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Hand & Foot Clinic

Your hands and wrists are essential tools that allow you to work, play and perform everyday activities. In fact, how well the hands, wrists, arms and shoulders interact depends upon the integrity and function of the related ligaments, tendons, muscles, joints and bones. Problems in any of these can affect upper extremity function - from the fingertips to the shoulder blades - causing major disruptions at home and at work and negatively impacting quality of life.

Why a specialised Hand and Foot Clinic?

Whether your condition is due to arthritis, carpal tunnel syndrome, a sports injury, an accident, a work-related injury or a congenital disorder, you can feel confident choosing the Hand Surgery and Foot Clinic at Apollo Gleneagles Hospitals, Kolkata for your care. Hand and Foot Surgery is a highly specialised branch of Orthopedic Surgery.  The clinic provides a multidisciplinary approach for the comprehensive care of individuals with injuries and/or disorders of the hand (includes wrist and elbow) and foot (includes the arch and ankle). Working in close collaboration with the Departments of Plastic Surgery, Orthopaedic Surgery, Neurology, Rheumatology, and Physical and Occupational Therapy, we provide evaluation, treatment and rehabilitative care for a wide variety of injuries and disorders, such as arthritis, tumors, fractures and vascular concerns. Our goal is to help individuals return to pain free, functional lives. State of the art digital radiology, CT and MRI scanning, as well as a fully integrated medical record, allow for streamlined and efficient care. Post-op visits are coordinated with the surgeon and therapist, as well as the entire medical support team.

Hand and Wrist Pain

With how much we rely on our hands, there's no wonder hand and wrist pain can be so disabling and frustrating. Your hand is made up of 27 bones, including eight in the wrist (called carpals), five in the palm (called metacarpals) and 14 (called phalanges) that make up your fingers and thumb. The bones are held together by ligaments and two main sets of muscles and tendons: flexors (used to bend the thumb and fingers) that connect to the underside of the forearm, and extensors (used to straighten them out) and connect to the top of the forearm.

Elbow Pain

Elbow pain is extremely common – whether due to aging, overuse, trauma or a sports injury. Your elbow is a hinge joint between the radius and ulna of the forearm, and the humerus of the upper arm. The bones are held together by ligaments. The primary ligaments of the elbow are the medial collateral ligament (MCL) on the inside of the elbow and the lateral collateral ligament (LCL) on the outside. Several muscles surrounding the joint are responsible for movement. The tendons attach the muscle to the bone, the cartilage covers and protects the ends of the bones, and bursa sacs provide lubrication and protection around the joint.
However, when necessary, our specialists are highly skilled in the latest techniques of microsurgery, arthroscopic surgery, advanced techniques of complex fracture fixation and laser surgery.

  • Arthritis of the Wrist and Hand
  • Arthritis of the Thumb Base
  • Carpal Tunnel Syndrome
  • Congenital Hand Deformity
  • De Quervain's Disease
  • Dupuytren's Disease
  • Tennis and Golfer's Elbow
  • Tendonitis
  • Trigger Finger

Our hand and upper extremity surgeons and therapists work together with the goal of reducing or eliminating pain, and restoring as much normal form and function as possible. At our Hand and Foot Clinic, the Department of Plastic Surgery has a team of surgeons specializing in the prevention, diagnosis and treatment of disorders of the skin and nails, muscle and tendons, nerves and vessels and bones, joints, and ligaments of the hand and upper extremity. Surgeons apply minimally invasive techniques, when possible, to reduce postoperative pain and quicken the return to function. This includes endoscopic carpal tunnel release and arthroscopic joint procedures.

As a team, our plastic surgeons collaborate with physicians from other medical and surgical specialties to give our patients comprehensive care of their hand and upper extremity needs. These include specialists in Pediatrics, Emergency Medicine, Vascular Medicine, Rheumatology, Hand Therapy and Dermatology.

Hand surgery and rehabilitation is commonly done for injuries and cumulative problems. This is most often performed as an outpatient surgery, except in the case of a major reconstructive procedure.

