Sore and aching feet – foot feformities

Generally

Pain and deformities in the feet is a very common problem and together with low back pain are the most common symptoms of orthopedic conditions. Most people will suffer from foot pain at least once in their lifetime.

Foot conditions can affect all ages in both sexes, including flat feet in children and Achilles tendon and ankle problems in athletes, and deformities of the joint of the big toe (bunion -“Hallux Valgus”, Hallux Rigidus) and clawing and overlapping toes in older ages.

At OSTEON Orthopedic Clinic, all diseases and deformities of the foot are treated by Dr. Panagiotis Symeonidis, the head of the Ankle and Foot Department, one of the few orthopedic surgeons specializing in foot conditions in Greece.

The philosophy of Dr. Symeonidis is the individualized treatment of each problem regarding patient’s feet, using the full range of conservative treatment and surgical techniques. The patient is fully informed about the condition of his foot, the treatment options and the rehabilitation in each case.

Why are foot problems so common?

Our feet have a hard job to do. They carry our weight for a lifetime, taking thousands of steps every day and more than a million during a year. There are activities, such as jumping or stair climbing, in which the weight carried by the feet is multiple of our body weight in a state of immobility. If during this strain we take into account factors such as long-term use of inappropriate footwear, extra body weight, excessive activity and prolonged standing, feet become weak and easily fatigued and then problems arise.

How important is the shoes we wear?

The more inappropriate the shoes we wear, the greater the chances of developing a foot problem. An example is women, for whom fashion imposes narrow shoes with high heels. Prolonged use of high heels either causes or worsens foot deformities. Especially for women, high heels are co-responsible for deformities, such as bunions “Hallux Valgus”. For this reason this condition is more common in women than in men.

But, there are other examples as well. Athletes, wearing inappropriate footwear for their sport or worn shoes, will also develop foot problems sooner or later. Respectively for dancers and even more ballet dancers it is very important to choose the right shoes based on their foot type, as foot injuries are very common.

Which type of shoes should we choose?

We often see shoes advertised as orthopedic or anatomical, but this claim is not scientifically substantiated. There are many orthopedic and anatomical shoes on the market, which people trust and not only they don’t solve their foot problem, but on the contrary, often make it worse.

Those who have foot problems should consult an orthopedist, specialized in foot conditions, on what kind of shoes they should wear. For example, there are shoes with high heels which are better than others with lower heels. An orthopedist specializing in foot problems can give you the right direction for the proper type of shoes in order to maintain good foot health, without neglecting your appearance.

What about foot scans? What is their value?

In Greece there is no legal framework for purchasing and operating a foot scanner. Anyone can buy a foot scanner and start producing or selling shoe insoles. Nevertheless, the correct diagnosis of a foot condition is based on the proper clinical examination and imaging tests.

A foot scanner is at best a supplementary tool to make a diagnosis. As a rule we would use it for the design of orthopedic shoe insoles. This applies to both the static and the dynamic foot scan. However, not all patients need orthopedic shoe insoles. Currenlty in Greece there is a very large number of uncertified foot scanners, which are operated by uncertified staff.

In OSTEON, we advocate the use of dynamic foot scans, which operate under standards of scientific international certification bodies. The shoe insoles which are produced are individually crafted based on the foot of each patient, as each side of a pair of insoles for each person is never the same.

However, special orthotic insoles are not recommended, except for patients who really need them. This is something that Dr. Symeonidis will decide, after measurements in order to assess the gait of each patient.

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Symptoms

What are all these bumps and lumps on our feet, such as bunions and calluses?

Bumps and lumps on our feet, such as bunions are nothing but bones moved out of position. And this is the reason why cutting a lump is wrong, because it will reappear. When cutting a bunion we amputate a normal bone. The right way of treatment is to put the bones back into place, with operations called corrective osteotomies.

Calluses are treated in the same way. Calluses occur in areas where a bone is displaced and then the skin reacts so as not to be torn by developing calluses.

Therefore, removing calluses or cutting off any foot bumps and lumps is not a permanent solution. The right way of treatment is to put the bones back into place.

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Diagnosis

How difficult is it to diagnose foot problems?

Foot pathology includes a wide range of conditions and sometimes the diagnosis is quite difficult. We often see patients coming to our clinic after three or even four visits to doctors without a clear diagnosis, having undergone a number of investigations, such as MRI, X-ray, and foot-scan, without any result.

