SERVICES
FOOT & ANKLE SURGERY
Foot and ankle surgery can treat severe arthritis, bunions, ruptured tendons, and many other conditions affecting the feet and ankles.
Surgery is considered when conservative treatment has failed, although certain traumatic injuries require urgent intervention. A strong emphasis is placed on advanced surgical techniques, particularly Minimally Invasive Surgery (MIS), allowing for smaller incisions, reduced soft tissue disruption, faster recovery, and improved cosmetic outcomes where appropriate.
Types of Foot and Ankle Surgery
The following are the different types of foot and ankle surgeries that Dr Oosthuysen performs:
1. Achilles Tendon Pathology
The Achilles tendon is a strong, fibrous structure that connects the calf muscles to the heel bone. It is the largest tendon in the body and plays a key role in walking, running, and jumping.
Achilles tendon problems are common and are generally referred to as Achilles tendinopathy. These conditions typically develop gradually due to overuse and repetitive strain, resulting in pain, stiffness, and reduced function. Common presentations include mid-substance tendinopathy, insertional Achilles tendinopathy, and Haglund syndrome.
Non-Surgical Management
Most Achilles tendon conditions can be successfully managed without surgery. Initial treatment focuses on:
- Activity modification
- Structured physiotherapy (including eccentric loading programmes)
- Appropriate footwear and orthotic support
- Anti-inflammatory strategies where indicated
A well-guided conservative programme leads to improvement in the majority of patients.
Surgical Management
Surgery is considered only when symptoms persist despite appropriate non-surgical treatment. Where surgery is required, Minimally Invasive Surgery (MIS) techniques are prioritised. These use small incisions and specialised instruments to minimise soft tissue disruption, reduce post-operative pain, and support a faster recovery.
Procedures may include:
- Minimally invasive Achilles tendon procedures
- Minimally invasive Zadek osteotomy for Haglund syndrome
- Burr techniques to address bony prominence and tendon irritation
When to Seek Specialist Care
Consider an assessment if:
- Symptoms are not improving despite physiotherapy and appropriate footwear or orthotics
- Pain is persistent or worsening over time
- You are unable to return to your usual level of activity or sport
- Stiffness, swelling, or weakness is affecting daily function
Early assessment allows for accurate diagnosis and appropriate treatment, helping to prevent long-term problems.
Treatment Goals
The aim of treatment is to relieve pain, restore strength and function, and allow a safe return to normal activity — whether that is everyday walking or higher-level sport.
2. Ankle Arthritis
Ankle arthritis occurs when the smooth cartilage within the ankle joint wears down over time. This results in pain, stiffness, swelling, and difficulty with walking and daily activities. Unlike hip or knee arthritis, ankle arthritis is often related to previous injury, such as fractures or ligament damage, although it may also develop with age or as part of inflammatory conditions.
Ankle Fusion (Arthrodesis)
Ankle arthrodesis involves permanently joining the bones of the ankle joint into a single, solid unit. This procedure reliably relieves pain, provides a stable and durable solution, and is well suited to patients with more severe deformity or higher functional demands. Although movement at the ankle joint is lost, most patients adapt well and are able to return to an active lifestyle.
Total Ankle Replacement
Total ankle replacement involves replacing the damaged joint surfaces with a prosthetic implant in order to preserve movement. This is a specialised procedure and is not as commonly performed as hip or knee replacement. It is not suitable for every patient, and careful patient selection is essential.
In the appropriate patient, total ankle replacement offers:
- Effective pain relief
- Preservation of ankle motion
- A more natural walking pattern compared to fusion
Choosing the Right Treatment
The decision between ankle fusion and replacement is individualised. Both procedures have excellent outcomes when appropriately indicated. The key is selecting the right procedure for each patient based on their anatomy, lifestyle, and functional goals.
When to Seek Specialist Care
Consider an assessment if:
- You have persistent ankle pain and stiffness affecting daily activities
- Walking distance and function are progressively declining
- There is noticeable deformity or instability
Treatment Goals
The aim of treatment is to relieve pain, restore function, and allow a return to a comfortable and active lifestyle.
3. Ankle Fractures
Ankle fractures are among the most common injuries affecting the ankle, typically resulting from a sudden twisting mechanism. Fractures may involve the tibia, fibula, or both, and can range in severity from minor avulsion injuries to complex, multi-fragmentary fractures.
