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Patient Guide to Achilles Tendinitis

Achilles tendinitis is an overuse injury of the Achilles (uh-KIL-eez) tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone.

Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It’s also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends.

Most cases of Achilles tendinitis can be treated with relatively simple, at-home care under your doctor’s supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.

Symptoms for Achilles Tendinitis:

The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity. Episodes of more severe pain may occur after prolonged running, stair climbing or sprinting.

You might also experience tenderness or stiffness, especially in the morning, which usually improves with mild activity.

When to see a doctor
If you experience persistent pain around the Achilles tendon, call your doctor. Seek immediate medical attention if the pain or disability is severe. You may have a torn (ruptured) Achilles tendon.

Causes of Achilles Tendinitis:

Achilles tendinitis is caused by repetitive or intense strain on the Achilles tendon, the band of tissue that connects your calf muscles to your heel bone. This tendon is used when you walk, run, jump or push up on your toes.

The structure of the Achilles tendon weakens with age, which can make it more susceptible to injury — particularly in people who may participate in sports only on the weekends or who have suddenly increased the intensity of their running programs.

Risk Factors of Achilles Tendinitis:

A number of factors may increase your risk of Achilles tendinitis, including:

  • Your sex and age. Achilles tendinitis occurs most commonly in middle-aged men.
  • Physical problems. A naturally flat arch in your foot can put more strain on the Achilles tendon. Obesity and tight calf muscles also can increase tendon strain.
  • Training choices. Running in worn-out shoes can increase your risk of Achilles tendinitis. Tendon pain occurs more frequently in cold weather than in warm weather, and running on hilly terrain also can predispose you to Achilles injury.
  • Medical conditions. People who have diabetes or high blood pressure are at higher risk of developing Achilles tendinitis.
  • Medications. Certain types of antibiotics, called fluoroquinolones, have been associated with higher rates of Achilles tendinitis.

Complications of Achilles Tendinitis:

Achilles tendinitis can weaken the tendon, making it more vulnerable to a tear (rupture) — a painful injury that usually requires surgical repair.

Cure your Achilles Tendinitis Today. Call +65 6471 2744 or SMS to +65 92357641 for Appointment


Definition of Bunionectomy

A bunionectomy is a surgical procedure to excise or remove a bunion. A bunion is an enlargement of the joint at the base of the big toe and is comprised of bone and soft tissue. It is usually a result of inflammation and irritation from poorly fitting (narrow and tight) shoes in conjuction with an overly mobile first metatarsal joint and over-pronation of the foot. Over time, a painful lump appears at the side of the joint, while the big toe appears to buckle and move sideway towards the second toe. New bone growth can occur in response to the inflammatory process, and a bone spur may develop. Therefore, the development of a bunion may involve soft tissue as well as a hard bone spur. The intense pain makes walking and other activities extremely difficult. Since the involved joint is a significant structure in providing weight-bearing stability, walking on the foot while trying to avoid putting pressure on the painful area can create an unstable gait.


 How Bunionectomy surgery done:

Bunions become more common later in life. One reason is that with age the foot spreads and proper alignment is not maintained. In addition, the constant friction of poorly fitting shoes against the big toe joint creates a greater problem over time. Ignoring the problem in its early stages leads to a shifting gait that further aggravates the situation.

Once surgery has been decided on, the extent of the procedure will depend on the degree of deformity that has taken place. There are several different surgical techniques, mostly named after the surgeons who developed them, such as McBride, Chevron, and Keller. The degree and angle of deformity as well as the patient’s age and physical condition play a significant role in the surgeon’s choice of technique, which will determine how much tissue is removed and whether or not bone repositioning will occur. If bone repositioning is done, that part of the surgery is referred to as an osteotomy ( osteo means bone). The type of anesthesia, whether ankle block (the most common, in which the foot is numb but the patient is awake), general, or spinal, will depend on the patient’s condition and the anticipated extent of the surgery. For surgery done on an ambulatory basis, the patient will usually be asked to arrive one to two hours before the surgery and stay for about two to three hours after the procedure. The procedure itself may take about an hour.

The surgeon will make an incision over the swollen area at the first joint of the big toe. The enlarged lump will be removed. The surgeon may need to reposition the alignment of the bones of the big toe. This may require more than one incision. The bone itself may need to be cut. If the joint surfaces have been damaged, the surgeon may hold the bones together with screws, wires, or metal plates. In severe cases, the entire joint may need to be removed and a joint replacement inserted. If pins were used to hold the bones in place during recovery, they will be removed a few weeks later. In some mild cases, it may be sufficient to repair the tendons and ligaments that are pulling the big toe out of alignment. When finished, the surgeon will close the incision with sutures and may apply steri-strips as an added reinforcement. A compression dressing will be wrapped around the surgical wound. This helps to keep the foot in alignment as well as help reduce postoperative swelling.

