FOOT AND ANKLE PROBLEMS

ANKLE INSTABILITY (SEVERE SPRAINS) - DR KHAIRUL FAIZI MOHAMMAD

2011-06-20T18:33:00.000-07:00

Picture during surgery showing a torn ligament of the ankle

stress xrays to show ankle instability

Ankle instability is a condition characterised by the ankle "giving way" or feeling unstable particularly when walking on uneven surfaces. The stability of the ankle is supported by ligaments on the outer aspect of the foot named the anterior talo fibular ligament and the calcaneo-fubular ligament. These ligaments arise from the fibular bone (next to the shin) and the to talus and calcaneum (heel) respectively. Ankle sprains damage these ligaments to varying degrees.

SYMPTOMS

Instability is characterised by the foot giving way. The feeling that the ankle is not reliable and loose. It may also be associated with pain and swelling to the outer aspect of the ankle.

CAUSES

Chronic instability of the ankle is the result of the ligaments not healing after a severe sprain or more commonly, repeated sprains. This is a very common occurence during sporting activities such as football, futsal, rubgy and badminton. These injuries may range from stretching of the ligament to complete tears.

When this occurs, small nerve in the ligament are damaged. This does not allow the brain to sense instability. Therefore the surrounding muscles are not reacting to the unstable condition. With this, you are more prone to strains and repeated trauma to your ankle.

DIAGNOSIS

If your ankle feels unstable or you have sustained repeated ankle sprains, please consult you Consultant Foot and Ankle Surgeon for a full assessment.

The diagnosis is usually achieved simply from the history and examination. The clinical examination will show that the ankle in unstable (positive anterior drawers test). The foot is able to be drawn forward on the ankle joint beyond normal. The ATFL and CFL tendon may be tender.

Stress radiographs (xrays) are best to demonstrate that the ankle joint is unstable. This is best done under anaesthesia. An MRI may also be taken if there is a suspicion of cartilage damage to the ankle joint.

TREATMENT

Treatment is dependant of the level of one activity.

1. Simple ankle sprains are treated with physiotherapy. This is to retrain the ankle to gain its nerve functions again. This also allows the surrounding muscles to strengthen.

2. Surgery may be of 2 types:

a) Damaged ligaments maybe tightened and reattached to the bones. This is a very successful procedure and is usually performed in active individuals and athletes.

b) If all has failed, tenodesis surgery can be performed. This involves ligament reconstruction using a tendon harvested from another part of the body. This is very durable but it will lead to stiffness of the ankle.

Should you have any of the symptoms above, please consult your Consultant Foot and Ankle Surgeon

Dr Khairul Faizi Mohammad

Consultant Foot and Ankle Surgeon

Kuala Lumpur Foot Ankle Clinic

Pantai Hospitals
(CHERAS (HQ), KUALA LUMPUR, AMPANG)

KUALA LUMPUR FOOT ANKLE CLINIC (KLFAC) - AOTrauma Foot and Ankle Course 2011 (Kuala Lumpur) - Dr Khairul Faizi Mohammad

2011-06-12T19:04:00.000-07:00

Dr Khairul Faizi Mohammad (KLFAC, Malaysia - centre)

Dr Les Grujic (Australia) centre

Dr Andrew Beischer (Australia) demonstrating.

Participants and Faculty members

KLFAC would like to congratulate Dr Khairul Faizi Mohammad on chairing and organizing the world accreditted AOTrauma Foot and Ankle Course in Kuala Lumpur on the 6th of June til the 8th of June 2011.

This course was over subscribed and attended by surgeons from Malaysia, Singapore, Indonesia, Thaiand, Myanmar, India and Australia. Speakers at this course included Dr Les Grujic (Australia), Dr Andrew Beischer (Australia), A/Prof Inderjeet Singh (Singapore), Dr Chong Keen Wai (Singapore) and Dr Khairul Faizi Mohammad (KLFAC, Malaysia).

DR KHAIRUL FAIZI MOHAMMAD: FLAT FEET (Kosmo - Malay version)

2011-03-21T20:36:00.000-07:00

The end of the first quarter of the year is ending and Foot and Ankle Problems has been relatively quiet. The Kuala Lumpur Foot Ankle Clinic, headed by Dr Khairul Faizi Mohammad has been very busy with clinical and academic activities related to foot and ankle surgery. We will be updating everyone with more information in the days to come. So as a start, this is a newspaper footage (in malay) on flatfeet and a patients account of his experience.

http://www.kosmo.com.my/kosmo/content.asp?y=2011&dt=0320&pub=Kosmo&sec=Kesihatan&pg=ke_01.htm

If you do have questions or suffer from flat feet, please consult you Consultant Foot and Ankle Surgeon.

EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT) FOR FOOT PROBLEMS - DR KHAIRUL FAIZI MOHAMMAD (KLFAC)

2010-09-05T21:28:00.000-07:00

ESWT being applied to the insertion of the achilles tendon

Close up view

WHAT IS EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT)?

ESWT is a non invasive surgical procedure that uses shockwaves to simulate the healing process in certain conditions of the foot such as achilles insertional tendinitis and plantar fasciitis. Extracorporeal means outside the body. This refers to the method in which the therapy is applied. There are no incisions. Patients benefit from no associated complications of surgery and it can be applied as an outpatient procedure.

WHO ARE THE CANDIDATES FOR EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT)?

Candidates for ESWT are those in which conservative treatments for their condition have failed. Conservative treats for heal pain include non steroidal anti inflammatory medication, point specific steroid injections, insoles, stretching exercises and physical therapy.

Patients who suffer from bleeding tendencies or who are on medication that leads to bleediong tendencies are contraindicated for the treatment. Your Foot and Ankle Surgeon will determine whether this treatment is suitable for you.

WHAT TO EXPECT FROM THE TREATMENT?

ESWT is mainly done on an outpatient basis. Anti inflammatory medication is stopped 5 days prior to the treatment. Shockwaves are applied using a machine to the respective areas in various intensities. Treatment usually takes around 30 minutes to be performed. Treatment will be performed 3 to 5 times, on a weekly basis dependant on the response to treatment.

Do contact your Consultant Foot and Ankle Surgeon if you are interested in knowing more about this treatment.