Together with your family, the surgeon will discuss possible treatment options, as well as details and expectations for recovery. Our goal is to restore the form, function and appearance of the hand as much as possible, as well as reduce or eliminate any pain being experienced by the patient. If hand therapy is required after your surgery, our hand therapists will work with you to help you restore the normal function of your hand, as well as minimize pain.

Carpal tunnel syndrome

Carpal tunnel syndrome is caused by nerve compression. Nerves that run between muscles, ligaments, bones and tendons through narrow channels, such as the wrist, are more likely to become constricted or compressed. When compressed over a period of time, the nerve sustains permanent damage.
In early stages of carpal tunnel syndrome, conservative treatment can be applied, such as the use of a wrist brace and anti-inflammatory medications. In advanced stages, however, surgery to release the compression of the nerves is usually required. By releasing the pressure, blood flow to the nerve is improved and further damage prevented.

De Quervain's tendinitis

This causes pain on the thumb side of the wrist and difficulty in making a fist, grasping objects, wrist movements, etc. it is common in women. It is caused by swelling of the wrist tendins over the base of the thumb and can be caused by repetitive stress or overuse. Rest in  a splint, anti-inflammatory medicines and ice compress may be tried. In recalcitrant cases, either a steroid injection or surgery to release the tight tendon, sheath may be required.

Finger, hand and wrist Fractures

These can cause pain, stiffness, swelling, deformity and loss of movement. Simple fractures can be treated by splinting for a few weeks followed by physiotherapy. Displaced fractures may need surgery and fixation with wires, mini-plates and mini-screws for the hand or special contoured plates for the wrist.

Arthritis of the Hand

This is caused by loss of cartilage of hand joints that normally allows them to move smoothly. In arthritis, the bone ends at the joint, rub against each other, causing pain and swelling. This is common in the base of the thumb, middle or end joints of the fingers. Early cases may be treated by physiotherapy, anti-inflammatory medicines, splints, etc. Occasionally, surgery may be required.

Minimally Invasive Surgery for the Hand and Wrist

Wrist arthroscopy is one minimally invasive procedure that may hasten an injured athlete's return to sports participation. Wrist arthroscopy is an outpatient surgical procedure that allows access to the joints in the wrist using several small incisions, a quarter of an inch in length, instead of the traditional long incisions. Through the arthroscope, the joint is visualized using a very small camera with an image projected onto a television monitor. In this way the joints, ligaments and cartilage structures can be evaluated as the wrist moves, facilitating diagnosis and treatment of complex problems without actually opening the joint. Athletes experience less post-operative pain, healing time is substantially lessened, and return to sports participation is hastened.

The Foot Clinic

Proper foot care is not something most of us think about until problems literally put us out of step. Yet, foot and ankle problems are among the most common health ailments. Virtually everyone will experience some degree of foot and ankle problems during their lifetime.

Although some problems are inherited, many stem from a lifetime of accumulated abuse and neglect, such as wearing improper footwear or not seeking early medical attention. Specialists at the Hand and Foot Clinic of our hospital treat all conditions that affect the foot and ankle, including diabetic foot problems.

Foot pain can affect any part of the foot, from toes to Achilles tendon at the back of the heel.
Although mild foot pain often responds well to home treatments, it can take time to resolve. Severe foot pain should be evaluated by your doctor, especially if it follows an injury.
Injury, overuse, or conditions causing inflammation involving any of the bones, ligaments or tendons in the foot can cause foot pain. Arthritis is a common cause of foot pain. Injury to the nerves of the feet may result in intense burning pain, numbness or tingling (peripheral neuropathy).

Some common causes of foot pain include:
  • Achilles tendinitis
  • Achilles tendon rupture
  • Avulsion fracture
  • Bone spurs
  • Broken ankle/broken foot
  • Broken toe
  • Bunions
  • Bursitis
  • Complex regional pain syndrome
  • Corns and calluses
  • Diabetic neuropathy
  • Flatfeet
  • Gout
  • Hammertoe and mallet toe
  • High heels or poorly fitting shoes
  • Ingrown toenails
  • Metatarsalgia
  • Morton's neuroma
  • Osteoarthritis
  • Osteomyelitis
  • Paget's disease of bone
  • Peripheral neuropathy
  • Plantar fasciitis
  • Plantar warts
  • Rheumatoid arthritis
  • Septic arthritis
  • Stress fractures
  • Tarsal tunnel syndrome
  • Tendinitis
  • Tumors

Plantar Fascitis

It is a common painful disorder affecting the heel and underside of the foot. Approximately 10% of people have plantar fasciitis at some point during their lifetime. The heel pain characteristic of plantar fasciitis is usually felt on the bottom of the heel and is most intense on the first steps of the day. Most cases of plantar fasciitis respond well to conservative methods of treatment.

