Health Blog

I was very fortunate to be invited recently to London Bridge Hospital to spend a morning observing Mr Sam Singh operating on various foot conditions that we see in practice quite commonly.

Bunions are so common and may or may not be a bother to the incumbent.  They normally run in families and can potentially restrict types of shoe, cause pain and create secondary issues in other toes and up to the knees.    I have seen many post-surgery cases, but to actually witness the process made it so clear.   Having realigned the long metatarsal bone, excess bone is removed and with the help of a small screw it is fixed in place.  As a perfectionist, Mr Singh assessed the alignment and if further correction was required he was able to remove a small wedge of bone from the next bone (1^st phalangeal) then staple it fixed.  The results were so satisfying to see.   Obviously with the rummaging around, there will be swelling but actually very little pain.   The recovery is about 6-8 weeks.

Something that probably bothers more of us than we realise is a small bunion on the outside of the foot that rubs to create hard skin and a bursa.    This is referred to as a Bunionette.   I was able to see two of these corrected and it was obvious to see how the patient will be able to wear narrower shoes once the swelling has subsided.

There was an arthroscopic (keyhole) debridement (clean up) and repair to the top of the Talus bone (where the ankle meets the long bone of the leg).  As this was on a screen and massively magnified, my first impressions were that the patient would never recover. However, as the small particles were removed and Sam showed me how small the instruments are I was able to calm down!!!  By creating damage to the surface of the bone where the affected articular cartilage had been removed, bleeding will form a scab of fibrous cartilage to fill the hole, which in turn should stop the moments of pain.   

The procedure that made the biggest impression on me was watching how Sam removed degenerative tendon tissue from a thickened Achilles tendon.  A thickened lump on the back of the heel is part of a chronic Achilles tendon pathology, with resultant pain after rest and on sudden movement.  There was a tear in the tendon and having spoken about tendon tears for years it was great to actually see one ‘in the flesh’ (and in fact if anything, it was a bit disappointing as there was no drama about it!)    Post operatively the thickness was completely gone, however the rehab from this type of procedure is lengthy, so this is only done as a last resort when conservative attempts have failed.

I have always referred any foot issues that I think require surgery to Sam Singh and this experience certainly confirmed my confidence in his work.    Thank you to Sam and the team at London Bridge for this opportunity.

Written by Mark Pitcairn-Knowles, Osteopath