Dr Khairul Faizi Mohammad

Consultant Foot and Ankle Surgeon

KUALA LUMPUR FOOT ANKLE CLINIC

(KLFAC)

Pantai Hospital Cheras

Pantai Hospital Kuala Lumpur

Pantai Hospital Ampang

DR KHAIRUL FAIZI MOHAMMAD (KLFAC) talks at BFM 89.9 on "BAREFOOT RUNNING"

2010-08-09T20:29:00.001-07:00

left to right:

Pete Pereira, Dr Khairul Faizi Mohammad (KLFAC), Shazmin Shamsuddin (BFM89.9)

The debate on shod running and barefoot running has been going on for the pass 40 years. Dr Khairul Faizi Mohammad from the Kuala Lumpur Foot Ankle Clinic and barefoot runner Pete Perriera are interviewed by Shazmin Shamsuddin from BFM 89.9. Listen in to our discussion!

www.bfm.my/barefoot-running-health.html

Kuala Lumpur Foot Ankle Clinic - Majlis Pelancaran Majalah i-Sihat - Dr Khairul Faizi Mohammad

2010-05-24T22:45:00.000-07:00

Utusan Karya Sdn Bhd has recently launched a new health based magazine called i-Sihat (i-health) This magazine will feature interviews, health related articles and advice pertaining to various aspects in a persons health.

Our Dr Khairul Faizi Mohammad from the Kuala Lumpur Foot Ankle Clinic has been appointed as a member of the Advisory Panel to the magazine. Once again we would like to congratulate Dr Khairul on his appointment and we hope the knowledge given will be beneficial to our society.

Malaysian Foot & Ankle Society (MFAS)

2010-05-24T22:37:00.000-07:00

We would like to congratulate Dr Khairul Faizi Mohammad from the Kuala Lumpur Foot Ankle Clinic (KLFAC) on his appointment as secretary at the inaugural meeting of the Malaysian Foot and Ankle Society on the 18th of May 2010.

This society has been inaugurated to cater for the growing interest in foot and ankle diseases amongst clinician in Malaysia.

KOSMO! features Dr Khairul Faizi Mohammad from KLFAC

2010-05-02T20:32:00.000-07:00

Dr Khairul Faizi Mohammad from the Kuala Lumpur Foot Ankle Clinic (KLFAC) featured in the newpaper KOSMO! on the 2nd of May 2010. Read the depiction of a patients experience from the incident to the treatment that was given. Click on the link below:

http://www.kosmo.com.my/kosmo/content.asp?y=2010&dt=0502&pub=Kosmo&sec=Kesihatan&pg=ke_01.htm

KUALA LUMPUR FOOT ANKLE CLINIC (KLFAC) and AOTrauma Asia Pacific (Malaysia)

2010-04-21T18:50:00.001-07:00

Dr Khairul Faizi Mohammad of Kuala Lumpur Foot Ankle Clinic (KLFAC) has long been associated with the AO Foundation based in Davos, Switzerland. He has been part of the teaching faculty in various country such as India, Jordan, Saudi Arabia, Switzerland and Malaysia. Now known as AOTrauma, this organization is the leading non profit making, educational organization for orthopaedic surgery.

In its 50th year anniversary, the creation of AOTrauma, it has completed the niche of surgeons specialising in musculoskeletal trauma and disease, fracture and its subsequent complications and problems.

We are glad to announce that our Dr Khairul Faizi Mohammad has been elected to the Malaysian Council as AOTrauma Education Chairperson. Congratulations!

KUALA LUMPUR FOOT ANKLE CLINIC (KLFAC) AND MALAYSIAN ASSOCIATION OF SPORTS MEDICINE (MASM)

2010-04-11T07:44:00.000-07:00

Dr Khairul Faizi Mohammad of Kuala Lumpur Foot Ankle Clinic (KLFAC) was elected to the council of the Malaysian Association of Sports Medicine (MASM) at the biennial general meeting on 10 April 2010 at the Royal Selangor Club in Kuala Lumpur.

KUALA LUMPUR FOOT ANKLE CLINIC - VIETNAM TRAUMA SEMINAR - DR KHAIRUL FAIZI MOHAMMAD

2010-04-04T22:24:00.000-07:00

Dr Khairul Faizi Mohammad of Kuala Lumpur Foot Ankle Clinic operating on a patient in Military Hospital 7a in Ho Chi Minh City, Vietnam.

Dr Khairul Faizi Mohammad of Kuala Lumpur Foot Ankle Clinic (centre) with sugeons from Cambodia.

Vietnam Orthopaedic Surgeons who participated in the Vietnam Trauma Seminar

Dr Khairul Faizi Mohammad of Kuala Lumpur Foot Ankle Clinic delivering one of his lectures at the Vietnam Trauma Seminar.

Dr Khairul Faizi Mohammad of Kuala Lumpur Foot Ankle Clinic, reviewing the patient, radiographs and planning for surgery at Military Hospital 7a, Ho Chi Minh City, Vietnam.

Dr Khairul Faizi Mohammad of Kuala Lumpur Foot Ankle Clinic (KLFAC) was invited to share his expertise with orthopaedic surgeons from Vietnam and Cambodia on the 26th of March 2010. The event "Vietnam Trauma Seminar" was hosted by the Vietnamese Orthopaedic Association.

Participants included senior orthopaedic surgeons from Ho Chi Minh City, Hanoi, the provinces and also Cambodia.

Three lectures and discussions were delivered in the morning and live surgery was conducted in Military Hospital 7a. This was the first time that a non Vietnamese Surgeon was allowed to enter and perform surgery in the military hospital.

The knowledge exchange was a phenominal experience.

Should you have any questions regarding signs and symptoms of an orthopaedic nature, do contact your orthopaedic surgeon.

Dr Khairul Faizi Mohammad

BMedSci(Hons), BMBS(Nottingham), MRCS(Edinburgh), MSOrth(UKM)

Consultant Orthopaedic, Foot and Ankle Surgeon

Kuala Lumpur Foot Ankle Clinic (KLFAC)

Pantai Hospital Cheras and Ampang

join us on Facebook:

http://www.facebook.com/pages/KUALA-LUMPUR-FOOT-ANKLE-CLINIC/275038854571?ref=ts#!/pages/KUALA-LUMPUR-FOOT-ANKLE-CLINIC/275038854571?ref=ts

ADULT ACQUIRED FLAT FOOT (PES PLANUS) - DR KHAIRUL FAIZI MOHAMMAD

2010-03-11T19:21:00.000-08:00

Pre and post operative radiographs of a patient with Flat Feet. The radiographs show a dorsilateral peritalar subluxation (the arrows). The radiograph of the right shows the reconstructed deformity with the midfoot fusion bolt and x-plate.