The majority of surgical procedures for ankle fractures involve Open Reduction and Internal Fixation (ORIF) — a technique used to surgically realign and stabilise the broken bone. Stable, undisplaced fractures may be managed non-operatively with immobilisation, while unstable or displaced fractures typically require surgical intervention to restore joint alignment and prevent long-term complications such as post-traumatic arthritis.
4. Ankle Ligament Injuries and Arthroscopic Management
Ankle ligament injuries are common and may lead to ongoing instability, particularly following repeated sprains. This condition, often referred to as chronic ankle instability, can result in persistent pain, a feeling of the ankle giving way, and reduced confidence during activity.
In addition to ligament injury, patients may develop associated intra-articular problems within the ankle joint. These can include cartilage damage, loose bodies, soft tissue impingement, and osteochondral lesions of the talus.
In some patients with recurrent ankle sprains, there may be an underlying foot alignment issue — most commonly a cavovarus foot. This alters the mechanics of the foot and ankle and predisposes to repeated instability. In these cases, addressing the underlying deformity is an important part of the overall treatment plan. (See Cavovarus Foot Deformity.)
Surgical Management
When symptoms persist despite appropriate conservative treatment, surgical intervention may be considered. Minimally invasive arthroscopic techniques are utilised for the majority of these conditions, allowing a comprehensive approach to both ligament stability and intra-articular pathology, with less soft tissue disruption and faster recovery.
Procedures may include:
- Arthroscopic ankle ligament repair (e.g. modified Broström technique)
- Arthroscopic ligament reconstruction where required
- Removal of loose bodies
- Treatment of soft tissue impingement
- Management of cartilage injuries, including microfracture techniques
Addressing both ligament instability and any associated intra-articular pathology at the same time is key to achieving optimal outcomes and reducing the risk of ongoing symptoms.
When to Seek Specialist Care
Consider an assessment if:
- You experience recurrent ankle sprains or instability
- Your ankle feels weak or gives way during activity
- Pain or swelling persists despite rehabilitation
- You are unable to return to sport or normal activity
5. Bunion Surgery
A bunion is a deformity of the big toe joint, where the toe gradually shifts outward and a prominent bump develops on the inside of the foot. This can lead to pain, difficulty with footwear, and progressive deformity over time.
Importantly, a bunion is not simply a bump that can be shaved off. It is the result of forefoot malalignment, where the metatarsal bones shift out of position, leading to subluxation of the joint. Effective treatment therefore requires correction of the underlying bone alignment, rather than simply removing the prominence.
Joint-Preserving (Corrective) Surgery
In many cases, bunions can be corrected while preserving the joint. This is achieved through osteotomies (controlled bone cuts) to realign the metatarsal and restore normal joint alignment. Minimally Invasive Surgery (MIS) techniques are used, employing specialised burrs and small incisions to perform these corrections with minimal disruption to surrounding tissues.
This approach offers:
- Less post-operative pain
- Smaller incisions
- Early mobilisation, with patients typically able to weight-bear immediately in a protective shoe
- Faster recovery compared to traditional open techniques
Joint Fusion (First MTP Fusion)
In cases where there is significant arthritis of the joint or compromised bone quality (such as osteopenia), a first metatarsophalangeal joint fusion may be the most appropriate option. This procedure provides reliable and durable correction, eliminates pain from the arthritic joint, and maintains good function for walking and most daily activities.
Treatment Goals
The aim of surgery is to correct the deformity at its source, relieve pain, improve footwear comfort, and restore a natural, functional foot.
6. Flatfoot Deformity (Adult Acquired Flatfoot)
Flatfoot deformity, also known as adult acquired flatfoot deformity (AAFD) or posterior tibial tendon dysfunction, is a condition in which the arch of the foot gradually collapses over time. This occurs when the supporting structures of the foot — particularly the posterior tibial tendon and surrounding ligaments — become weakened or overloaded. As the arch drops, the foot becomes flatter and often turns outward, leading to pain, fatigue, and difficulty with walking.
Why Early Assessment Matters
Flatfoot is a progressive condition. Once the arch begins to collapse, the deformity can worsen over time if not addressed. Early assessment is important, as treatment options are more flexible in the earlier stages. Seek help if you notice:
- Progressive flattening of the foot
- Pain along the inside of the ankle or arch
- Difficulty with prolonged standing or walking
Surgical Treatment Options
Joint-preserving reconstruction — When identified early, it is often possible to restore the arch while preserving the joints of the foot. This may involve osteotomies (bone realignment), tendon transfers to support the arch, and soft tissue procedures to rebalance the foot.