Diagnosis / Preparation before Bunionectomy Surgery:

Intense pain at the first joint of the big toe is what most commonly brings the patient to the doctor. Loss of toe mobility may also have occurred. Severe deformity of the foot may also make it almost impossible for the patient to fit the affected foot into a shoe. The condition may be in either foot or in both. In addition, there may be a crackling sound in the joint when it moves. Diagnosis of a bunion is based on a physical examination, a detailed history of the patient’s symptoms and their development over time, and x rays to determine the degree of deformity. Other foot disorders such as gout must be ruled out. The patient history should include factors that increase the pain, the patient’s level of physical activity, occupation, amount of time spent on his or her feet, the type of shoe most frequently worn, other health conditions such as diabetes that can affect the body’s ability to heal, a thorough medication history, including home remedies, and any allergies to food, medications, or environmental aspects. The physical exam should include an assessment while standing and walking to judge the degree to which stability and gait have been affected, as well as an assessment while seated or lying down to measure range of motion and anatomical integrity. An examination of the foot itself will check for the presence of unusual calluses, which indicate abnormal patterns of friction. Circulation in the affected foot will be noted by checking the skin color and temperature. A neurological assessment will also be conducted.

Conservative measures are usually the first line of treatment and target dealing with the acute phase of the condition, as well as attempting to stop the progression of the condition to a more serious form. Measures may include:

  • rest and elevation of the affected foot
  • eliminating any additional pressure on the tender area, perhaps by using soft slippers instead of shoes
  • soaking the foot in warm water to improve blood flow
  • use of anti-inflammatory oral medication
  • an injection of a steroidal medication into the area surrounding the joint
  • systematic use of an orthotic, either an over-the-counter product or one specifically molded to the foot
  • the use of a cushioned padding against the joint when wearing a shoe

If these measures prove unsuccessful, or if the condition has worsened to significant foot deformity and altered gait, then a bunionectomy is considered. The doctor may use the term hallux valgus when referring to the bunion. Hallux means big toe and valgus means bent outward. In discussing the surgical option, it is important for the patient to clearly understand the degree of improvement that is realistic following surgery.

X rays to determine the exact angle of displacement of the big toe and potential involvement of the second toe will be taken. The angles of the two toes in relation to each other will be noted to determine the severity of the condition. Studies in both a standing as well as a seated or lying down position will be considered. These will guide the surgeon at the time of the surgery as well. In addition, blood tests, an EKG, and a chest x-ray will most likely be ordered to be sure that no other medical condition has gone undiagnosed that could affect the success of the surgery and the patient’s recovery.

Aftercare Bunionectomy Surgery:

Recovery from a bunionectomy takes place both at the surgical center as well as in the patient’s home. Immediate post-surgical care is provided in the surgical recovery area. The patient’s foot will be monitored for bleeding and excessive swelling; some swelling is considered normal. The patient will need to stay for a few hours in the recovery area before being discharged. This allows time for the anesthesia to wear off. The patient will be monitored for nausea and vomiting, potential aftereffects of the anesthesia, and will be given something light to eat, such as crackers and juice or ginger ale, to see how the food is tolerated. Hospital policy usually requires that the patient have someone drive them home, as there is a safety concern after having undergone anesthesia. In addition, the patient will most likely be on pain medication that could cause drowsiness and impaired thinking.

It is important to contact the surgeon if any of the following occur after discharge from the surgical center:

  • fever
  • chills
  • constant or increased pain at the surgical site
  • redness and a warmth to the touch in the area around the dressing
  • swelling in the calf above the operated foot
  • the dressing has become wet and falls off
  • the dressing is bloody

While the patient can expect to return to normal activities within six to eight weeks after the surgery, the foot is at increased risk for swelling for several months. When the patient can expect to bear weight on the operated foot will depend on the extent of the surgery. The milder the deformity, the less tissue is removed and the sooner the return to normal activity level. During the sixto-eight-week recovery period, a special shoe, boot, or cast may be worn to accommodate the surgical bandage and to help provide stability to the foot.