If the Orthopedist is not specialized and doesn’t have extensive experience and does not know his subject very well, then there is a high probability to make a wrong diagnosis.

In any case, the correct diagnosis presupposes a careful and thorough clinical examination of the patient and obtaining his medical history.

Treatment

How are foot conditions treated?

We always try to treat conservatively whatever it can be treated conservatively. Conservative treatment has not received due attention or in-depth specialization. Surgically speaking, we have to personalize the techniques based on the needs of each patient. It is a big mistake to have a couple of techniques and apply them to all patients. We need to be familiar with many surgical techniques and personalize the treatment for each foot.

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Frequently asked questions

Why do some patients hesitate to visit a foot specialist?

There are some patients who believe that their doctor will only tell them that they need surgery. This does not apply in the case of Dr Symeonidis. In many foot problems the Foot and Ankle specialist will recommend a wide range of conservative measures. Surgical solution is the final choice and it is selected only when there are no available alternative options for the patient.

There is also another group of patients who are afraid of surgery, and have personal experience or heard from people around them that foot surgeries fail and hurt. So, even though they would have tackled their problem with an operation effectively, they avoid going to the doctor who will simply tell them that they surgery is the best option for a definitive management.

Besides, unfortunately many patients are deceived by advertisements of products that appear to be miraculous for the foot and finally they buy them without having any beneficial effect.

The right choice is to trust the right doctors and solve your problem once and for all.

How dangerous are ankle conditions?

Our feet are the base of support of our entire body. If the support base bends, in addition to certain foot problems that will occur, such as pain, stiffness, swelling and deformity, this can also affect the rest of the body, causing problems in the knee, hip or waist.

Is it true that foot surgeries fail?

The truth is that foot can prove to be the Waterloo of an inexperienced surgeon. Many foot surgeries fail because they are performed on patients with a wrong diagnosis or because the doctor does not use the right technique or doesn’t have the proper training and adequate experience to perform it correctly.
A typical example is surgeries performed for cosmetic reasons. People who do not have a functional problem, end up having a surgery, although there are clear instructions from all the official scientific organizations worldwide, related to the treatment of foot problems, that surgeries for cosmetic reasons should not be performed unless there is pain or a functional problem.

Is it true that foot surgery hurts too much?

Definitely not. With the technique of regional anesthesia, a very good analgesic result is achieved, not only during the surgery but also for a long time after it. The foot remains numb for 16-20 hours after surgery, and so the patient does not need to take strong painkillers intravenously. Sensation returns gradually and when this happens, postoperative pain is already minimal.

On top of that, in foot surgeries we use materials that hold the bones together tightly. As a result, micro-movements of the bones, which cause more pain, are avoided.

Finally, we use postoperative specially made footwear so as to fit patient’s foot in such a way that it does not hurt after surgery. Thus, patient walks painlessly from the very next day.

How reliable is the percutaneous, or so-called “laser” technique?

The use of the term “laser” is misleading and has been used in a wrong way with unethical aggressive marketing, resulting in many patients having the wrong surgery. There is no laser in foot surgeries! On the other hand, indeed we use the percutaneous technique to correct some foot deformities. However, it is just one of the many methods available for an orthopedic surgeon and its success is ensured only if it is applied to the appropriate patients and if the materials used during the operation will hold together the bones. This is called internal fixation. Without the internal fixation, with which materials such as screws are used to hold the bones together, percutaneous surgery techniques have very high rates of complications, which are very difficult to be treated.

Which method is the best and safest for me?

The best and safest method is decided each time individually depending on the patient and his problem. It is extremely important the surgeon to be specialized with extensive experience in a wide range of techniques which he will apply when as required, in order for him to achieve the optimal treatment for each patient. Continuous training on new techniques and familiarization with the latest developments in medical technology is important so as to find more ways in which we can help our patients.

How common is the use of implants?

Implants are used to stabilize the bones after their restoration to their correct position, without allowing micro-movements that cause more pain. This is called internal fixation, For instance, during bunion and claw toe operations, implants such as screws are inserted. These allow the patient to get up and walk right away, minimizing postoperative pain and eliminating the risk of recurrence of deformities.

