Foot Surgeries

An Achilles Tendon Repair might be suggested if your specialist suspects a rupture. Prior to surgery an Ultrasound or MRI will be carried out to assess the extent of damage and the gap between the tendon ends.

The surgery helps to restore normal anatomy and function of the achilles. An incision will be made at the back of the calf and the two torn ends attached together with a strong suture. If there is severe damage then a part of the tendon may be removed and replaced with a healthy tendon from another part of your foot.

Where possible, the procedure will be carried out through a minimally invasive technique where 2-3mm incisions will be made. This will help reduce possible complications during recovery.

If you have a job that does not require significant physical activity, then you can continue working after 1-2 weeks. If you have an active job then you may need to wait 6-8 weeks before returning to work. Your specialist will run through your recovery plan during your consultation. It may take 6-12 months to gain sufficient strength to return to sports or significant physical activities requiring exertion.

An ankle arthroscopy may be advised to treat ankle arthritis that is caused by debris from torn cartilage or from a bone chip. There may bone spurs at the front of the ankle that cause pain or restriction in movement.

The arthroscopy procedure uses a fiber-optic viewing camera to allow for minimally invasive surgery, this in turn reduces recovery. With the use of the camera, 2-3mm small incisions will be made followed by repair of any cartilage damage, removal of bone spurs and fixation of ligaments.

The minimally invasive procedure allows early mobilisation in most cases. Weight-bearing is allowed immediately in a protective shoe or boot. Return to full activity can be anything from 4 to 8 weeks depending on the level of surgery and damage repaired. It may be a few months before you may return to sporting activities. Crutches might be used initially to help mobilise in the first couple of weeks.

In more severe cases an ankle fusion may be suggested to assist with ankle arthritis. This is where two or more of the bones in your ankle are fused into one piece with the use of a screw fixation. Where possible, minimal invasive surgery will be carried out, small 2-3mm incisions would be made and the procedure carried out with the assistance of a camera.

Post-operative recovery after an ankle fusion procedure requires a below knee cast and no wait to be put onto the ankle for approximately eight weeks. Careful mobilisation is required over the next couple of months and it might be 6 to 12 months before any significant physical activity, such as sports, is allowed.

The Brostrom-Gould Ankle Stabilisation is a widely used procedure for treatment of lateral ankle sprains, where the ligament on the outside of your ankle is repaired. This would typically be carried out following a twist or sprain to your ankle where the ligament has become torn or stretched.

The stretched or injured ligaments are repaired using an Arthrex Ankle Brace, this allows faster recovery. Key-hole ankle surgery may also be performed to treat subsequent damage to a chronic injury.

Following surgery you should be able to mobilise almost immediately with the use of an air cast boot, which you’ll need to wear for the first three weeks. The total recovery takes six – eight weeks.

Modern fixation techniques with an internal brace and anchors have allowed surgeons to improve the post operative rehabilitation following ankle ligament repair, allowing predictable recovery and a quicker return to sports.

Ankle impingement can develop in the front or back of the ankle region following a sprain. This is where a bony growth forms which restricts range of motion in the ankle.

Anterior Ankle Impingement

Anterior Ankle Impingement, also known as footballer’s ankle, is where the impingement is located at the front of the ankle.

Symptoms may include:

  • Pain when pulling toes towards your body
  • Clicking sensation in the front of your ankle
  • Weakness in the ankle

During the procedure your surgeon will make two small incisions at the site of the impingement, using an arthroscope. They will then identify the thickened tendon or ligament. A small shaver is used to remove any thickened or inflamed tissue, alongside any bone spurs that may be present.

Following the surgery you’ll be provided with an ankle splint and crutches to be used over the first one-two weeks. You’ll be able to gradually increase activity during this period. It will take four-six weeks before you can return to normal activities.

Posterior Ankle impingement

The ankle bone (talus) sits on the heel bone (calcaneus), forming a secondary joint in the ankle (the subtalar joint). At the back of the ankle bone there are two small bony lumps (tuberosities), one on the inside and one on the outside. In about 15% of people, the outside lump is naturally separated from the talus, and is called the Os Trigonum.

