Elective
View allEnd-stage ankle arthritis
Predominantly post-traumatic tibiotalar arthritis. Surgical options for end-stage disease are ankle arthrodesis (open or arthroscopic) and total ankle replacement; joint-preserving options (supramalleolar osteotomy, distraction arthroplasty) are used for asymmetric or earlier disease.
ElectiveHallux valgus
Lateral deviation of the hallux with medial deviation of the first metatarsal, causing a painful bunion and transfer symptoms. Footwear modification and orthoses relieve symptoms but do not correct deformity. Surgery corrects the deformity with distal or shaft osteotomies (chevron, scarf with Akin), first tarsometatarsal fusion (Lapidus) for severe or hypermobile deformity, or minimally invasive percutaneous osteotomies.
ElectiveHallux rigidus
Degenerative arthritis of the first metatarsophalangeal joint with dorsal osteophytes, pain and stiffness. Early disease is treated with footwear, orthoses and injections, or cheilectomy. Advanced disease is treated with first MTP arthrodesis, the established standard, or with motion-preserving options such as a synthetic cartilage implant or arthroplasty.
ElectiveInsertional Achilles tendinopathy
Degenerative pain at the Achilles insertion, often with a Haglund deformity, retrocalcaneal bursitis and intratendinous calcification. First-line care is load management and loading exercise programmes, with extracorporeal shockwave therapy (ESWT) for persistent symptoms. Surgery (debridement, Haglund resection and reattachment, with or without FHL transfer) is reserved for failed non-operative care.
Trauma
View allAnkle fractures
Malleolar fractures range from stable isolated Weber B fibular fractures to unstable bimalleolar, trimalleolar and syndesmotic injuries. Stable fractures are treated non-operatively with short immobilisation and early weight-bearing. Unstable fractures are usually treated with open reduction and internal fixation; in older adults close contact casting is an alternative. Syndesmotic injuries are stabilised with screws or suture-button devices.
TraumaAchilles tendon rupture
Acute rupture of the Achilles tendon, typically in middle-aged recreational athletes. Options are non-operative treatment with functional rehabilitation, open repair, or minimally invasive repair. Early weight-bearing in a functional brace has largely replaced prolonged plaster immobilisation.
TraumaCalcaneal fractures
Displaced intra-articular calcaneal fractures usually follow a fall from height and carry a risk of subtalar arthritis, heel widening and soft-tissue complications. Options are non-operative treatment with early mobilisation, open reduction and internal fixation through an extensile lateral approach, minimally invasive or sinus tarsi fixation, and primary subtalar fusion for severely comminuted fractures.
TraumaLisfranc (tarsometatarsal) injuries
Injuries to the tarsometatarsal joint complex, from purely ligamentous sprains to high-energy fracture-dislocations. Stable, non-displaced injuries are usually treated non-operatively. Unstable injuries need anatomical reduction and stabilisation: open reduction and internal fixation (transarticular screws or dorsal bridge plating), primary partial arthrodesis of the medial column, or, for isolated ligamentous (C1–M2) injuries, flexible fixation with a suture-button device such as TightRope.