. Foot Physiotherapy as well a consistent Home Exercise Programme provide the best chances for a painfree nice forefoot (with scars!) for years to come. However, wearing high heel shoes with a pointed toe box again on a daily basis will again cause the foot architecture to change for the worse.

Bunions / hallux valgus is regularly confused with another condition involving the joint between the big toe and the midfoot bone, namely progressive osteo-arthritis leading to pain and stiffness. An enlarged bony collar can be found and walking on tiptoes or running becomes painful. After a thorough clinical exam and radiographic imaging, therapeutic options consist of shoes with a harder toe box cover, taping, anti-inflammatory gel application, cortisone injection or surgery.

The type of surgery depends on the state of wear and tear of the joint. Sometimes taking off the bony excesses or collar can buy time. If not, an artificial joint replacement or a fusion can be offered with the ultimate goal to provide painfree walking.

Keyhole surgery or arthroscopy of the ankle joints has become a very important tool in the hands of the foot and ankle surgeon to remedy ankle joint problems such as mild to moderate osteo-arthritis, localized cartilage damage (osteo-chondritis dissecans), entrapment of synovium or ruptured ligaments etc.. The procedure is done in a Day Care Setting under short general anaesthesia. Usually crutches are not required and the ankle is wrapped in a comfortable dressing enabling you to walk in a velcrostrap sandal.

Like the medial arch supporting the foot in the length there is also a transverse arch critical to support the midfoot bones and toes. With age the arches can become less sturdy and the supporting pillars start to shift resulting in abnormal pressure on the digital nerves running in between. Inflammation kicks in and protective scar tissue develops acting as an aching ball in between the toes (Morton's neuroma). Arch support, anti-inflammation gel application, gel pads, cortisone injections and in the last instance surgery are options once the diagnosis is confirmed with ultrasound or MRI scanning.