Lateral view of the right foot

Clinical pictures of flat foot with dorsilateral peritalar subluxation

Post operative pictures with the foot arches reconstructed

INTRODUCTION

Flat foot is a very common problem and for many, it may not cause any problems at all. Problem start to occur when the deformity worsens and leads to malalignment of the axis of the limb leading to imbalances in the ankle, knees, hips and back.

CAUSES

Flat foot can be congenital or acquired during the adult life. The shape of the foot is determind by many factors such as genes, bones, muscles, supporting tendons and ligaments. Any pathology or injury to these structures can lead to flat foot.

PROBLEMS WITH FLAT FOOT

A foot that is flat is structurally at a disadvantage compared to a normal one. Although it may be without any symptoms of pain, the altered mechanics leads to increased stresses and strains due to normal day to day load.

Two common causes of adult acquired flat foot are:

1. tibialis posterior dysfunction

This is due to inflammation and degeneration of the tibialis posterior tendon. This leads to gradual pain, swelling and flattening of the arches of the foot (flat foot). It is often missed and may lead to serious permanent disability.

2. osteoarthritis

Osteoarthritis of the joints (tarso-metarso and subtalar joint). The reasons for arthritis of these joints may be trauma, inflammatory or degenerative but if left over time will lead to pain and progressive deformity.

TREATMENT

Non Surgical

Most patients with flat foot canbe treated with orthotic footwear. Flexible flat foot can conform to inner soles worn in the shoes. Insoles can be custom made to correct the flatten arches of the foot.

In addition to this, physio will be require to stretch the muscles which are frequently contracted due to flat feet.

Surgical

Surgery for flat foot ranges from tendon transfers, bone reshaping, fusion and releasing of muscle contractures. Patients will invariably be in a plaster cast post operatively to allow for healing of the soft tissue and bones prior to resuming mobility. Surgery is aimed at correcting overall alignment of the foot and to prevent abnormal malalignment stresses on the surrounding joints of the ankle, knee, hip and back.

Should you have any enquiries about flat foot, please consult you Consultant Foot and Ankle Surgeon.

SYMPTOMATIC ACCESSORY NAVICULAR AND HALLUX VALGUS - DR KHAIRUL FAIZI MOHAMMAD

2010-02-11T03:23:00.000-08:00

This is another case of hallux valgus with a symptomatic accessory navicular bone which was recently treated. The xrays show the improvement in the positioning of the big toe in relation to the second toe with less crowding in the webspace. Note that rotation of the big toe has also been corrected.

The intra operative photo shows the X-plate(TM) . This is the first of its kind in Malaysia which provides advanced forms of fixation for this type of surgical correction for hallux valgus.

HALLUX VALGUS AND BUNIONS

2010-02-01T18:26:00.000-08:00

See how common this condition is. It affects anyone.

http://www.dailymail.co.uk/tvshowbiz/article-1247690/Barefoot-Victoria-Beckham-hit-wave-dips-toes-Pacific.html

CLUBFOOT (TALIPES) - DR KHAIRUL FAIZI MOHAMMAD, KUALA LUMPUR FOOT ANKLE CLINIC (KLFAC)

2010-01-17T18:43:00.000-08:00

CLUBFEET

(CONGENITAL TALIPES EQUINOVARUS - CTEV)

TREATMENT by SERIAL CASTING

WHAT IS CLUBFOOT (TALIPES)?

Clubfoot or Talipes equino varus is a condition which leads to deformity of the foot in babies. This condition occurs in the womb and leads to feet to be turned inwards and downwards. This treatable condition affects approximately 150000 - 200000 births per year worldwide. This is one of the most common congenital deformities to occur at birth. It has been observed that fetuses develop with normal and the deformity can be detected in the womb at around 3 months. Most are born without any absences of bone, muscles or connective tissues. One or both feet can be affected and this condition is not painful but if neglected in a child who is walking, it may be painful and causes difficulties in walking. It is easily detected by observing the deformity at birth. The deformity can be flexible (easily correctable or stiff and rigid).

HOW WILL I KNOW?

The condition is detectable at birth. The foot are turned inward and downwards (refer to picture above). Before the child is born, the condition can be appreciated during ultrasound scans performed by the Obstetrician. If you are wondering if your child has clubfoot, please contact your Physician or Foot and Ankle Surgeon who has experience in diagnosing this condition.

WHAT HAS CAUSED IT?

It is still unknown why clubfeet occur. Many have postulated it to be cause of a tight womb leading to a packing disorder of the fetus. It is inherited. The likely hood of a sibling to develop the condition if very high.

HOW IS IT TREATED?

Clubfeet has been treated by either serial casting or surgery. Dr Ignacio Ponseti has developed a method of treating clubfeet by serial casting and bracing. This method is currently the gold standard for the treatment of clubfeet. It involves serial casting above the knees, gentle manipulation and a special protocol. It has been shown to be able to treat clubfeet in 95 per cent of cases. Treatment is usually started immediately after birth.

Clubfoot in older childer and in those with failed surgery can also be treated by Ponseti method. This method is used widely in developing countries where children present later with this condition.

If you would like to know more about Clubfeet, please contact:

Dr Khairul Faizi Mohammad

BMedSci(Hons), BMBS(Nottingham), MRCS(Edinburgh), MSOrth(UKM)

CONSULTANT ORTHOPAEDIC, FOOT AND ANKLE SURGEON,

KUALA LUMPUR FOOT ANKLE CLINIC,

PANTAI HOSPITAL CHERAS.

t: +603-91322022 ext 3333 (appointments)

f: +603-91320687

KUALA LUMPUR FOOT ANKLE CLINIC - Where are we?

2010-01-05T21:55:00.000-08:00

KUALA LUMPUR FOOT ANKLE CLINIC

(KLFAC)

PANTAI HOSPITAL CHERAS

1/96a, TAMAN CHERAS MAKMUR,

56100 KUALA LUMPUR

MALAYSIA

CONTACT US:

t: +603-91322022 ext 3333

f: +603-91320687

PLANTAR FASCIITIS - DR KHAIRUL FAIZI MOHAMMAD

2010-01-04T18:08:00.000-08:00

PLANTAR FASCIITIS

MRI of the heel showing inflammation at the heel attachment of the plantar fascia

Anatomy of the plantar fascia

PLANTAR FASCIITIS (pronounced as plantar fash-shee-eye-tis)

This is a very common cause of heel pain. It occurs when the long fibrous ligament called the plantar fascia tears and leads to inflammation at its attachment to the heel. The plantar fasia spans from the heel of the foot all the way to the toes. It acts like a bowstring to help maintain the arch of the foot. It stretches with every step that an individual takes. With strenuous and repeated activity, it may tear and lead to inflammation.