Insertional Achilles Tendonitis

This is a degeneration of the fibres of the Achilles tendon directly at its insertion into the heel bones. It may be associated with retrocalcaneal bursitis and Haglund's deformity. There is tenderness directly over the back of the heel bone and often there is a bony prominence at this area. Conservative therapy is usually effective in the majority of patients with liberal use of heel lifts, stretching and shoes. Surgical treatment is indicated is there is failure with several months of non-surgical treatment.

Achilles Tendon Rupture

The Achilles is the strongest and thickest tendon in the body as well as the most commonly injured tendon. There is a 25% incidence of missed ruptures on initial evaluation, so a high index of suspicion is necessary on the part of the physician. Early surgical repair of the tendon is beneficial. Surgery offers a significantly smaller risk of re-rupture compared to traditional non-operative management as well as faster rehab of the patient.

Flatfoot deformity

Also known as pes planus it is a postural deformity in which the arch of the foot collapses. Flatfoot can occur in both children as well as in adults. In children the foot is usually flexible and treatment is initially conservative with special shoes. In those not responding to conservative therapy, surgery is a useful option to restore the arch of the foot. In adults however, the foot is usually rigid with arthritis of the foot joints. In such cases conservative therapy is of little use and surgery in the form of osteotomies or fusion is indicated.

Forefoot Deformity

Forefoot deformities like Hallus Valgus, Hallux Varus, Claw and Crossover toes are commonly encountered in the general population. They are more common in patients with inflammatory arthritis like Rheumatoid Arthritis. These deformities are quite debilitating for the patient causing pain, difficulty in walking and wearing shoes. Commonly available splints can help in early cases but surgery is usually the treatment of choice for them.

Bunions

A bunion is a bony bump that forms on the joint at the base of your big toe. A bunion forms when the big toe pushes against the next toe, forcing the joint of the big toe to get bigger and stick out. A bulging bump on the outside of the base of your big toe, swelling, redness or soreness around your big toe joint, thickening of the skin at the base of your big toe, corns or calluses — these often develop where the first and second toes overlap, persistent or intermittent pain, restricted movement of your big toe are some of the symptoms for which a physician's opinion is sought. Doctor may recommend surgery because bunions can result in other painful foot problems. Surgery can be done on mild or severe cases.

Corns and Calluses

Corns and calluses are thick, hardened layers of skin that develop when your skin tries to protect itself against friction and pressure. They most often develop on the feet and toes or hands and fingers. If a corn or callus becomes very painful or inflamed, see your doctor. If you have diabetes or poor blood flow, call your doctor before self-treating a corn or callus because even a minor injury to your foot can lead to an infected open sore (ulcer). Orthopaedic shoe inserts or surgery for foot deformities may help correct the problem.

Hammer Toe and Mallet Toe

Hammertoe is a contracture (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. If your feet regularly hurt, you should see a doctor. There are several treatment options. These are based on how severe the problem has become. The sooner a person seeks treatment, the more options that person may have. Medication that reduces inflammation can ease the pain and swelling. Our doctor may recommend foot exercises to help restore muscle balance. Splinting the toe may help in the very early stages. There are several surgical techniques used to treat hammertoes.
Mallet Toe: A mallet toe is a fixed or flexible deformity of the distal interphalangeal (DIP) joint of the toe. Pain, callosity, or both may be the presenting complaints when the DIP joint of the toe has abnormal flexion, either fixed or flexible. The usual indication for surgery is the presence of painful deformity. Occasionally, cosmesis may be raised as a presenting complaint.

