FOOT SURGERY

Our Senior Podiatrist is trained in traditional (‘open’) foot and ankle surgery and utilizes these techniques in combination with minimally invasive surgical procedures. Minimally invasive foot and ankle surgery refers to treatment of bone and soft tissue injuries without the need for traditional open incisions.

A major factor in recovery time and discomfort is the amount of tissue that has been involved by the incision. With minimally invasive foot surgery, a small incision is made in the patients’ skin and a specially designed instrument is inserted into this opening. The entire procedure is performed through this tiny opening. At the conclusion of the surgery, a small bandage protects the area. The condition has been corrected, the patient remains ambulatory and discomfort and prolonged disability have been avoided.

Retrocalcaneal Pain – Haglund’s Deformity

 

 

What Is Haglund’s Deformity?

 

Haglund’s deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).

Causes

Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, any shoes with a rigid back, such as ice skates, men’s dress shoes, or women’s pumps, can cause this irritation.To some extent, heredity plays a role in Haglund’s deformity. Inherited foot structures that can make one prone to developing this condition include:

  • A high-arched foot
  • A tight Achilles tendon
  • A tendency to walk on the outside of the heel.

Symptoms

Haglund’s deformity can occur in one or both feet. The symptoms include:

  • A noticeable bump on the back of the heel
  • Pain in the area where the Achilles tendon attaches to the heel
  • Swelling in the back of the heel
  • Redness near the inflamed tissue

Diagnosis

After evaluating the patient’s symptoms, Ozan Amir will examine the foot. In addition, x-rays will be ordered to

Non-Surgical Treatment

Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Non-surgical treatment can include one or more of the following:

  • Medication. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce the pain and inflammation
  • Ice.To reduce swelling, apply an ice pack to the inflamed area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again
  • Exercises. Stretching exercises help relieve tension from the Achilles tendon. These exercises are especially important for the patient who has a tight heel cord
  • Heel lifts. Patients with high arches may find that heel lifts placed inside the shoe decrease the pressure on the heel
  • Heel pads. Pads placed inside the shoe cushion the heel and may help reduce irritation when walking
  • Shoe modification. Backless or soft backed shoes help avoid or minimize irritation
  • Physical therapy. Physical therapy modalities, such as ultrasound, can help to reduce inflammation
  • Orthotic devices. Custom arch supports control the motion in the foot
  • Immobilization. In some cases, casting may be necessary

When Is Surgery Needed?

If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. Ozan will determine the procedure that is best suited to your case.

Our Senior Podiatrist is trained in traditional (‘open’) foot and ankle surgery and utilizes these techniques in combination with minimally invasive surgical procedures. Minimally invasive foot and ankle surgery refers to treatment of bone and soft tissue injuries without the need for traditional open incisions.

A major factor in recovery time and discomfort is the amount of tissue that has been involved by the incision. With minimally invasive foot surgery, a small incision is made in the patients’ skin and a specially designed instrument is inserted into this opening. The entire procedure is performed through this tiny opening. At the conclusion of the surgery, a small bandage protects the area. The condition has been corrected, the patient remains ambulatory and discomfort and prolonged disability have been avoided.


Flatfeet can be broadly classified into flexible and rigid in nature. The type of flatfoot is determined through clinical testing. Most flatfeet are flexible and can be treated well with orthoses and specific exercises. Mr. Ozan Amir works closely with Podiatrists and will refer you to one of his colleagues near your area to have orthoses fabricated.

 

In a minority of cases, conservative care does not alleviate the symptoms that can be associated with flatfeet. When this is the case Ozan will order the appropriate x-rays to evaluate the severity of deformity.

There are a number of surgical procedures available to correct and restore the alignment of the flatfoot, inlcuding minimally invasive procedures such as the hyprocure extra-articular subtalar joint implants and a multitude of other ‘traditional open’ tendon and bone re-alignment procedures. Ozan will discuss in depth with you which procedure(s) would be suitable for you, so you can make an informed decision on how to proceed.

Bunions

 

What Is A Bunion?

 

A bunion is a often described as a bump on the side of the big toe. But a bunion is more than that. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment – producing the bunion’s “bump.”

Bunions are progressive , they don’t go away, and will usually get worse over time. But not all cases are alike – some bunions progress more rapidly than others. Osteoarthritis can develop in the big toe joint as the bunion worsens over time, causing increased pain and stiffness in the joint. Even though bunions are a common foot deformity, many people may unnecessarily suffer the pain of bunions for years before seeking treatment.

