Hand and Foot Surgery

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Ingrown Toenails

This is a common nail condition where the side of the nail cuts into the adjacent soft tissue, or lateral nail fold. It is most common in the big toe and may be caused by a number of factors such as ill-fitting shoes, improper nail-trimming, excessive sweating, soft-tissue abnormalities of the toe or nail deformity. It may result in redness, swelling and discharge and often causes pain or sensitivity.

Ingrown toenails may be treated by non-surgical methods, often by a podiatrist. Surgery is indicated if these measures are not successful. ‘Wedge excision’ is an operation to remove the affected side of the nail, the part from where it grows and adjacent tissue, and is a simple and effective surgical treatment. Operations to remove the entire nail and prevent re-growth, such as Zadik’s procedure, are usually only required for management of more deformed nails.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a condition caused by compression of the median nerve as it runs through a narrow tunnel between the wrist and the hand. Common symptoms are pain, tingling or numbness in the thumb, index, middle finger and thumb side of the ring finger. Pain may sometimes be felt up the arm. There may be hand weakness, noticed as a weak grip. Onset of symptoms is usually gradual and may be initially noticed at night. There are a number of risk factors and associated medical conditions. Diagnosis is based on symptoms, findings on physical examination and can be confirmed on nerve conduction testing.

Surgery for Carpal Tunnel Syndrome, or Carpal Tunnel Release, cuts the roof of the carpal tunnel, formed by the transverse carpal ligament. This releases pressure on the nerve by providing more space in the tunnel. It is most or commonly performed as an open operation through a small cut in the palm. Endoscopic surgery uses a small video camera and special instruments to cut the tissues.

Ganglion

A ganglion cyst is a lump filled with jelly-like material associated with a joint or tendon, formed when lubricating fluid leaks from a joint capsule or tendon sheath. Common sites include the back and front of the wrist, the palm at the base of a finger and near the base of a fingernail. They may also occur on the foot. Often the presence of the lump is the only symptom but occasionally they may cause pain or numbness.

If there is no pain, treatment is not necessary as many ganglion cysts will disappear on their own. Surgery is an option to remove symptomatic ganglion cysts. An alternative option is needle aspiration of the fluid with injection of a corticosteroid medication however there is a higher rate of the ganglion recurring compared with surgery.

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