Joint fusion — In more advanced cases where the deformity has become stiff or severe, joint-preserving surgery may no longer be sufficient. Correction is then achieved through fusion of selected joints in the foot to restore alignment and relieve pain. While fusion reduces movement at the affected joints, overall foot function is well preserved, and most patients experience significant improvement in pain and walking ability.
Treatment Goals
The aim of treatment is to restore the arch, relieve pain, and allow a return to comfortable, stable walking.
7. Cavovarus Foot (High Arch Foot)
A cavovarus foot is a condition where the foot has an abnormally high arch and tends to tilt inward, placing more weight along the outer (lateral) border of the foot. The heel tilts inward (varus position), and the forefoot often develops a curved appearance. These feet are typically rigid with limited flexibility, reducing the foot's ability to absorb shock during walking and activity.
Common Symptoms and Problems
- Lateral foot pain due to overload along the outer border of the foot
- Pain under the ball of the foot, particularly around the sesamoids
- Recurrent ankle sprains and instability due to the inward tilt of the foot
- Lateral ankle pain, often related to overuse of the peroneal tendons
- Difficulty with prolonged standing, walking, or sporting activity
Underlying Causes
- Neurological conditions — most commonly Charcot-Marie-Tooth disease, especially when the deformity is severe, affects both feet, and is associated with hand involvement
- Spinal pathology — which may affect muscle balance and foot posture
- Congenital (idiopathic) causes — where the foot shape develops without a clear underlying condition
Treatment Approach
Early treatment may include footwear modification and custom orthotics to redistribute pressure and improve alignment. In more symptomatic or progressive cases, surgical correction may be required, typically involving realignment procedures (osteotomies), tendon balancing, and in selected cases, joint fusion for more rigid deformities.
Treatment Goals
The goal of treatment is to improve foot alignment, reduce pain, enhance stability, and allow a safe return to normal activity.
8. Lesser Toe Deformities
Lesser toe deformities are common conditions affecting the smaller toes, usually resulting from an imbalance between the intrinsic and extrinsic muscles of the foot. Over time, this imbalance leads to progressive changes in toe position, causing pain, pressure areas, and difficulty with footwear.
These deformities rarely occur in isolation. They are often associated with underlying foot conditions such as hallux valgus, flatfoot deformity, or cavovarus (high arch) feet. Addressing overall foot alignment is therefore an important part of treatment.
Types of Lesser Toe Deformities
- Claw toes — The toes bend into a claw shape, often digging into the shoe and leading to painful calluses
- Hammer toes — The toe bends at the middle joint, causing pressure on the top of the toe
- Mallet toes — A deformity at the tip of the toe (DIP joint), which may be flexible or rigid
Surgical Management
Most lesser toe deformities can be effectively corrected using MIS techniques. These involve small incisions, realignment of the toe, and correction of soft tissue and bony imbalance. Where appropriate, correction of associated conditions (such as bunions or foot alignment issues) is performed at the same time to ensure a balanced and durable result.
Treatment Goals
The aim of treatment is to restore normal toe alignment, relieve pain and pressure, improve shoe comfort, and achieve a functional foot.
9. Midfoot and Hindfoot Arthritis
Arthritis affecting the midfoot and hindfoot occurs when the joints in these regions gradually wear down over time, leading to pain, stiffness, and progressive changes in foot shape and function.
Common Symptoms
- Mechanical pain with walking, typically worsening with activity and improving with rest
- Stiffness in the foot, particularly after periods of inactivity
- Swelling and tenderness over the top or inner aspect of the foot
- Palpable bony prominences (osteophytes), often felt as bumps over the foot
- A sensation of tightness or pressure across the top of the foot
Surgical Management
Surgery for midfoot and hindfoot arthritis primarily involves fusion of the affected joints. In simple terms, this means taking a stiff, painful joint and making it stiffer — but pain-free. By eliminating micro-movement at the arthritic joint, the source of pain is removed. Although this reduces motion at the specific joints involved, overall foot function is usually well maintained, as these joints often already have limited movement due to the arthritis.
Treatment Goals
The aim of treatment is to relieve pain, improve function, and restore a stable, comfortable foot for walking and daily activity.
10. Common Foot Pathology
A number of common foot conditions can cause pain and discomfort, often affecting daily activities such as walking, standing, and exercise.
Forefoot and Heel Pain
- Morton's neuroma — A condition affecting the ball of the foot where a nerve between the toes becomes thickened and irritated. It most commonly occurs between the third and fourth toes and can cause burning pain, tingling, or numbness.