Most of the implants don’t need to be removed. There are two major categories of implants, those made of titanium, which is one of the friendliest and most inert elements, and the bioabsorbable materials. We routinely use special screws, whose head is buried inside the bone and does not protrude. Due to this technological development, removal of materials, which used to be a standard protocol, is currently performed only in 10 to 20% of the cases. However, even when the materials need to be removed, it is currently performed under local anesthesia and not with an extensive open surgery.

Finally, we avoid surgeries that allow materials to protrude from the skin, such as needles that protrude like a scaffolding, because they cause discomfort to the patient and increase the risk of infections.

What type of anesthesia will I receive?

In the vast majority of foot surgeries, regional anesthesia is performed, during which the area below the knee (popliteal block) or below the ankle (ankle block) is anesthetized.

This provides sufficient anesthesia to perform the entire operation without the patient feeling any pain. If we want to put the patient to sleep, this is done by sedation which is not performed by intubation, but by the administration of injectable, mild medication, similar to those administered during gastroscopy and colonoscopy.

Furthermore, the numbness due to regional anesthesia lasts for 16 to 20 hours after surgery, allowing the patient to get over painlessly the critical period after the operation, where normally the pain is greater. Thus, the administration of injectable or oral analgesics, is avoided. When sensation returns to the foot, the pain is then quite manageable.

In this way there is the possibility of performing operations with absolute safety in patients who, due to other health issues, are unable to receive general anesthesia with intubation.

How long does the hospitalization last?

The vast majority of patients stay in the hospital for one night. The following day the dressings are changed and the patients return home. In rare cases they may need to stay in the clinic for a second day.

When can the patient return to daily routine and work?

Many times surgeons promise a quick or immediate return to work and activities, without the patient having adequate healing or biological recovery time. This results in symptoms, complications and ultimately failures. For each operation, the time of return to activities is individualized, and this must be clear to the patient. We do not proceed with any operation without the patient being fully aware of the entire treatment plan.

Are there any postoperative complications?

Yes. There can be many complications in foot surgeries, but usually they are mild and the possibility of their occurrence is significantly reduced, provided that the right specifications are met. In OSTEON we achieve this to the greatest extent possible, operating in highly clean operating theatres in Athens Medical Group. We use the best materials for the safety of patients and take our time in order to achieve the best possible result. We do not attempt to impress by promising 10-minute surgeries at the cost of increased risk of complications. Thus, we achieve a very small percentage of complications in our surgeries.
One of the most common complications is stiffness, which we treat together with the patient and specialized physiotherapists.

Oedema (swelling) is also a very common complication after foot surgery. This can occur even in the most successful procedures, and may last for a long time before it goes away.

On the contrary, recurrence of deformities is a complication that in the right hands will occur in less than one in 10 cases. Most of the times it happens either when the wrong surgical technique is applied or the postoperative recovery is inadequate. Recurrences may also occur in patients that are not disciplined and doesn’t follow the instructions given to him.

Internationally, the recurrence rate of deformities after surgery is 10%. However, if the prescribed procedures and protocols are followed, the probability of recurrence of a foot deformity is significantly lower.

Finally, another complication is the delayed healing of the surgical wound. This can happen to smokers or patients with health problems that affect healing, such as diabetes, autoimmune diseases, etc. In these patients, a team of doctors in “OSTEON” focuses on each patient in order to reduce the risk factors before the surgery, in order to have a smooth healing process after the operation.

What happens in case of recurrence?

As a rule, relapses should be prevented. They do not occur overnight and proper monitoring of the patient will prevent a relapse and a further surgery. One of the reasons why the deformities recur is that surgeons do not follow up on the patients after surgery.

Why should the patient go to an orthopedic foot and ankle specialist?

We live in an age of specialization. In foot problems in particular, there is a wide range of pathology and treatments, both conservative – which is not widely known to the public- and operative, where many different techniques are available. Therefore, many patients who do not have a correct diagnosis and suffer from a chronic untreated condition or had a failed surgery, instead of going from one doctor to another, they can find a definitive solution if they visit an orthopedic foot and ankle specialist.

Are there many orthopedic foot and ankle specialists in Greece?

No. Specialization in foot conditions is taking place only abroad and there are very few orthopedic surgeons who have more than 6 months of specialized experience abroad, including clinical work and surgeries and not only laboratory / research work.

What is the training of Dr. Symeonidis

Dr. Symeonidis has spent many years devoted to clinical work and training in foot problems, in renowned international medical centers. He was trained by world-leading surgeons, in the United Kingdom, Germany, USA and Australia.

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