Expected result of Bunionectomy Surgery:

The expected result will depend on the degree of deformity that has occurred prior to surgery, the patient’s medical condition and age, and the adherence to the recovery regimen prescribed. Some degree of swelling in the foot is normal for up to six months after the surgery. Once wound healing has taken place, the surgeon may recommend exercises or physical therapy to improve foot strength and range of motion. It is important to be realistic about the possible results before consenting to the surgery. Since over-pronation of the foot is not corrected with the surgery, orthotics to help keep the foot/feet in alignment are usually prescribed.

Success rate for Bunionectomy Surgery:

According to the American Orthopaedic Foot & Ankle Society, less than 10% of patients undergoing bunionectomy experience complications, and 90% of patients feel the surgery was successful.


Factors that will increase in getting Foot Pain

Foot pain is a very common complaint. Around 70% of the Singapore population will suffer foot pain at some time in their lives. The foot is quite a complex structure of 26 bones and 33 joints, layered with an intertwining web of over 100 muscles, ligaments and nerves. With each step you take, a force of 2-3 times your body weight is placed on your feet and during a typical day you may take 7 or 8,000 steps! Therefore it comes as no surprise that at some time in our lives we will suffer from some kind of foot complaint. This website provide detailed information regarding the most common types of foot pain, how it occurs and what you can do to alleviate and prevent foot pain.

Factors that will increase the chances of getting foot pain:

– Age: as we get older, our feet widen and our arches flatten. Also, the fat padding on the sole and heel area wears thinner and the skin on our feet becomes dryer. Foot pain in older people could well be the first sign of arthritis, diabetes and circulatory disease.

– Gender: Women are at higher risk than men for foot pain, mostly because of high-heeled and tight they wrear or have been wearing in the past. Severe foot pain is quite common in older women.

– Occupational Risk Factors: people who are on their feet all day because of the work they do, will always run the risk of suffering some type of foot pain or discomfort, as well as aching legs and low back pain.

– Sports and Dancing: especially heel pain, shin splints, and knee pain can increase with sports, running or dancing.

– Weight gain: being overweight puts added stress on the feet which often leads to various types of foot pain

– Pregnancy: pregnant women have an increased risk of foot pain problems due to weight gain, swelling in their feet and ankles. Plus, the release of certain hormones may cause ligaments to relax, causing weakness in the feet and ankles

– Over-pronation: rolling inwards of the foot and flattening of the arches (over-pronation) is a major contributing factor to foot pain.

Stop Your Foot Pain Today! Call +65 6471 2744 or Email to: info@boneclinic.com.sg For Appointment

Stiff Big Toe (Hallux Rigidus)

The most common site of arthritis in the foot is at the base of the big toe. This joint is called the metatarsophalangeal, or MTP joint. It’s important because it has to bend every time you take a step. If the joint starts to stiffen, walking can become painful and difficult.

In the MTP joint, as in any joint, the ends of the bones are covered by a smooth articular cartilage. If wear-and-tear or injury damage the articular cartilage, the raw bone ends can rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk. The result is a stiff big toe, or hallux rigidus.

Hallux rigidus usually develops in adults between the ages of 30 and 60 years. No one knows why it appears in some people and not others. It may result from an injury to the toe that damages the articular cartilage or from differences in foot anatomy that increase stress on the joint.


  • Pain in the joint when you are active, especially as you push-off on the toes when you walk
  • Swelling around the joint
  • A bump, like a bunion or callus, that develops on the top of the foot
  • Stiffness in the great toe and an inability to bend it up or down

If you find it difficult to bend your toe up and down or find that you are walking on the outside of your foot because of pain in the toe, see your doctor right away. Hallux rigidus is easier to treat when the condition is caught early. If you wait until you see a bony bump on the top of your foot, the bone spurs will have already developed and the condition will be more difficult to treat.

Your physician will examine your foot and look for evidence of bone spurs. He or she may move the toe around to see how much motion is possible without pain. X-rays will show the location and size of any bone spurs, as well as the degree of degeneration in the joint space and cartilage.

Having toe stiffness?? Get professional opinion and treatment for your toe. Call +65 6471 2744 or Email to: info@boneclinic.com.sg

Hammertoe (Mallet Toe)

A hammertoe is a toe that’s curled due to a bend in the middle joint of a toe. Mallet toe is similar, but affects the upper joint of a toe. Otherwise, any differences between hammertoe and mallet toe are subtle.

Both hammertoe and mallet toe are commonly caused by shoes that are too tight in the toe box or shoes that have high heels. Under these conditions, your toe may be forced against the front of your shoe, resulting in an unnatural bending of your toe and a hammer-like or claw-like appearance.