The Os Trigonum can cause problems in people who regularly point their feet downwards sharply, it is most common in ballet dancers. When the Os Trigonum gets pressed between the bottom edge of the shinbone (tibia) and the top surface of the heel bone, the tissues above and below the Os Trigonum can become trapped, leading to inflammation and swelling.

The Os Trigonum can be removed through a small incision at the back of the ankle. Typically you will require rest at home for non manual jobs, where you will use a back slab and crutches.

Bunion Surgery

Surgical intervention is currently the only way of fully correcting a Bunion. There are many types of Bunion Surgery and your surgeon will recommend a particular procedure suited to your particular case.

Types of Bunion Surgery

At our clinic the four most common types of Bunion Surgery include:

The scarf and akin osteotomy is a common procedure carried out to correct a bunion. It is used to correct moderate bunions and allows for early weight-bearing due to the titanium screws used and the stability of the bone following surgery.

Your bunion surgeon will start by making an incision on the inner side of the big toe joint and release the tight ligaments that are holding the toe out of alignment. The bump will be removed and the metatarsal and big toe proximal phalangeal bones will be realigned to a corrected position. Titanium screws are used to fix the toe in position and allow predicted correction and excellent stability.

Recovery

Over the first two weeks you should rest at home whilst elevating your foot as much as possible. You will be able to slightly increase activities at one week, but should still rest at home. You’ll be able to start wearing trainers at two weeks and return to high impact activities at six-eight weeks following surgery.

Minimally Invasive Surgery, also known as Keyhole Surgery, uses specialised techniques and equipment to reduce the size of incision and soft tissue interruption during a bunion operation. This can help reduce the overall recovery period, postoperative pain and scarring.

There are several minimally invasive surgeries available, our bunion surgeon, Mr Kaser Nazir, favours the PECA bunion correction system. This technique involves only three-four 2mm incisions. 3-4 PECA screws are used to stabilise the bone.

Recovery

Over the first two weeks you should rest at home whilst elevating your foot as much as possible. You will be able to slightly increase activities at one week, but should still rest at home. You’ll be able to start wearing trainers at two weeks and return to high impact activities at eight weeks following surgery.

Traditional bunionectomy is typically reserved for for very minor bunions in elderley patients where the bunion bump is the main concern and the alignment operation is not suggested due to osteoporosis, poor health or frailty.

An incision is made to the inner side of the big toe. The bony bunion growth is then removed, no pins or screws are used during the procedure.

Recovery

The patients can mobilise very early with this procedure. Elevation of the foot is required for a couple of days and wound healing will typically take 2 weeks.

The lapidus bunion procedure is typically carried out for severe bunions or for patients who are hypermobile where there is a significantly higher chance of the bunion recurring after more traditional surgeries. The procedure involves mending of two bones towards the arch of the foot.

An incision is made to the top or side of the foot. The bunion bony growth is then removed. The joint near the instep (tarsometatarsal joint) is realigned and fused with a fixation such as screws, plates and/or implants.

Recovery

You should rest at home for the first two weeks and elevate your foot as much as possible. At two weeks following the surgery you will be transitioned into an Aircast boot for a further four-six weeks, you should be able to stop using crutches at four weeks postoperative and just mobilise with the Aircast boot. At three months following surgery you should be able to return to high impact activities, such as the gym and running.

Bunion Surgery Cost

Initial Consultation

£200 – The initial review with Consultant Podiatric Surgeon, Mr. Kaser Nazir, includes a full assessment of your Bunion and formation of a treatment plan.

X-rays

£132 – X-rays are often requested during the first appointment to assess the size and severity of the Bunion. This allows us to determine the best course of treatment.

Package Fees for Surgery

One Foot Bunion Procedure

Single Package Fee


£3755


Both Feet Bunion Procedures

Single Package Fee


£5311


One Foot Bunion Procedure

Postoperative Care Package†


£4189


Both Feet Bunion Procedures

Postoperative Care Package**


£5793


† Includes postoperative x-rays and 4 sessions of in-house physiotherapy

** Includes postoperative x-rays and 6 sessions of in-house physiotherapy

All of our packages include follow up appointments with Mr. Nazir to monitor your progress after the procedure.

