This is a condition usually involving the interval between the 3rd and 4th toes, where there is a burning sensation in the foot. The pain may be difficult to localise; many patients speak of the pain beginning without obvious cause and relate a burring pain with radiation of this pain to the interval between the 3rd and 4th toes.
Occasionally the interval between the 2nd and 3rd toes is involved.
Usually, treatment is non operative, with injections, changes to footwear and podiatry. Where such treatment is ineffective, you may be referred to see A/Prof Miniter who will perform a careful physical examination and then advise you of the most appropriate method to manage this problem.
Surgery if needed is performed as a day only case but you do need to rest after surgery and will need some time off work, usually a week to 10 days.
This is a condition where a patient presents with pain under the ball of the foot. The pain usually develops slowly and may involve just one ray, such as the second, or may involve a number of regions.
The usual treatment for this condition is non operative: this will include shoe wear changes, special orthoptics and so on, but where non operative treatment is unsuccessful, you may be advised to consider surgical treatment.
Diabetic foot care
Diabetes is an increasingly significant problem in our community. One of the long term effects of diabetes is the loss of feeling that occurs in the feet.
This is a gradual process and will often catch patients unawares. Many are not even conscious of the gradual and almost imperceptible loss of sensation that occurs over months and years.
This loss of sensation is called diabetic neuropathy. It occurs more commonly in patients with less adequate diabetic control . If you are diabetic, it is one of the most significant issues in the long term.
If your diabetic control is poor, you are more likely to experience this problem.
If you are diabetic, you should be proactive with your diabetic care. Do not take it for granted and make sure that you see your GP regularly; your GP should check your overall control in various ways; there are blood tests such as HbA1c. He should also examine your feet and make sure that your sensation ( feeling) is regularly checked.
If your sensation is starting to be an issue then it is wise to see a Diabetic Clinic. A clinic such as this is run at The Canberra Hospital and A/Prof Miniter is involved in this clinic regularly.
In this clinic, you will be reviewed by a multidisciplinary team; this includes, amongst others podiatrists, endocrinologists, vascular surgeons, orthopaedic surgeons, physiotherapists, diabetic nurses. It is a one stop shop for those that need integrated care of this sort.
When the sensation in your foot is abnormal, you may not be able to sense that a injury is taking place. This is called “ protective sensation” and is crucial to prevent us damaging our bodies.
If you have significant diabetic neuropathy, with the loss of feeling that accompanies this, then you may start to experience swelling in the foot after what seems to be inconsequential injury. There may be no injury.
If the matter is more significant then the foot may adopt an unusual posture as various soft tissues and then joints collapse. The foot may become deformed and ulcers develop.
This sequence of events is a very serious issue. It may lead to the loss of the limb through amputation if not managed quickly and professionally. This is the place for a multidisciplinary team who are well equipped through experience to assess the foot and then recommend treatment if needed. Such treatment requires optimal diabetic control and may also require the application of a total contact cast for immobilisation whilst the foot is allowed to heal. It is a slow process but surgery is not usually needed where early intervention is undertaken.
When is surgery an option?
Where non operative treatment has failed and where serious deformity is present. Such deformity may cause ulceration and infection.
A/Prof Miniter is well placed to discuss such issues with you if this occurs. He sees diabetic patients in his office and also in the clinic at TCH.