Relieving the pain and pressure of hammertoe and mallet toe may involve changing your footwear and wearing shoe inserts. If you have a more severe case of hammertoe or mallet toe, you may need surgery to experience relief.

Signs and symptoms of hammertoe and mallet toe may include:

  • A hammer-like or claw-like appearance of a toe
  • In mallet toe, a deformity at the end of the toe, giving the toe a mallet-like appearance
  • Pain and difficulty moving the toe
  • Corns and calluses resulting from the toe rubbing against the inside of your footwear

Both hammertoe and mallet toe can cause pain with walking and other foot movements.

When to see a doctor
See a doctor if you have foot pain that’s persistent and that affects your ability to walk properly and carry out other motions with your foot. Also, see doctor if one or more of your toes has developed a clenched or claw-like appearance.

A common cause of hammertoe and mallet toe is wearing improper footwear — shoes that are too tight in the toe box or shoes that have high heels. Wearing shoes of either type can push your toes forward, crowding one or more of them into a space that’s not large enough to allow your toes to lie flat.

Hammertoe and mallet toe deformities can also be inherited and may occur despite wearing appropriate footwear.

The result is a toe that bends upward in the middle and then curls down in a hammer-like or claw-like shape. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses. The bottom of the affected toe can press down, creating the mallet-like appearance of mallet toe.

At first, a hammertoe or mallet toe may maintain its flexibility and lie flat when you’re not wearing crowded footwear. But eventually, the tendons of the toe may contract and tighten, causing your toe to become permanently stiff.

Other causes of hammertoe and mallet toe may include:

  • An injury in which you jam or break your toe
  • Abnormal foot mechanics because of nerve and muscle damage to your toe resulting from diabetes (diabetic neuropathy)
  • Other diseases that affect nerves and muscles, such as arthritis or stroke

Treatments for Hammertoe

If your toe is still flexible, your doctor may recommend that you change to roomier and more comfortable footwear and that you wear shoe inserts (orthotics) or pads. Wearing inserts or pads can reposition your toe and relieve pressure and pain.

If your toe has become tight and inflexible, your doctor may recommend surgery. The specific procedure depends on how much flexibility is left in your toe:

  • If your toe has some flexibility, your doctor may straighten it by making an incision in the toe and releasing the tendon.
  • If your toe is rigid, your doctor may not only cut or realign tendons but also remove some pieces of bone to straighten your toe. This procedure may require that the bones be fixed temporarily with pins while your toe heals.

Usually, you can go home from the hospital on the day of your toe surgery.

Stop the pain and get your foot checked. Call +65 6471 2744 (24 Hours) / Email: info@boneclinic.com.sg

Freiberg’s Disease

Freiberg’s Disease is also commonly known as Freiberg’s infraction which means incomplete fracture or Freiberg’s infarction which means necrosis or bone death due to obstruction of circulation.

In any event the condition is a result of avascular necrosis meaning the blood supply to the affected bone has been cut causing the bone to undergo changes usually resulting in pain.

The disease can vary in severity and usually gets worse as time goes on. It usually begins in the second decade of life however may not manifest itself as pain until the patient reaches their early twenties. It is far more common in females then males.

As previously mentioned it is thought to be due to disruption of circulation to the head of the metatarsal bone, usually, but not always the second metatarsal bone. This disruption is thought to occur primarily from repetitive stress and not necessarily one incidence of trauma. The trauma is to the growth plate of the bone (from which the bone grows in length over time), which is located at the distal (front) part of the bone nearer the toes.

The repeated stress to the growth plate of the bone causes micro fractures in the growth plate which eventually lead to a disruption of the blood supply to that area of the bone. It occurs while this growth plate is open (growth plates eventually close and there is no longer any further bone growth) which is during puberty. During this time period there is rarely pain, but the pain occurs later on , generally in females in their twenties and early thirties in response perhaps to wearing high heels or participating in athletics.

Typically the patient complains of localized pain in the ball of the foot near the bone that is affected. The pain is usually exacerbated by excessive activity and can worsen overall with time.

An xray reveals the classic flattening of metatarsal head. There can also be fracture and fragmenting of the bone resulting in loose bodies of bone in the area causing further pain. All of this leads to degeneration of the joint between the metatarsal bone and toe.

The treatment of Freiberg’s disease is dependent on the amount of bone destruction and the amount of pain the patient is experiencing. In the younger patient who is in the early stages of bone destruction, the acutestage, it may be appropriate to try a non-weightbearing cast for a minimum of four weeks in an effort to prevent further bone and joint destruction. Anti-inflammatory medication may be given in conjunction with the cast to reduce symptoms.

