Dr Sean Ng

Tarsal tunnel syndrome is not common. And if diagnosed accurately, it depends on what the cause is. There are plenty of causes, including bone spurs, tumours/growths, cysts, inflammation of tendons/tendon sheaths, rheumatoid arthritis, diabetes, and even broken or sprained ankles. The tibial nerve running in the tarsal tunnel gets compressed/ trapped, and results in paresthesia/pain, burning sensation over the heel and plantar surfaces of the big toe/2/3 toes as well. It can be irritating, even debilitating.

A lisfranc injury is a potentially complicated and troublesome one to have. Did you do your weight-bearing X-rays and MRI yet? Did the doctor mention if it a soft tissue or bony Lis-Franc? Treatment is definitely available here in Singapore. A thorough assessment and physical examination of the foot has to be done. To add on, it will be coupled with the necessary radiological investigations. The management can be conservative or surgical. Conservative management would include [1]: medication, an off-load walker and surgery.

There are many grades of spondylolisthesis. In fact, there are 5 grades [1]. Moreover, there are many causes of spondylolisthesis as well. Special X-rays and MRIs have to be done and a thorough clinical examination of your spine has to be performed. Clinically, it also has to depend on how symptomatic you are. Management is tailored according to the above factors, and it includes physiotherapy, medication and in some cases surgery. It encompasses decompression and stabilisation if needed. It would be best to see an orthopaedic surgeon to further assess your spine.

For patients with a connective tissue problem, the bunions are usually a result of the lax connective tissue. Minimally invasive surgery will not be a suitable method for correction of the bunions. I would need to assess the foot, the bunion, and the overall “laxity” of yourself. You would need, most probably, a fusion procedure and a soft tissue procedure in tandem for the correction of the bunion. What is a bunion? A bunion is a bony bump that forms when your big toe is pushed against the adjacent toe, causing the joint at the base of the big toe to grow bigger and stick out.

For elbow bursitis, it depends on several factors. Mainly size - if it’s big, it is very unlikely to become smaller and will cause a lot of discomfort and inconvenience; and whether it’s infected (which has to be treated first). Assuming there is no infection, we can either observe, aspirate or excuse. Aspiration doesn’t usually help very much as the recurrence rate is very high. So either observe if it’s small, or excise if it’s big. Aspiration is usually temporary and willusually require a repeat procedure.

I am sorry to hear of your injury, and it does sound quite bad with a fracture + sprain. When was the injury? And what has been done thus far - crutches/ cast/ medication? You would need to get your foot & ankle examined. X-rays would have shown the fracture - it’s important to see the configuration location of the fracture as well, as that determines what treatment would be needed. If the ankle is very painful n swollen, you may need an MRI to determine the severity of injury. Taking both injuries into account, I think firstmost is to keep the affected foot on non-weight bearing.

Hi, X-rays will not show actual inflammation in your lower back. It does show: the alignment of the spine whether there are any fractures, or perhaps indirectly show spasm of the lumbar muscles by showing the abnormal Alignment of the spine. To show actual inflammation, nerve compression, slipped discs or tears in the discs, tumours etc, an MRI would be required. So if you have persistant back pain, an MRI would often be needed to further highlight any other potential pathology in the lumbar spine.

The “lump” circled is on the dorsum of the foot. Bone spurs are usually at the base or back of the heel. Sometimes patients with midfoot arthritis may have bone spurs on the dorsum. Have any X-rays/ scans been done? Management will depend on the size/ depth and symptoms of the lump. I would have to examine your foot, see the X-rays/ scans, and then decide. Management can be conservative or surgical, depending on several factors. It would be best to seek an opinion from an Orthopaedic surgeon.

To see bunions, you would have to consult an orthopaedic surgeon, preferably someone that subspecialises in foot and ankle surgery. He would be able to assess your feet, and advise you on the proper management of the bunions. It can be either conservative or surgical management, and I am sure the surgeon will go through and advise you on the appropriate steps to take.

Hi,The surgical indications for a bunion, whether it is a mild/moderate/severe one, is:1. Pain2. Progressive deformitySurgery is never indicated for cosmetic reasons. The type of surgical correction would be dependent on the severity of the bunions.

It would be a bit difficult to answer your question, as there are many potential factors. Your fracture must have been pretty serious to have a radial head replacement instead of an open reduction internal fixation. Were there any other concomitant injuries (ligament, capsule etc) that needed to be addressed as well? Physiotherapy is extremely important in elbow surgery, and my advice is to keep at it. Do not stop physiotherapy. You may need 3-4 months of physiotherapy.

Hi, I am sorry to hear of your Injury. The best treatment for your meniscal tear depends on: The location Configuration Extent of the tear According to these factors, treatment modalities will be recommended by your doctor. For minor ones meniscal tears, your doctor may consider trying a course of medication and physiotherapy first. If it doesn’t get better, arthroscopic (keyhole) surgery would be the next best option. Severe meniscal injuries are usually treated by arthroscopic surgery, which may be either a meniscal repair or a partial meniscectomy.

To answer your question, it depends on what type of elbow surgery you’re referring to. It can either be a fracture , ligament, tennis elbow/ tendinous surgery or a combination of all - both bony and soft tissue. An elbow arthroscopic debridement May have a quicker healing and recovery time. Complete healing usually takes 2-3 months, and post-op physiotherapy and rehabilitation is extremely important for elbow surgery. This is to prevent stiffness and get back the range of movement.

Hi Carpal tunnel Syndrome (CTS) can sometimes be tricky. It is a compression of the median nerve at the carpal tunnel at the wrist. That compressive band is always there. Hence non-surgical methods, like anti-inflammatory medication, injections and splinting can all be done first. Symptoms may improve, but they may recur. As the causative problem is still present. Thus, it is hard to answer your question of how long does it take to get better. It also depends on whether there are other causes. Pregnancy is a risk factor for CTS, and the symptoms resolve after delivery.

For your osteochondral injury, there are several factors which we consider in its management. The size, anatomical location, and depth of the lesion. I would really have to see the MRI and examine your knee, before making an assessment. If you have tried conservative management methods like medication, physiotherapy, braces etc, and it doesn’t work and you’re still symptomatic, the osteochondal lesion is unlikely to heal.