SYMPTOMS

The most common complaint is that of stabbing, burning or aching pain at the heel and may extend into the mid part of the arch of the foot. Most sufferers will experience the pain first thing in the morning when putting the foot down off the bed. This is because the plantar fascia tightens over night. Thus when applying pressure first thing in the morning, it becomes taut and pain is very acute. The pain usually wears off as the plantar fascia stretches but easily recurs.

Since it is difficult to rest the foot, the condition gradually becomes worse because it is agravated by weight bearing.

Plantar fasciitis is a condition the usually subsides spontaneously in 95 per cent of individuals after a period of 12 to 18 months. However it is difficult to predict how long the symptoms will last for each individual. The diagnosis is made clinically and can be confirmed by Ultrasound or Magnetic Resonance Imaging (MRI).

TREATMENT

NON SURGICAL

There are so many modalities of treatment for plantar fasciitis but no actual cure for it. Therefore treatment options are aimed at alleviating symptoms whilst the condition resolves spontaneously.

The KUALA LUMPUR FOOT ANKLE CLINIC (KLFAC) offers an integrated approach to the treatment of plantar fasciitis. We can therefore select the treatment of combination of treatments that best suits the individual.

We offer the full range of treatment for plantar fasciitis including physiotherapy, ultrasound guided injections, orthoses and taping.

SURGICAL

In a very small number of individuals, surgery may be considered if the symptoms of pain persist after a period of 12 months. The operation involves releasing the plantar fascia and a small nerve which can be trapped and leads to the symptoms of a burning sensation.

____________________________________________________________________

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KUALA LUMPUR FOOT ANKLE CLINIC (KLFAC) - DR KHAIRUL FAIZI MOHAMMAD

2010-01-01T09:51:00.000-08:00

DR KHAIRUL FAIZI MOHAMMAD

BMedSci(Hons), BMBS(Nottingham), MRCS(Edinburgh), MSOrth(UKM)

CONSULTANT FOOT AND ANKLE SURGEON

The Kuala Lumpur Foot Ankle Clinic (KLFAC)

was inaugurated on January 4, 2010.

CENTRE OF EXCELLENCE

This centre is lead by Dr Khairul Faizi Mohammad, a very experienced Consultant Foot and Ankle Surgeon who can provide a comprehensive diagnosis, selection of treatment and surgery and physiotherapy.

The focus of this centre is to provide the safest and most advanced treatments options to deliver maximum recovery of mobility to our patients. The specialist expertise of Dr Khairul in the Kuala Lumpur Foot Ankle Clinic (KLFAC) is essential to successful diagnosis and treatment.

With 28 bones in the foot and over 100 operations, this is a highly complex field which is relatively new in Malaysia.

The Kuala Lumpur Foot Ankle Clinic works closely with leading medical research departments and expert medical suppliers in the development of newer treatment options. This enables us to treat foot and ankle disorders where previous treatments have failed.

Situated in along the middle ring road in Cheras, Hospital Pantai, Cheras is part of the public listed Pantai Group of Hospital and provides some of the most up to date hospital facilities in Malaysia:

four operating theatres

200 beds

physiotherapy

MRI, CT scan

DIRECTIONS

It is strategically located in Taman Cheras Makmur, Cheras. Situated at the intersection of the Middle Ring Road (MRR2) and the Cheras Highway. There is ample parking on the premises of the Hospital.

CLINIC TIMES

SUITE 21, 3rd FLOOR, HOSPITAL PANTAI, CHERAS

Monday to Friday (0900 - 1300)

afternoons by appointment only

CONTACT US

+603-91322022 ext 3333

(CLINIC NURSE MANAGER)

drkhairulfaizimohammad@gmail.com

khairul_mohammad@yahoo.com

SHOES FROM THE PERSPECTIVE OF A FOOT AND ANKLE SURGEON - DR KHAIRUL FAIZI MOHAMMAD

2009-09-23T03:28:00.000-07:00

Shoes are an important part of maintaining the overall health of your feet. Many patients’ foot and ankle problems stem from faulty or improper shoes. Shoes can also be an integral part of the recovery of a patient in the post operative phase of treatment.

Running shoes are the most comfortable and convenient shoes available. A running shoe provides a superior balance of lightweight material, excellent shock absorption properties in the midsole and a generous toe box. Just like our bodies, a shoe has a specific anatomy to understand.

Shoe Anatomy

Toebox: The area in the front of the shoe containing the toes. The size of the toebox is important to accommodate bunions, hammertoes, and other maladies. Having adequate space can decrease the friction and irritation from these problems. Toebox design varies from model to model. Some models are specifically made deeper and wider to accommodate various foot shapes.

Vamp: This is the area of the shoe where the laces are found. Lacing pattern can affect how the shoe fits. Some people experience impingement of nerves and tendons on the top of their foot if the laces are not in the proper place. The best way to see if this will be a problem is to try the shoes on and test them. There are alternative methods to lace shoes up that can help prevent the heel from slipping during ambulation/running or relieve pressure points that can result from a high instep.

Insole: The bottom inside portion of the shoe that is in direct contact with the foot. Most shoes have removable insoles that aid in creating space when prescriptive inserts or orthotic therapy is needed. Good insoles are made from compressible foam that will mold to the contours of your feet. It should be noted, however, that most insoles that come with shoes will break down a lot faster than the shoe itself. There are a large variety of over-the-counter shoe inserts that can aid in prolonging the comfort and life of the shoe.

Outsole: This is the portion of the shoe in direct contact with the ground. The traction pattern and materials of the outsole are specific for the playing surface. For example, a court shoe will be flat and flexible with a lot of traction, while a trail-hiking shoe will have a more rigid outsole with more aggressive traction pattern.

Midsole: This is the layer that lies between the insole and outsole. Most of the technology of shoes is focused on this area. The majority of the midsole contains ethylene vinyl acetate (EVA) foam, polyurethane foam or a combination of the two (dual-density midsole). EVA foam provides better cushioning but has less durability than polyurethane. In addition to foam, many companies have their own cushioning systems, such as air bladders, honey-comb cut foam, shock-absorbing gel materials and various other high-tech materials.

The support of the shoe is very much based on the construct of the midsole. In the past, there was a tradeoff when it came selecting between support and cushioning. In general, it used to be that the more supportive midsoles resulted in a heavier and less cushioned shoe. Today, knowledge of foot function and advances in materials and shoe design has blended together to produce shoes that offer maximum support without sacrificing cushioning or weight. Some shoes contain different densities of foam or more rigid devices (such as plastic heel plugs) in the midsole that aid in controlling abnormal foot motion.