After the cast is removed the patient should limit themselves to very conservative, stiff shanked shoes to limit the bending at the ball of the foot. An orthotic may also provide protection as well. Generally theorthotic should have a metatarsal bar built in to take pressure off the head of the bone. High heels are definitely out of the question, as is athletic endeavors. Patient compliance is a must in these situations because if the disease cannot be “quieted” down there will be further damage to the metatarsal boneresulting in chronic pain.

In those situations surgery becomes a viable option. An MRI of the bone and joint should be performed prior to any surgical procedure in order to get a clear picture of the diseased joint, to see if there are any loose bone fragments in the joint and to check the overall bone stock or quality of the metatarsal bone.

This is necessary because surgical intervention can range from a minimum of cleaning out the diseased joint of bone spicules (spurs) and loose bone bodies all the way to performing bone grafts and surgical breaking and resetting of the metatarsal bone in an effort to create better bone and joint alignment.

Even though lesser metatarsal implants exist, at this writing, there is not a general consensus that they are effective in treating Freiberg’s disease.

To schedule for an appointment, call us at +65 6471 2744 or SMS to +65 9235 7641 (24 Hours)

Haglund’s Deformity

Haglund’s Deformity Introduction
Foot is an important body part. No one will disagree with my opinion considering the advantages one enjoys with the help of foot. Foot comprises of various organs like heel, toes, bones, muscles, ligaments, joints etc. The bones present in the foot in general and heel in particular may develop certain abnormalities. Development of such abnormalities can lead to certain serious complications and result in temporary or permanent dysfunction of foot. We must pay proper attention towards up keep of foot and ensure foot strength with the help of nutritious diet and physical exercises. Ignorance on part in taking proper care will result in abnormalities.

Description of Haglund’s Deformity
Haglund’s deformity is a medical condition characterized by enlargement of bone at back of heel bone. In this condition the back of the heel bone, area where Achilles tendons and bone of heel attaches with each other gets affected and develop enlargement.

Haglund’s deformity is also known by other names ‘retroocular bursitis’ and ‘pump dump’.

Causes responsible for development of Haglund’s Deformity
Excessive pressure against the shoes and bursitis are considered as the two major causes responsible for development of Haglund’s Deformity. The stitching or height of the heel counter of a particular foot wear may aggravate this condition. In simple words wearing inappropriate shoes – shoes that does not fit properly or provide comfort and exert pressure on heel bone – is the main cause behind development of Haglund’s deformity.  

Symptoms of Haglund’s Deformity
Following are the most common symptoms of Haglund’s deformity.

  • Redness of area at the back side of heel
  • Swelling at the back side of heel area

Treatment of Haglund’s Deformity
There are some remedies available for treatment of Haglund’s deformity. The method of treatment is associated with the root cause behind development of this condition and severity of the condition. Mild cases of inflammation and projection enlargement of bone – at the back of the heel – are treated using methods such as compression, application of ice blocks, change of foot wear, use of medical aids like heel grip pads, Achilles heel pads and tortoise.

In cases, where the bone enlargement is considerably large, surgery may be required. Your doctor may prescribe you with Cortisone injections for relieving pain. However, the use of such injections for prolonged periods may lead to occurrence of certain other abnormalities related to foot such as Achilles tendon rupture.

Use of anti-inflammatory medications and immobilization are other options available for treating Haglund’s deformity.

Your doctor will recommend best suiting treatment for you after conducting examination and ascertain cause of development of Haglund’s deformity.

Prevention is the best way of treating any disease. Haglund’s deformity is not exception to this rule. Adopt lifestyle like maintaining hygiene by keeping foot clean and dry, proper exercises for enhancing muscle strength; use properly fitting shoes etc and avoid occurrence of Haglund’s deformity in particular and other abnormalities associated with foot in general.


Useful Tips to Keeping Your Feet Healthy

It only takes very little effort to take care of your feet and keep your feet in a healthy shape. Here are some habits you can develop:

Wear only shoes that fit. Your feet need room to breathe, so do not cramp them inside fashionable but very uncomfortable shoes.

Keep your feet dry. Make sure that the areas between your toes are completely dry before you put socks on. If you have sweaty feet, consider regularly dabbing them with cotton wool. Some experts also suggest that you avoid wearing the same trainers everyday – allow a pair to dry for 24 hours first before using it again.

Wash your feet daily. A simple scrub down in the shower does wonders.

Use clean socks. Never use an unlaundered pair, or you could be inviting fungi.

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