 

Causes

 

Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to eveloping a bunion. Footwear can cause pressure on the bump leading to pain, but do not actually cause the bunion.

 

When Is Surgery Needed?

 

If non-surgical treatments fail to relieve bunion pain and when the pain of a bunion interferes with daily activities. The goal of surgery is the reduction of pain.A variety of surgical procedures is available to treat bunions. In selecting the procedure or combination of procedures for your particular case, Mr. Ozan Amir will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors.

Hammer Toe

 

What Is Hammertoe?

 

Hammertoe is a bending of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.
Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with non-surgical measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.

Hammertoes are progressive – they don’t go away by themselves and usually they will get worse over time. However, not all cases are alike – some hammertoes progress more rapidly than others.

 

Common Causes

 

The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people.

Hammertoes may be aggravated by shoes that don’t fit properly. A hammertoe may result if a toe is too long and is forced into a cramped position when a tight shoe is worn. Occasionally, hammertoe is the result of an earlier trauma to the toe. In some people, hammertoes are inherited.

 

Your Diagnosis

 

Ozan will obtain a thorough history and physical examination of your foot. During the physical examination, Ozan will evaluate the cause and extent of the contracture of the toes and will correlate the finding s with x- rays.

 

When Is Surgery Needed?

 

In some cases, usually when the hammertoe has become more rigid and painful, or when an open sore has developed, surgery is needed. Often patients with hammertoe have bunions or other foot deformities corrected at the same time.

In selecting the procedure or combination of procedures for your particular case, Ozan will take into consideration the extent of your deformity, the number of toes involved, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

 

Interdigital Neuroma (Perineural Fibrosis)

 

 

Interdigital neuroma (Morton’s Neuroma) of the foot includes common, paroxysmal, neuralgia affecting the web spaces of the toes. It involves entrapment neuropathy (nerve compression) of the common digital nerve below and between the metatarsal heads, typically between the third and the fourth metatarsal heads. The pain is most commonly felt between the third and fourth toes but can also occur in the area between the second and third toes.

Symptoms of interdigital neuroma typically manifest as a sharp, burning or tingling sensation in the forefoot. The pain radiates toward the lesser toes and is aggravated by shoe wear. The pain is relieved when the shoe is removed and the forefoot is massaged. Sometimes the symptoms involve specific toes. The cause of this problem is often due to impingement of the plantar nerve fibres between the metatarsal heads and the intermetatarsal ligament. It is entirely a biomechanical phenomenon. Differential diagnoses include stress fracture, capsulitis, bursitis or ligament injury at the metatarsal-phalangeal joint, a tendon sheath ganglion, foreign-body reaction and nerve-sheath tumour.

 

Diagnostic Procedures For Interdigital Neuroma

 

 

The diagnosis of interdigital neuroma is usually made by physical examination and review of the patient’s medical history.MRI ad High Definition Ultrasound examination may be useful to confirm the diagnoses however they may still not be 100% reliable.

The commonest reason for this is de to natural substances present in between the metatarsal heads and between the fat pad and the intermetatarsal ligament. These natural substances i.e. bursa, fat, capsular thickening and even bony growths, can all be a factor in the impingement process and may need to be surgically cleared

 

Treatment

 

 

Conservative treatment involves a reduction in the inflammation and removing the impingement factor. Reduction in inflammation is achieved via rest, elevation, ice, and massage with anti-inflammatory gels. Removing foot wear and and/r wearing broad type footwear would also help. Injection therapy is useful in reducing symptoms.

Surgery

 

 

Majority of publications including peer review journal articles, surgical technique description and textbooks promote surgical excision as a gold standard treatment. Surgical excision is described as the most definitive mode of treatment for symptomatic Morton’s neuroma with reported success rates varying between 79% and 93%.

Various surgical techniques are described, essentially categorised as dorsal versus plantar incision approaches. Beyond this the commonest technical variation described as influencing the outcome of surgery involves burying and anchoring transacted nerve into soft tissue such as muscle.

 

What Is Involved In Neuroma Surgery?

 

Surgery to excise the neuroma is usually performed under general anaesthetic in a day surgery facility. After surgery you will have to keep your foot dry for two weeks. Generally neuroma surgery allows for early weight bearing and protection in some type of post op shoe gear. Some neuromas may reoccur, but this is rare. Most studies on patient satisfaction after neuroma surgery show approximately 90% reduction of pain and about 85% of all patients rated the overall satisfaction with the results as excellent or good.