It should be noted that midsole cushioning can be too soft, leading to maximum compression of the material, which can in turn result in a loss of support. Also, with less cushioning comes less shock absorption-less shock absorption is linked to degenerative changes in joints and low back pain. Finally, one needs to be aware that the use of orthoses in shoegear with extremely soft midsoles may decrease their ability to control abnormal motion.

Heel Counter: The heel counter wraps around the back of the heel and acts to stabilize the heel and aid in motion control.

Sole: The sole refers to the insole, midsole and outsole combined.

Upper: The upper holds the foot to the sole and is generally the most aesthetic part of the shoe (colorful, company logo, etc). One should be warned… while how a shoe looks is important; it should never take precedence over the function of a shoe. The fact is that the “look” of a shoe will not prevent injuries associated with improper fit or function. The good news is that most companies are designing great shoes with a decent blend of support, cushioning and style.

MERDEKA! MERDEKA! MERDEKA!

2009-08-31T08:02:00.000-07:00

Malaysia most famous iconic image of Tunku Abdul Rahman declare independence from the British at Stadium Merdeka on Aug 31, 1957.

Information Department of Malaysia photographer Ng Weng Hong, was the one who took the iconic picture of the Tunku raising his hand to proclaim the nation’s independence at the stadium.

ANTERIOR ANKLE ARTHROSCOPY - DR KHAIRUL FAIZI MOHAMMAD

2009-08-31T07:32:00.000-07:00

Panoramic view of the ankle joint.
(to the left is the medial malleolus and to the right is the tip of the fibula (lateral malleolus). This is a combination of ankle arthoscopy pictures taken and put together to give the whole picture)

This is a procedure being performed during the ankle arthroscopy
(a pneumatic burr is inserted via one of the portals to remove a meniscoid lesion within the ankle joint)

This is how I perform an ankle arthoscopy

Arthroscopy - arthro (joint), scopy (to look at view telescope)

Arthroscopy of joints such as the knee, shoulder and hip are pretty well known in orthopaedic practice. It allows orthopaedic surgeons to make diagnosis via direct visualization of the joint and perform therapeutic procedures should the need arise.

In Foot and Ankle Surgery, this procedure allows me to looking into the ankle and subtalar joints should the need arise. It is very new and the instrumentation used are different than that of the other joints mentioned above.

In addition to the joints being scoped (medical jargon for looked at), the tendon tunnels and sheaths can also be looked at in the area of the foot and ankle.

Should you have pain in your ankle after an injury or for any other reason, consult your consultant foot and ankle surgeon.

Foot and Ankle Deformities - BFM 89.9 Interview Dr Khairul Faizi Mohammad

2009-08-15T04:43:00.000-07:00

Interview at BFM 89.9fm

To listen to the interview, click below:

http://www.bfm.my/Foot-Ankle-Deformities-Khairul-Mohamad-Orthopaedic.html

CHARCOT ANKLE - TREATMENT - DR KHAIRUL FAIZI MOHAMMAD

2009-08-15T04:09:00.000-07:00

post operative xrays showing an intramedullary nail
(views from the side)

Intramedullary nail inserted from the heel to the tibia
(views from the front)

Side view of the ankle and foot
(normal alignment has been restored)

Views from the front
(The deformities prior to surgery has been corrected. The swelling of the joint has resolved)

The treatment of Charcot Arthropathy of the ankle is fraught with complications. Most of the modes of treatment is salvage by amputation. Various other methods of limb preservation surgery has been performed such as with external fixators and casting.

Problems associated with surgical intervention is the inability of the bone to unite and infection.

One mode of treatment which I perform for selected patients with this condition is called tibiotalocalcaneal fusion. This is performed by inserting a metal rod through the heel into the tibia in a retrograde fashion. This realigns the ankle and subtalar joint and provides a stable post which one can walk on.

There is lost of motion at the ankle and subtalar joint after the procedure as these joints are fused. Of all the patients who have had the surgery, all were happy with the outcome and function.

CHARCOT ANKLE - RADIOGRAPHS - DR KHAIRUL FAIZI MOHAMMAD

2009-08-15T03:06:00.000-07:00

Xray of the ankle from the side.

(note the complete destruction. The ankle joint has completely disappeared. The talus has been totally destroyed leaving only the head. There is evidence of bone shards in the the synovial lining that we can seen on the xrays)

loss of alignment of the ankle joint seen on the xray.
(the ankle joint is completely destroyed)

Normal Ankle Xray.

(the left is an xray taken from the front and the right from the side)

Radiographs of an ankle that is affected by Charcot Arthropathy depends on the chronicity of the problem. Deformity and loss of normal alignment is the first this that strikes one's mind. Complete destruction of the ankle joint and the surrounding joints such as the subtalar joint and midtarsal joints maybe evident. We should also look for evidence of osteomyelitis (infection of the bone). This is very important, as this needs to be removed to prevent infection.

Charcot arthropathy is very difficult to clinical differentiate from septic arthritis (infection within the joint). Very frequently one can be mistaken for the other. Another investigation to help differential the two is a technitium 99 bone scan.

The diagnosis of Charcot arthropathy is made by a combination of clinical impression, radiological investigations (plain xrays and bone scan) and a positive finding of bone shards in the joint synovium (joint lining).

DIABETIC CHARCOT ARTHROPATHY OF THE ANKLE - DR KHAIRUL FAIZI MOHAMMAD

2009-08-15T02:33:00.000-07:00

deformity of the ankle due to Diabetic Charcot Arthropathy

Lateral view of the ankle showing the ankle joint sagging posteriorly. This deformity is hypermobile and painless. The patient is a longstanding sufferer of Diabetes.

Diabetes is a common problem in Malaysia. It is common confounded with problems to the eyes, kidneys and heart. It also leads to a loss in sensation to the feet which leads to ulceration and destruction of the joint in the feet called Charcot Arthropathy.

This condition leads to a progressively painless, derformed, hypermobile and unstable foot. As our feet are the post on which we stand on, these characteristics causes loss of the normal mechanics of the feet. This will lead to high contact pressures on areas in which are not use to pressure. Repeated trauma to these areas may subsequently lead to ulceration, infection and eventually osteomyelitis (infection in the bone).

FACES OF LUDHIANA (in the state of Punjab)

2009-04-07T18:38:00.000-07:00

The many pleasant faces of the people of Ludhiana.

