The view from singapore with British High Commissioner to ... - NUSS

Who’s at risk? Mostly individuals
who wear shoes that are tight,
narrow or a size too small, especially
women. However, some people appear
to face an inherited risk.
How it feels: A persistent or intermittent
pain around your big toe
joint, which is also restricted
in movement.
Soothe the pain! Switch to
roomier, more comfortable shoes so
that your toes have space to wriggle
around. Consider getting off-the-shelf
or custom-made padded shoe inserts
too – these distribute pressure evenly
when you move your feet and helps
provide relief.
treat the problem: Your doctor
may tape your affected foot in a normal
position to reduce stress on the
bunion. However this does not work
in the long-term. To relieve pain, you
may be prescribed medications like
ibuprofen or given cortisone shots.
“Surgery is considered only if
the bunion causes frequent pain or
interferes with your activities. Surgical
procedures, such as a bunionectomy,
involve surgically removing
the swollen tissue from around the
big toe joint and straightening it by
realigning the bone. Sometimes even
after surgery, there may still be pain
or a bunion can recur,” noted A/Prof
Inderjeet.
Morton’s neuroma
What it is: A thickening of the tissue
that surrounds the digital nerve leading
to the toes (usually the third and
fourth toes) in response to irritation,
trauma or excessive pressure.
Who’s at risk? Runners and women
who usually wear high-heeled, narrow
shoes.
How it feels: A persistent pain
in your foot that feels like you are
standing on a marble in your shoe.
In some cases, there can be a sharp,
burning pain in the ball of your foot.
Your toes may also sting, burn or
feel numb.
Soothe the pain! Change to wider
and more comfortable shoes with
softer soles so that the bones are
spread out, reducing the pressure on
the nerves. Arch supports and foot
pads may help to reduce pressure.
treat the problem: Your doctor
may inject corticosteroids into the
affected area or recommend a minimally
invasive procedure known as
cryogenic neuroablation, a procedure
which exposes the nerves to extremely
cold temperatures to temporarily
stop the transmission of pain signals.
The surgical removal of the painful
nerve may be necessary.
Wearing high-heeled,
narrow shoes is
a risk factor for
Morton’s Neuroma.
living
“Surgery is
considered only if
the bunion causes
frequent pain or
interferes with
your activities.”
A/Prof inderjeet Singh
Senior Consultant
Department of Orthopaedic Surgery
Singapore General Hospital
Achilles tendinitis
What it is: An inflammation of the
Achilles tendon (the largest tendon
in your body that connects your calf
muscles to your heel bone) as a result
of being under too much strain such
as during strenuous, high-impact
exercises like jogging.
Who’s at risk? Runners and women
who wear high-heeled shoes.
How it feels: A feeling of soreness
and stiffness at the Achilles tendon,
especially after running or climbing
the stairs. Your lower leg may also
feel weak and stiff.
Soothe the pain! Rest your feet and
apply ice on the painful area. You can
also relieve the pain in your tendons
by getting orthotics such as heel lifts
which move the heel away from the
back of the shoe so no abrasive rubbing
occurs.
treat the problem: Your doctor
is likely to prescribe NSAIDs such
as ibuprofen to help with the pain.
Treatment will also normally include
leg exercises such as calf stretches
that strengthen the calf muscles and
reduce stress on the Achilles tendon.
In severe cases, surgery, such
as gastrocnemius recession (the
surgical lengthening of the calf) or
debridement (removing part of the
Achilles tendon), and repair may be
recommended.
The article was contributed by Singapore
Health Services (SingHealth). The group
consists of the Singapore General Hospital, KK
Women’s and Children’s Hospital, National
Cancer Centre Singapore, National Dental
Centre Singapore, National Heart Centre
Singapore, National Neuroscience Institute,
Singapore National Eye Centre and SingHealth
Polyclinics. www.singhealth.com.sg
Jan-Mar 2013 THE GRADUATE 37