Our package fees cover the typical costs that most patients require when undergoing this procedure. They are intended as a guide for self-funding patients. We will provide a full breakdown of fees tailored to your particular case prior to any surgery.

Gastrocnemius Recession

A Gastrocnemius recession is typically carried out due to equinus contractures, where you are unable to put your foot in neutral position due to tightness of the calf muscles and/or tendons in the calf. The aim of the procedure is to lengthen the calf muscle to create greater flexibility. The procedure is commonly accompanied by the HyProCure or general flat foot correction and chronic achilles or forefoot problems that are associated with overly tight calf muscles.

Initially your podiatric surgeon will make a small incision to the inner calf, half way between the knee and the ankle. The muscle is then lengthened. No fixations (wires, screws, implants or pins) are used during this procedure.

You will need to take six-eight weeks off from non manual work and eight-twelve weeks off from manual work. You will use a cast for the first two-four weeks following surgery whilst non weight bearing. Following this you will be provided with an Air cast boot to mobilise in for a further two weeks. At three-six months you should be able to continue with high impact activities, such as the gym and running.

Corn and Callus Excision

Surgical removal of corns is advised when there is burning pain or the patient is concerned that they have developed unsightly lumps over the small joints of their toes.

An elliptical incision is made over the corn allowing the full depth of the corn to be excised as well as the fibrous scar tissue and bursal tissue that is often present.

You can carefully mobilise straight away but it is recommended that you try and rest as much as possible for the first 48 hours. You should avoid high impact activities for two-three weeks. 

In some cases surgical corn removal is not suggested due to the size of the corn or the fact that it is caused by deformity of the toe. In such cases, correction of the toe to shorten or straighten the toe may also be recommended instead to avoid the risk of recurrence. Click here to find out more on toe correction.

Tendon Transfer

Tendon Transfer can be carried out for both flat foot, high arched foot, unstable ankles and drop foot.

As part of a flat foot corrective procedure, the damaged posterior tibial tendon, which attaches the muscle in the inner calf muscle to the bone on the inner side of your foot, is replaced by a transfer of the flexor digitorum longus tendon, which is found on the inner side of your leg.

For dropped foot and high arched feet with unstable ankles, a range of tendon transfers are performed dependent on case by case.

As part of the flat foot correction when the tibialis posterior tendon fails, an incision is made from the inner ankle so both tendons are exposed. The damaged section of the posterior tibial tendon is removed and replaced with a section of the flexor digitorum longus tendon, this is then sutured into place. The procedure is often carried out alongside a calcaneal osteotomy, gastrocnemius recession or midfoot fusion.

You will require a cast for the first two weeks and will then start to use an Aircast boot for a further four weeks. At two weeks postoperative you should be able to return to sedentary work. Return to sports typically takes 6 months.

The HyProCure procedure is minimally invasive with the use of a stent. The procedure is carried out to reduce pain and to realign the foot and correct a flexible flat foot. The procedure is carried out for flexible flat feet when there is no indication of arthritis and typically in younger patients. The HyProCure procedure is carried out one foot at a time.Your foot surgeon will make a small incision (8-10mm) over the outer side of your foot/ ankle. A small stent is placed into the canal (sinus tarsi), which stops the foot from collapsing.

You should rest at home for one-two weeks following the procedure. Light exercise can start from six weeks but high impact should not be carried out until three months following the procedure.

This procedure is sometimes carried out alongside a gastrocnemius recession.

Patients with flat feet can have the heel bone shifted too far to the outside. The purpose of the calcaneal osteotomy is to realign the calcaneus (heel bone) with your tibia (shin bone), it allows the heel bone (calcaneus) to sit directly underneath the midline of the leg.An incision is made to the outer side of your heel bone. A bone cut is made along the heel bone and then the back section is aligned and fixed into position with surgical screws and/or a plate.

Following the surgery you will be placed in a cast to wear for 4 – 6 weeks, this will be followed by the use of an Aircast boot for a further 2 – 4 weeks.

A return to sports can take up to 6 months.

This procedure may be arranged alongside additional surgeries, such as the tendon transfer, gastrocnemius recession and midfoot fusion.