Ingrown Toenails

Ingrown toenails are a common condition in which the corner or side of a toenail grows into the soft flesh. The result is pain, redness, swelling and, sometimes, an infection. Ingrown toenails usually affect your big toe. Diabetes or another condition that causes poor blood flow to the feet, can pose a greater risk of complications of ingrown toenails. Doctor may recommend lifting the nail, partially removing the nail, and removing the nail and tissue.

Complex Foot Deformity

These are quite commonly seen especially in the Indian subcontinent as a sequel of trauma, poliomyelitis, cerebral palsy or other neuromuscular conditions. Surgery is the definitive treatment for these pathologies.

Hindfoot Arthritis

It encompasses ankles and subtalar arthritis, either primary arthritis or as a consequence of past trauma or deformity. It is a painful condition which prevents the patient from going about his/her regular activities. Depending on the cause and severity of the problem, fusion of the joint is indicated. However, nowadays with the advent of newer technology, Total Ankle Replacement can also be a viable alternative which allows the patient to preserve motion at the joint unlike a fusion which does not allow any joint motion.

Sports Injuries

Sports person including amateur and professional may suffer from a number of injuries which in some cases can have a huge impact on their career. Notable among them are ankle sprains, lisfranc ligament injuries, chronic instability of the ankle to name a few. Early and accurate diagnosis is critical in these cases. Some of these injuries respond well to conservative therapy while some may require open or arthroscopic surgery.

Ankle Arthroscopy

With the advent of Ankle Arthroscopy surgeons have developed a new tool to do minimally invasive surgeries for a host of foot and ankle pathologies. Ankle Arthroscopy is being increasingly used to treat ankle impingement, chronic ankle instability, osteochondral cysts of the talus and even arthroscopic tendon transfers. This technique has the advantage of having minimal surgical scars and faster recovery.

Foot and Ankle Fractures

Common fractures include calcaneum or heel bone fractures, talus and ankle fractures and lisfranc fracture dislocations. New fixation methods have enabled foot and ankle surgeons to provide better fixations with less wound complications than before.

Diabetic Foot deformities

The loss of nerve function – neuropathy – among diabetic patients in their feet and legs typically develops over time. Because patients cannot feel foot injuries as acutely as those without diabetes, they may inadvertently ignore foot problems. Therefore, pain is not an early indicator of problems in diabetic patients. Poor circulation and decreased immunity to infection can also lead to serious diabetic foot problems.
Symptoms of diabetic foot problems include pain or a tingling foot sensation in the feet at night. Ulcers, infections, and other problems may be painless. As a result, routine self-inspection of each foot is of utmost importance. Additionally, patients may experience unsteadiness in standing and walking due to the loss of sensation. Finally, the foot may have swelling, redness, ulcers, and bleeding, all of which should alert the patient to call a physician.
With Diabetes affecting increasing number of people, number of diabetic foot problems is also on the rise. Most of these include intractable foot ulcers with joint destruction leading to severe foot and ankle deformities. Surgery offers a viable alternative to these patients for a stable plantigrade foot.
As a team, our plastic surgeons collaborate with physicians from other medical and surgical specialties to give our patients comprehensive care of their hand and upper extremity needs. These include specialists in Pediatrics, Emergency Medicine, Vascular Medicine, Rheumatology, Hand Therapy and Dermatology. Additionally, our plastic surgeons work closely with Orthopaedic Surgeons and the Orthopaedic Surgery

What are the benefits of treatment?

If you are diabetic and have a foot problem, you should contact your doctor for evaluation and treatment. To take care of the foot, you should do the following:
  • Wear shoes that fit properly.
  • Inspect each foot daily for blisters, cuts, sores, and other problems.
  • Avoid going barefoot.
  • Avoid exposure to temperature extremes.
  • Do not self-treat corns, calluses, or ingrown toenails.
  • Instead, see a physician for treatment.
  • Have regular foot examinations.
  • Keep your feet warm.
  • Control your diabetes by monitoring your blood sugar levels and taking prescribed medications.
  • Do not ignore minor problems, as they can become severe very quickly in diabetics.
Serious foot problems that have resisted conservative treatment methods may require surgery. Surgery may be aimed at removing a foot infection, realigning bony deformities, or an amputation to prevent furt

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