End-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.