Tendon Transfer can be carried out for both flat foot, high arched foot, unstable ankles and drop foot.As part of a flat foot corrective procedure, the damaged posterior tibial tendon, which attaches the muscle in the inner calf muscle to the bone on the inner side of your foot, is replaced by a transfer of the flexor digitorum longus tendon, which is found on the inner side of your leg.

For dropped foot and high arched feet with unstable ankles, a range of tendon transfers are performed dependent on case by case.

As part of the flat foot correction when the tibialis posterior tendon fails, an incision is made from the inner ankle so both tendons are exposed. The damaged section of the posterior tibial tendon is removed and replaced with a section of the flexor digitorum longus tendon, this is then sutured into place. The procedure is often carried out alongside a calcaneal osteotomy, gastrocnemius recession or midfoot fusion.

You will require a cast for the first two weeks and will then start to use an Aircast boot for a further four weeks. At two weeks postoperative you should be able to return to sedentary work. Return to sports typically takes 6 months.

A midfoot fusion may be suggested to correct flat foot deformity or due to midfoot arthritis affecting the joints. This is carried out when the midfoot has collapsed in flat foot deformity, often the rearfoot is still well positioned or may also need alignment. The affected joints are fused and arch is raised.One – three incisions are made at the top and inner side of the foot. Fixations, such as screws, are used to fuse the joints together.

You should rest at home for two-four weeks following surgery. Initially you will require a splint for the first two weeks, this will be followed by four weeks in a cast and then the use of an Aircast boot for a further four weeks.

This procedure may be carried out alongside additional surgery, such as the gastrocnemius recession, tendon transfer or calcaneal osteotomy.

The cheilectomy procedure is carried out to remove excess bone at the big toe, which is caused by osteoarthritis.

During the surgery excess bone and debris will be removed, this will help free up movement in the joint and reduce pain and stiffness.

Initially an incision will be made over the joint of the second toe. The excess bone and fragments are then removed. Range of motion of the toe is checked intraoperatively to ensure sufficient movement.

For non manual work you will require 1 – 2 weeks off from work where you should rest at home, if instead you have an active job then 5 weeks is suggested. At 6 weeks following the surgery, your foot should feel more normal and swelling would have mostly subsided. It is typically suggested that you avoid sports / high impact activities for 3 months.

Surgery to the big toe with the use of an implant may be recommended as a surgical option for arthritis to help reduce pain in the joint.

The implant preserves movement in the toe following surgery.

An incision is typically made at the top or side of your toe. Excess bone growth and fragments will be removed. The bone cut and a silastic implant is used to replace the joint. The implant allows for greater flexibility in the joint.

Typically you will require 2 weeks rest from non manual work, manual work would instead require six weeks. At eight weeks the foot will start to feel more normal and swelling would have mostly subsided. You should wait until three months before undertaking high impact activities.

Fusion of the joint in the big toe can be carried out for severe and painful hallux rigidus (arthritis of the big toe).

An incision is typically made at the top or side of the toe. Excess bone growth and fragments (osteophytes) will be removed. The bone is cut and then fused together with a fixation, such as specially designed screws and plate. This surgery can stop pain when walking and jogging. Following surgery the big toe will not be able to bend

You will require approximately six weeks off for non manual work and eight weeks for manual work. For the first six-eight weeks you will have a plaster cast, followed by the use of an air cast boot for mobilisation. At eight weeks postoperative you the foot should feel more normal and swelling will subside. You should wait until three months postoperative before carrying out sports/ high impact activities.

If you have a persistent or recurrent ingrown toenail, or a fungal nail, then your specialist may suggest to have the nail partially or fully removed. The procedure can also be carried out with the use of a chemical called phenol, this is applied to the nail bed to stop the nail from growing back, this is typically applied when you have a recurrent issue.

This procedure is usually carried out as a minor outpatient procedure under local anaesthesia, you can leave directly following rather than being admitted into a hospital.

Your foot specialist will start by cleaning the toe and injecting local anaesthesia to either side of the base of the toe. Once numb, the section of the nail or whole nail will be cut down to the base of the nail. The nail will be removed and hypergranulation tissue (scab under the nail) will be removed.

It’s suggested that you take a cab home and rest for the remainder of the day, you can return to non manual work the following day. For the first 3 weeks you will need to re-dress and salt water bathe the toe daily. At two weeks postoperative you can continue with high impact activities.