BACK AGAIN!

2009-04-07T18:35:00.000-07:00

Its been a fantastically busy 2.5 months and I am back!

I will be putting more information into the blog soon.

Stay tune!

HAPPY CHINESE NEW YEAR

2009-01-20T22:16:00.000-08:00

This picture reminds me of Chinese New Year. The vibrant red hue. Fantastic!
(Street market, Pusan, South Korea 2006)

I would like to wish everyone a very Happy Chinese New Year.

Lets make this a healthy and prosperous year for everyone.

Dr Khairul Faizi Mohammad

Consultant Orthopaedic Surgeon
Specializing in Foot and Ankle Surgery, Advanced Trauma Reconstruction

Clinic Schedules:

Universiti Kebangsaan Malaysia Medical Centre Monday, Friday (0900 - 1300)
tel: +603-91455555 (orthopaedic clinic)

Pantai Hospital Cheras (visiting consultant) Wednesday (0900 - 1300)
tel: +603-91322022 (ask for Nurse Sheila Kaur)

Alpha Specialist Centre (visiting consultant) Monday, Friday (1400 - 1630), Saturday (0900 - 1230)
tel: +603-61418533 (ext 727)

INJECTIONS INTO THE ANKLE - DR KHAIRUL FAIZI MOHAMMAD

2009-01-13T20:04:00.000-08:00

Injections into the joint have been performed by doctors for diagnostic and therapeutic purposes for a long time. Almost all joints of the body can be injected. The main joints that are easily injected are the knee and shoulder joint.

The ankle joint is another joint that can be injected. It is rarely done due to the intricate anatomy and small joint space which makes the procedure more difficult that the joints mentioned above.

This procedure can be performed to inject high molecular weight hyaluronic acid for arthritis, local anaethetics for diagnotic purposes and radio-opaque dyes to outline the joint. I personally do not recommend injections of steroids into the joint as it has adverse effects to the cartilage.

Below is a video of how I perform the procedure.

TOWER BRIDGE, LONDON

2009-01-06T21:38:00.000-08:00

Tower Bridge, London.
Still under maintainence?
Hmmm, I'm always there when its under maintainence or has it never been right?

The City, London.
London's financial district. In the background is Canary Wharf. IMHO not many lights on in the background. Financial crisis maybe??

SO WHAT'S SO SPECIAL ABOUT IT?

2009-01-06T20:46:00.000-08:00

Comminuted fracture of the distal 1/3 of the tibia. The fibula is at a level slightly higher than the tibia.

Lateral radiograph of the tibia and fibula. The foot is rotated and the fracture is oblique and unstable.

Insertion of the specialised locked compression plate through a small skin incision after adequete fracture reduction.

Specialised locked screws were inserted through stab incisions to complete the minimally invasive plating method.

Fracture reduction seen on flouroscopic imaging intra-operatively.

Fracture reduction seen on flouroscopic imaging intra-operatively.

Specialized cloverleaf locked compression plate

Specialized distal tibia metaphyseal locked compression plate.

I advocate minimally invasive plating procedures where possible such as in the distal tibia because it is easier to control rotational and angular deformities. There have been a few published articles regarding this method. In an unpublished series of 120 patients that i have done over the pass 3 years, we have not had any bones that did not unite. We have had superficial skin infections up to a period of 5 months post operatively which was not related in anyway to the initial surgery. Results have need just as good as the intramedullary nail without the complications associated with the nailing technique.

Post operatively, in patients with non osteoporotic bone, weight bearing will be allowed as early as 3 weeks. In my series of patients, bone union rate is on average 8 weeks.

Why can we do minimally invasive plating now?

Well this is mainly because of the changing technology and understanding of fracture fixation. These fractures are being treated by methods of relative stability whereby the fracture is bridges by specialized locking plates. These plates have mechanical advantages over the conventional plates of previous years. Now that the knowledge of maintaining the fracture biology is being adhered to, without making an incision over the fracture site (which preserves the nutrients for fracture healing), bony union rates in theory should increase.

NB. I am speaking from my experience of these fractures and do not represent the whole orthopaedic community. All I am saying is that in my hands, this is what I will most probably do.

PROBLEMS FACED

2009-01-06T00:25:00.000-08:00

Plaster of Paris

Intramedullary Nail

External fixator

Slide 3

The problems faced in the management of these fractures are:

1. The fractures are highly unstable. This renders techniques of Plaster of Paris not suitable.

2. Intramedullary nail techniques

This technique has lead to problems of anterior knee pain for patients who kneel down on a regular basis. The nail is a semi-rigid device and may lead to fracture displacement leading to malunion and even delayed union.

3. External Fixation

Pin tract infection and non union are possible complications of this method of treatment for this particular fracture.

4. Open insertion of plates

The soft tissue (skin) is tenuous. The skin will have difficulty in healing and may subsequently become infected.

MINIMALLY INVASIVE DISTAL TIBIA FRACTURES FIXATION

2009-01-05T23:19:00.000-08:00

Radiograph of a distal tibia.

Slide 2

Fractures of the lower end of the tibia are very challenging to treat. They comprise of 7.2 per cent of all tibia fractures. Its is mainly due to high energy trauma. The main problems associated with the treatment are its close proximity to the plafond (ankle joint) and the thin soft tissue envelop surrounding the bone.

Insertion of fracture plates can be performed in various places in the body but we will just focus on the region of the foot and ankle for this matter.

MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO)

2009-01-02T19:00:00.000-08:00

Clinical picture showing healed small incisions for the insertion of the plate and screws

The radiograph of the tibia post operatively

The preoperative radiographs. Shows a very comminuted fracture of the tibia and fibula. This is a very unstable fracture with large soft tissue damage from a high velocity injury.

Preoperative radiographs (Lateral view)

Now that's a mouthful to say. In simplistic terms, it means putting in a plate for fractures in the least-most invasive manner ie minimal trauma to the skin and tissues within the fracture area.

In Malaysia, I have been performing MIPO for fractures since 2005. We currently have one of the largest unpublished series of MIPO for the fractures of the tibia (distal end (around the ankle)) in the world.

I will elaborate more on this in my coming scribblings.

KFM

HAPPY NEW YEAR

2009-01-02T18:37:00.000-08:00

Davos, Switzerland. December 2008

Land of the World Economic Forum and the AO Foundation

I would like to wish everyone a very Happy New Year and let's keep healthy!