Interdigital neurectomy (removal of the diseased nerve) in right hands, should give satisfactory results almost all the time. Some of the reasons behind failure is when not enough nerve is dissected, mistakes in initial diagnosis, or bad handling of adjacent nerves, tendons and joint capsules during the operation. It is very common and acceptable to have some numbness in the area where the nerve used to be. This never causes any discomfort and often gets better in few years.

It is crucial to address the biomechanical pathologies underlying the impingement of the nerve during and after the surgery. Ozan will work closely with your Podiatrist in providing appropriate orthotic therapy to address these biomechanical issues.

Heel Pain (Plantar Fasciosis/Fasciitis)

 

Heel pain is most often caused by plantar fasciosis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst.Because there are several potential causes, it is important to have heel pain properly diagnosed. Ozan Amir is able to distinguish between all the possibilities and determine the underlying source of your heel pain.

What Is Plantar Fasciosis?

 

Plantar fasciosis is a chronic degeneration of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.

 

Causes

 

The most common cause of plantar fasciosis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciosis.Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciosis. This is particularly evident when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciosis.

 

Symptoms

 

The symptoms of plantar fasciitis are:

  • Pain on the bottom of the heel
  • Pain that is usually worse upon arising
  • Pain that increases over a period of months

People with plantar fasciosis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.

 

Diagnosis

 

To arrive at a diagnosis, Ozan Amir will obtain your medical history and examine your foot. Throughout this process Ozan rules out all the possible causes for your heel pain other than plantar fasciitis.In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

 

Non-Surgical Treatment

 

Initially see your local podiatrist, who may add one or more of these treatment approaches:

  • Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia
  • Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis
  • Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain
  • Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal
  • Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients
  • Physical therapy. Exercises and other physical therapy measures may be used to help provide relief

When Is Surgery Needed?

 

Although most patients with plantar fasciosis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Ozan Amir will discuss the surgical options with you and determine which approach would be most beneficial for you.

Ingrown Toenail

 

What Is An Ingrown Toenail?

 

When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides of the nail). This “digging in” of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe.

If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odour. However, even if the toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.

 

Podiatry Care

After examining the toe, Ozan will select the treatment best suited for you. If an infection is present, an oral antibiotic may be prescribed. Sometimes a minor surgical procedure, often performed in the office, will ease the pain and remove the offending nail.After applying a local anesthetic, Ozan removes part of the nail’s side border.

Some nails may become ingrown again, requiring removal of the nail root. Following the nail procedure, a light bandage will be applied. Most people experience very little pain after surgery and may resume normal activity the next day.

Retrocalcaneal Pain – Haglund’s Deformity

 

What Is Haglund’s Deformity?

 

Haglund’s deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).

 

Causes

 

Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, any shoes with a rigid back, such as ice skates, men’s dress shoes, or women’s pumps, can cause this irritation.To some extent, heredity plays a role in Haglund’s deformity. Inherited foot structures that can make one prone to developing this condition include:

  • A high-arched foot
  • A tight Achilles tendon
  • A tendency to walk on the outside of the heel.

Symptoms

 

Haglund’s deformity can occur in one or both feet. The symptoms include:

  • A noticeable bump on the back of the heel
  • Pain in the area where the Achilles tendon attaches to the heel
  • Swelling in the back of the heel
  • Redness near the inflamed tissue

Diagnosis

After evaluating the patient’s symptoms, Ozan Amir will examine the foot. In addition, x-rays will be ordered to

Non-Surgical Treatment

Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Non-surgical treatment can include one or more of the following:

  • Medication. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce the pain and inflammation
  • Ice.To reduce swelling, apply an ice pack to the inflamed area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again
  • Exercises. Stretching exercises help relieve tension from the Achilles tendon. These exercises are especially important for the patient who has a tight heel cord
  • Heel lifts. Patients with high arches may find that heel lifts placed inside the shoe decrease the pressure on the heel
  • Heel pads. Pads placed inside the shoe cushion the heel and may help reduce irritation when walking
  • Shoe modification. Backless or soft backed shoes help avoid or minimize irritation
  • Physical therapy. Physical therapy modalities, such as ultrasound, can help to reduce inflammation
  • Orthotic devices. Custom arch supports control the motion in the foot
  • Immobilization. In some cases, casting may be necessary

When Is Surgery Needed?

If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. Ozan will determine the procedure that is best suited to your case.

Manly Foot Clinic associates provide expert care, diagnosis and treatment of ankle and foot disorders for children, adults, and seniors. The Manly Foot Clinic has been serving the Northern Beaches since 1989.

Get In Touch

1300 347 652

info@manlyfootclinic.com.au

3 Corrie Rd North Manly 2100