If you have had a recurrent ingrown toenail, which has previously been partially or fully moved, then your specialist may advise on excision of the nail bed. This will remove the root that contains the cells where the nail grows, this will stop the nail from growing back.

The procedure may be carried out under local anaesthesia or sedation, you will typically be admitted into hospital for half a day. Your surgeon will excise the corner of the base of the nail and remove the root, alongside the affected section of the nail that is causing you pain. This is then closed with stitches.

Following the procedure you should rest at home for 3 – 5 days. You should avoid high impact activities for the first 3 – 4 weeks.

Ingrown toenails can also be caused by a subungual exostosis, this is where a small bone spur on top of the bone underneath your nail. This can cause the nail to lift and push into the sides of the toes. Prior to surgery X-rays are carried out to confirm the presence of the bone spur.

The procedure can be carried out under local anaesthesia or sedation as a day case, you will typically be admitted into hospital for half a day.

Your surgeon will start by making an incision at the top or the end of the toe. The nail may need to be partially or fully removed so that they can access the bone spur, the bone spur is removed by specialised instruments and the wound is then stitched.

You should rest at home for five days following the procedure. Stitches are removed 10-14 days following the surgery. The wound should be soaked in salt water and re-dressed daily until the wound has healed. You will need to avoid high impact activities for three-four weeks.

Neuroma Excision

Excision of a neuroma is where part of the damaged nerve that is causing pain and irritation is removed. The procedure may be carried out under local anaesthesia, sedation or general anaesthesia as a day case; you will only need to be admitted into hospital for half a day.

Your surgeon will make a small incision over the top of the foot above the neuroma. Nerves on either side of the neuroma are cut and the neuroma is removed.

Following the procedure you should rest at home for two weeks. For non manual work you can then return work at two weeks postoperative. At six weeks following the procedure you can return to high impact activities.

Plantar Fascia Release

Plantar fascia release is carried out to reduce tension and chronic inflammation to the tendon.

A small incision is made on the inside of the heel. The plantar fascia is then detached from the heel, alternatively small incisions may be made on either side to release tension. Damaged tissue may be removed if your foot surgeon finds some present, alternatively the bone may be smoothed, which allows the plantar fascia to heal under less tension.

You should rest at home for the first two-four weeks following the procedure. Between two-four weeks you can return to work. You should avoid high impact activities until three months postoperative.

Plantar Plate Repair

Plantar plate repair may be suggested following an injury to the plantar plates, which are thick ligaments that are located beneath the balls of your feet. This can result in pain and hammertoes, most commonly to the second toe. The procedure involves shortening an elongated ligament or repairing a tear.

Your surgeon will make an incision over the affected toe. The toe is flexed to allow access to the plantar plate, which is then detached. Holes are created in the proximal phalanx and sutured into the realigned position.

Over the first two weeks you should rest at home. At two weeks postoperative you can return to work. At three months postoperative you can return to high impact activities, such as the gym or running.

Verruca Removal Surgery

If more conservative measures fail to resolve your verrucae, surgical removal may be recommended. There are many ways to achieve this, at our clinic this will typically involve either of the following:

Verruca Excision is a minor surgical procedure used to remove plantar warts.

The procedure involves the use of local anesthetic to numb the area. Following this the verruca is scraped away using a curette. Depending on the size of the verruca a small stitch may be used while the area heals.

A Verruca Excision be carried out in an out-patient setting, meaning you can return home the same day with no overnight stay in hospital.

Recovery can take between 1- 2 weeks, depending on the number and size of the verrucae.

Electrosurgery can be used to treat Verrucae if over-the-counter treatments have failed to resolve the problem. It is a minor surgery that makes use of a machine called a Hyfrecator.

Hyfrecation involves the use of electrical current to burn away the verrucae. This is often used in conjunction with surgical excision; the wart is excised surgically and any remaining wart is then removed with the Hyfrecator.

The area heals quickly over a matter of weeks (usually 2-4 weeks). Sensible shoes and as much rest as possible will help the healing process. You can normally go back to work soon after the procedure. Your specialist will advise you on this.

If surgery is advised to lengthen your metatarsal (and realign toe position), your specialist will initially carry out an X-ray to assess which surgery is most appropriate for you.