KFM

COMPLICATIONS

2008-11-21T00:08:00.000-08:00

Complications of surgery include:

Incomplete excision leading to recurrent symptoms

Fracture of the calcaneum

Rupture of the Achilles tendon

Surgical wound infection

Shortening of the calcaneum (if osteotomy performed) and decreased toe off power

ENDOSCOPIC HAGLUND DECOMPRESSION WITH FLUOROSCOPIC GUIDANCE

2008-11-20T23:19:00.000-08:00

Endoscopic Haglund Decompression. (A) Small incision portal

(A) Haglund bump being burred endoscopically with the assistance of fluoroscopy (xray).

Endoscopic picture of the inflammed retrocalcaneal content

OPEN HAGLUND DECOMPRESSION

2008-11-20T23:04:00.000-08:00

Incision for an open Haglund decompression

Bone and bursa removed during the decompression

Immediately post operative picture.

TREATMENT

2008-11-20T22:55:00.000-08:00

Radiograph of the foot post operatively. The Haglund bump (A) and calcific deposits (B) in the Achilles tendon had been removed.

TREATMENT

The treatment of Haglund Syndrome can be divided into non surgical and surgical methods. In the majority of cases, treatment starts non surgically. Surgical treatment will be offered should the symptoms do not respond to non surgical means.

a) NON SURGICAL TREATMENT

The primary cause of the pain is shoewear and pressure over the back of the heel. The first obvious approach would be not to wear shoes with counters such as slippers. If shoes are to be worn, silicon padding could be applied over the counters to provide a softer area to prevent attrition.

Other modes of treatment are aimed to decreasing the inflammation of the surrounding area and Achilles tendon. This can be done with non steroidal anti-inflammatory medication, wax therapy and ultrasound. Trancutaneous electro nervous stimulation could be applied for pain relief.

If the symptoms are not relieved by these means and there are signs of mechanical impingement such as a large Haglund bump and calcification within the Achilles tendon, surgical intervention may be warranted.

b) SURGERY

The main aim of surgery is to relieve the pressure over the back of the heel by reducing the prominence. This may be done by removing the Haglund bump or by performing a calcaneal wedge osteotomy. With time, the thicken tissue over the back of the heel with shrink to its normal size.

REMOVAL OF HAGLUND BUMP

The Haglund bump may be removed surgically by two methods: open (via an incision) or endoscopic (small incisions). In both modes, a portion of the bump is removed and reshaped to prevent impingement onto the Achilles tendon. The retrocalcaneal bursa and space are thoroughly debrided. In patients with calcified Achilles tendons, an open method of excision would be appropriate to remove the calcification within the tendon.

After the operation, the incisions will be sutured and the foot wrapped in soft bandaging. A half plaster cast would be applied to prevent excessive movement and for pain relief.

WHAT SYMPTOMS WILL I HAVE AND HOW IS THE DIAGNOSIS MADE?

2008-11-20T22:34:00.000-08:00

Radiograph of the foot pre operatively. (A) Calcified Achilles tendon ((B) Haglund bump.

SYMPTOMS

The main symptom is pain over the back portion of the heel. Initially this occurs when this area of swelling rubs on the rigid counters of the shoes. As the swelling increases, the pain may extend into the Achilles tendon. In severe cases, this may lead to wasting of the calf muscles and also rupture of the Achilles tendon.

DIAGNOSIS

The diagnosis begins with a complete history taken by the Orthopaedic Surgeon and physical examination. The condition is quite obvious with a swelling at the back of the heel with or without signs of inflammation. A radiograph of the heel will be taken to ascertain the shape of the calcaneum, presence of a Haglund bump and calcification within the Achilles tendon. Other causes of heel pain will also need to be excluded.

ANATOMY – which part of the foot is affected?

2008-11-18T19:26:00.001-08:00

Figure 1. Radiograph of the Heel (calcaneal bone)

(on the upper surface of the heel is a bony protruberence called the Haglund Bump aka "pump bump". At the back of the heel, the achilles tendon attaches and we can see calcific deposits or spurs into the attachment area. In between these two structures, lies the retrocalcaneal bursa.)

ANATOMY

The heel contains the largest bone in the foot called the Calcaneus. At the back part of the calcaneus is the attachment of the Achilles tendon. This large tendon is very strong and aids in walking and jumping. The retrocalcaneal bursa lies between the Achilles tendon and the calcaneus. It is a fluid filled sac which allows the tendon to glide smoothly over the calcaneal bone. Bursae can be found all over the body where tendons slide over bone.

The Haglunds syndrome occurs when the retrocalcaneal bursa is inflamed due to repeated pressure on the back of the heels by shoes. The bursa and the Achilles tendon are impinged between the Haglunds bump and the shoes. This leads to inflammation of these structures, swelling and pain. With repeated impingments, the Achilles tendon may calcify at its attachment with the calcaneus. This inherently weakens the tendon and predisposes it to ruptures.

HAGLUND SYNDROME

2008-11-18T19:13:00.000-08:00

Figure 1. (A) Swelling at the heel causing inflammation and pain.

INTRODUCTION

Haglunds syndrome is a very common cause of heel pain in the population. It results in swelling, pain and the inability to wear shoes. This condition may affect any age group. It mainly affects people who wear shoes with rigid counters. This condition is very debilitating as it limits ones ability to walk properly.

DOES YOUR HEEL HURT AND LOOK LIKE THIS?

2008-11-10T20:59:00.000-08:00

Bump at the heel that rubs on the shoe. It may be inflamed, causes pain and affects walking.

MORE TO COME ON THIS.....

ITS BREAK TIME!!

2008-11-10T20:18:00.001-08:00

Early signs of rotational deformity of the big toe and early clawing of the lesser toes

(Picture taken of a statue in Berlin, Germany 2007.)

Bronze foot with sandal
Picture taken at National Museum, Riyadh, Kingdom of Saudi Arabia 2008

(2-3 century AD. Qaryat al-Faw, King Saud University,
Kingdom of Saudi Arabia)

HALLUX VALGUS (part II)

2008-10-17T19:49:00.000-07:00

Custom made medial arch support insole

Flat foot (obliteration of the medial arch)
Bunion (swelling at the base of the big toe)

PRECAUTIONARY MEASURES

In the early stages, certain measurements can delay the evolution of Hallux Valgus:

To avoid the high-heeled shoes
To avoid the pointed shoes with the front one
For those with the flat feet: a plantar orthosis with a support of arch.

However in the later stages, there is side luxation of the tendons. This results in a gradual pull leading to the deviation of the big toe.