- Plantar fasciitis — A common cause of heel pain due to inflammation of the plantar fascia (the thick band of tissue running along the sole of the foot). Pain is typically worst with the first steps in the morning or after periods of rest.
Tendon Conditions
- Foot and ankle tendinopathies — Overuse or mechanical overload can lead to tendon irritation and degeneration around the foot and ankle.
- Tibialis anterior tendinopathy — Pain over the front of the ankle and foot, often related to overuse or altered biomechanics.
Platelet-Rich Plasma (PRP) Therapy
For selected tendon conditions, Platelet-Rich Plasma (PRP) treatment is offered. PRP involves drawing a small sample of the patient's own blood, processing it to concentrate the platelets, and injecting this into the affected tendon. Platelets contain growth factors that may help stimulate healing in chronically damaged tissue. PRP is typically used where symptoms persist despite standard treatment, and can be a useful adjunct to avoid or delay surgery.
Nail and Soft Tissue Conditions
- Ingrown toenails — A common and often painful condition where the nail grows into the surrounding skin, leading to inflammation and sometimes infection.
- Ganglions and soft tissue masses — Benign lumps or swellings around the foot and ankle that may cause discomfort, pressure, or concern.
11. Tendon Transfers for Foot Drop and Foot Muscle Deficiencies
Difficulty elevating the front of the foot is known as foot drop (or drop foot). The condition typically affects one foot and can significantly alter gait. A tendon transfer involves moving a tendon from one part of the foot or ankle to another in order to restore function. This procedure can assist in treating various foot muscle deficiencies, including foot drop.
12. Paediatric Foot Pathology
Children's feet are constantly growing and changing, and it is common for them to develop aches, pains, or differences in the way they walk. While many of these are part of normal development, some conditions benefit from early assessment and treatment. Specialised care is provided for a wide range of paediatric foot and ankle conditions, with a focus on keeping children active, pain-free, and able to enjoy their daily activities.
Conditions Treated
Developmental conditions: clubfoot (talipes equinovarus), metatarsus adductus, flexible flatfoot.
Heel and foot pain in active children: Sever's disease, Iselin disease, accessory navicular syndrome.
Sports injuries and fractures: ankle sprains, foot and ankle fractures, stress injuries.
Walking and alignment concerns: tarsal coalition, toe walking, high-arched or stiff feet.
Infections and other conditions: osteomyelitis, ingrown toenails, foot infections, and skin conditions.
A Practical, Child-Focused Approach
Every child is different. Treatment is tailored to your child's needs and may include simple reassurance, activity modification, physiotherapy, or supportive devices such as insoles or orthotic boots. When necessary, surgical options are discussed carefully and only considered when truly beneficial. The aim is always the same: to relieve pain, restore function, and get your child back to doing what they love.
13. Complex Foot and Ankle Trauma
The foot and ankle function together to provide stability, balance, propulsion, and smooth movement. Trauma to this complex structure may occur during intense physical activity, sports participation, accidental falls, or high-impact injuries. In some cases, injuries may also result from repetitive strain, poor training technique, or inappropriate footwear.
A wide range of complex foot and ankle injuries are managed, including:
- Lisfranc injuries — Involving damage to the ligaments and/or bones of the midfoot, affecting the joints that stabilise the arch. These injuries can range from subtle ligament sprains to severe fracture-dislocations. Early diagnosis is critical, as untreated Lisfranc injuries can lead to chronic pain and deformity.
- Ankle fractures — Occurring when one or more of the bones forming the ankle joint break, usually following a twisting injury, fall, or high-impact trauma. Stable fractures may be treated with immobilisation; unstable or displaced fractures typically require surgical fixation.
- Calcaneus fractures — Involving the heel bone, often caused by high-energy trauma such as falls from a height or motor vehicle accidents. Management depends on the fracture pattern and soft tissue condition, ranging from immobilisation to surgical reconstruction.
- Pilon fractures — Complex injuries involving the lower end of the tibia where it forms the ankle joint, typically caused by high-impact trauma with associated joint surface damage. Careful planning and staged management are often required.
A strong emphasis is placed on accurate diagnosis and appropriate early management to optimise long-term function and alignment. Conservative management is prioritised wherever possible — many injuries can be treated successfully without surgery through immobilisation, protected weight-bearing, physiotherapy, and structured rehabilitation. Surgical intervention is considered only when necessary to restore stability, alignment, or joint integrity.