This is a relatively common operation where extra length is achieved by inserting additional bone. This process of inserting additional bone is also known as a bone graft. The new bone need only be small, typically up to 1.5cm, the bone can be taken from another part of the body, such as the heel bone.

Once the bone is inserted, the area is stabilised with a bone plate and screws that remain in the foot indefinitely. There is a limit to the additional length that can be achieved with this procedure. As a result this surgery is generally recommended when less than 1.5cm lengthening is required and only for one toe.

You will need to take the first 4 – 6 weeks off from work following surgery. You may require a cast for the first 4 – 6 weeks, following this you may be transferred into an aircast boot for a further 2 – 4 weeks. Full bone healing takes up to three months. Swelling subsides over 6 – 12 months for the final result to be appreciated.

This procedure allows for a greater increase in bone length. The operation involves a precise cut to the bone that does not impede the blood supply followed by attachment of an external fixator device that will stretch the short bone over time. The external device allows you to slowly increase the bone length a little each day, after which the device is removed.

The bone will gradually increase 1mm per day until the desired length is achieved. Once the bone has healed the fixation will be removed between 1 – 2 months postoperatively. Full bone healing takes up to 3 months. You will be in a specialised cast or boot for a period of up to 3 months. Larger deformities in bone length can be corrected using this technique.

Fifth Metatarsal Osteotomy

A fifth metatarsal osteotomy is often used to treat a Tailor’s Bunion (Bunionette).

An incision will be made around the Bunionette, the exact location will depend on the shape of the bony prominence. Via this single incision, excess bone growth (the Bunionette) is removed, which is followed by a shifting of the head of the bone inwards to decrease the width of the foot. A screw is used to keep the newly positioned bones in place while they heal.

Recovery following surgery will take place over 6-8 weeks, with a complete return to strenuous activity, such as sports, at 3 months. You can return to work between 2 – 6 weeks after the operation, depending on how active your job role is. You can typically return to driving at 6 weeks.

Toe Surgery

If conservative measures are not successful in eradicating the hammertoe symptoms surgery may become the recommended treatment. There are several surgical procedures that can be used to correct toe deformities.

Types of Toe Surgery

An incision is made over the top of your toe. A small piece of bone will be removed and then sutured at the joint capsule between the bone ends.

You should rest at home for two weeks following the procedure. You can return to work after two weeks postoperative. At six weeks postoperative you can continue with high impact activities, such as the gym or running.

You should rest at home for two weeks following the procedure. You can return to work after two weeks postoperative. At six weeks postoperative you can continue with high impact activities, such as the gym or running.

An arthrodesis procedure is where the affected joint of the toe is removed and then the bones fused together into a corrected position. This fused joint will no longer move.

An incision is made over the top of your toe. The affected joint is removed and then fused with the use of K-wires. The wires will protrude out the tip of your toe until they are removed at 4-6 weeks post operatively. We also use newer implants that allow an early return to shoes and do not require wires sticking out of the end of the toes in most cases.

You should rest at home for the first three – four weeks following your procedure. You can return to work between three – four weeks postoperatively but need to use a postoperative shoe until the K-wires are removed. At five-six weeks the K-wires will be removed and you will be able to start wearing trainers. At six weeks following your procedure you can return to high impact activities, such as the gym and running.

The main benefit of carrying out toe correction fusion (Arthrodesis) with the use of a Nextradesis or Smart toe implant is the initial recovery. Typically when wires are used you will need to rest at home for a minimum of 4 weeks, with the use of implants you can instead return to work and closed shoes at two weeks following your procedure.

An incision will be made at the top of the toe. The damaged joint is removed and the implant is inserted in its place.

Following the procedure you should rest at home for two weeks. You can then return to work at two weeks postoperative. At six weeks postoperative you can return to high impact activities, such as the gym or running.

Toe Surgery Cost

The price for Toe Surgery can vary, depending on a number of factors, including:

  • The number of toes that need correcting
  • Whether the procedure is for both feet or just one foot
  • Whether toe implants are used
  • If you are self funding or using private insurance; insurance providers often set the fees.

Our team will be able to provide a detailed breakdown of fees following your assessment.