For comfort, it goes without saying a rather broad shoe which corresponds to real width of the forefoot is recommended. Shoes made of soft leather will be most comfortable. Shoes can also be stretched to enlarged the shoebox. It is also necessary to avoid if possible shoes which have a seam right in the vicinity of the bunion.

In early Hallux Valgus, the pain may be due to stretching of the joint capsule. This can be partly relieved by a toe separator worn in the evening. In the advanced cases, the capsule is stretched so much that it is not sensitive any more.

Occasionally the bunion becomes inflammed. This is mainly due to it rubbing with shoewear. In such cases a change of shoewear and application of ice may releave it.

Current surgical methods have had excellent result. It corrects the deformity, alleviates the pain and allows for the application of normal shoe ware again.

SURGICAL TREATMENT

The surgery for Hallux valgus has had a bad reputation in the pass. There are over 150 different types of surgery for Hallux valgus. SOme have had better results than others.

Multiple variables must be taken into account for an effective surgery with less chance of recurrence. This includes:

The clinical stage
The age of the patient
The degree of deviation of the big toe
The angle between the 1st and the 2nd metatarsal bone
Relative lengths of 1st and 2nd metatarsal
The slope of the head of 1st metatarsal (DMAA) and particular anatomy of the head of this metatarsal
Osteoarthritis, arthritis.
Hypermobility of the 1st ray
Lesser toe deformities

Essentially, the principles of surgery involves correction of soft tissue imbalances causing the deforming forces to deviate the toe and osteotomies to realign the metatarsal. One example of the surgery is the Scarf Osteotomy.

Pre operative radiographs

Post operative radiographs
(The Scarf Procedure has been performed to the 1st metatarsal with soft tissue release to correct the Hallux valgus deformity. A Weil Osteotomy was performed to the lesser toes to realign the toes and correct the deformities)

Two weeks - post operative appearance

Six weeks - post operative appearance

(correction of the Hallux valgus deformity. The bunion has been excised. Surgical scar well healed)

COMPLICATIONS

Swelling and Stiffness: This is usually temporary. The swelling will resolve after a period of approximately 8 weeks and physiotherapy will be started as soon as 2 weeks to prevent stiffness.

Poor fixation and fractures: rare if the osteotomy is fixed in a solid way, but more frequent if fixation is doubtful or non-existent. The rate is higher if the patient is osteoporotic.

Infections: rare (approximately 1 per cent). This for patients not-diabetics with a good peripheral circulation. Diabetic patients have a higher rate of infection but this is minimized with pre operative preparation and antibiotics.

Non-union and avascular necrosis: This is very rare but may occur if overzealous soft tissue release is performed.

Chronic regional pain syndrome: very rare. This can occur after any type of surgery or fracture. The foot becomes overtly sensitive and goes through changes in temperature. This condition requires physiotherapy and patience because it lasts several months.

HALLUX VALGUS

2008-10-15T06:45:00.000-07:00

(Radiograph of the foot with Hallux valgus)
(note that the big toe is deviating to the lesser toes. The 2 small bones (sesamoids) underneath the big toe are not longer in their normal position. The joint of the big toe (1st metatarsal phalengeal joint) is not congruent)

This is a condition where the big toe deviates towards the lesser toes and rotates outwards. This condition is commonly associated with a prominence over the base of the toe called a “bunion”. This deformity can be accentuated by inflammation due to rubbing of shoewear. The general incidence of Hallux valgus in the population is 2 – 4 per cent. This is the same for population wearing shoes and barefooted. However, the incidence increases to 48 per cent with those wearing small pointed high healed shoes. The incidence of Hallux valgus is higher among women. It can also occur in childhood where the condition is hereditary and transmissible by the mother with variable genetic penetrance of 72 per cent. The usual form has an undeniable family tendency.

FORMS

COMMON FORMS

There is frequently a combination of these factors: a certain family tendency and the deformation which gradually increases during the years to shoewear.

• Youthful forms (which thus occur during childhood)

The genetic factor is paramount. These are often severe with the deforming forces of shoewear.

• Arthritic forms

The degradation of the capsule and the ligaments leads to malalignment. This results in inflammation of the joint involved with Hallux valgus.

RARER FORMS

• Post-traumatic

Hallux valgus can occur after an accident which has rupture or divided the articular capsule. It can also occur in post traumatic disorders leading to flat feet. The overuse of the extensor halucis tendons will lead to hallux valgus.

• Neurological

Hallux valgus can appear because of the paralysis of certain muscles, or the spasticity of other muscles generating a muscular imbalance.

PROBLEMS WITH THE BIG TOE (HALLUX)

2008-10-13T00:28:00.000-07:00

(Hallux varus - the big toe (left side) deviates towards the other foot. The lesser toes are also deformed due to Rheumatoid arthritis)

(Hallux Valgus - the big toe deviates towards the lesser toes)

The foot is a very important organ of the body that is poorly understood. Problems with the toes are very common and can be due to either pain or deformity. This can subsequently lead to problems of footwear, ulceration, decrease ability to walk and imbalance.

The increase in incidence is attributed to high-fashion foot wear and is predominantly seen in females. The incidence is relatively low in the male population. While ill fitting shoes may contribute to the majority of problems, other associated conditions with toe deformities include inflammatory arthritis, trauma, congenital deformities and neuromuscular disorders.

Inflammatory arthropathies such as rheumatoid arthritis, gout, psoriatic arthritis, systemic lupus erythematosis and non specific synovial inflammatory disease may be precursors to deformities of the toes. Isolated or repeated trauma may lead to deformities such as mallet toe, hammer toe or Frieburg infarction. Congenital deformities include crossover little toe, contracted lesser toes and malalignment of metatarsophalengeal joint. Neuromuscular disorders that lead to toe deformities include muscular dystrophies, Charcot-Marie-Tooth disease, poliomyelitis and even lumbar disc disease.

The toes can be broadly divided into the Hallux (Big toe) and Lesser toes (other smaller toes). Common deformities of the hallux include hallux valgus, hallux varus and halux rigidus.

WELCOME

2008-10-07T16:59:00.001-07:00

(bony structure of the foot and ankle of a prehistoric woolly mammoth.)
Pic taken at the National Museum, Riyadh, Saudi Arabia

Welcome to this site. The main aim of this site is to create public awareness regarding foot and ankle problems and the solutions available. This area of the body has not been given due attention as the technology and knowledge is increasing by the day. Therefore, I would like to share some of this information with you. Cheers. Happy reading.

(some of the images maybe graphical and not suitable for all.)