Not being able to be active is probably one of the things I fear the most. I was recently knocked off my feet by a dog (don’t laugh!) and fell on my knees – and it made me realise just how much we need them working properly. Luckily, they’re nearly back to normal, but it highlights how anything like painful ankles, knee pain or sore bunions that hinder us or cause discomfort shouldn’t be ignored.
Here, consultant orthopaedic surgeon DR KEVIN KOO highlights common conditions in the legs and feet and gives advice on symptoms, causes and treatments. He also discusses getting imaging tests such as an X-ray, CT scan or MRI as a starting point to see what’s a the root of the issue, and the options with bunion surgery.
# Bunions – surgery, treatment & causes
It’s not just our feet that play a really important role in walking and being active, but also our toes. Toe pain can impact our ability to get around and to lead an active, happy life. And one of the most common causes of toe pain is bunions.
What are bunions and what causes them?
A bunion is a deformity of the big toe where it drifts or deviates outwards or towards the second toe. A bony bump forms on the base of the big toe and, over time, this bump can become inflamed and painful. The most common causes are tight narrow shoes and they can be hereditary.
What are the bunion symptoms to look out for?
Aside from causing pain, bunions can make it difficult to put on shoes or to find the right shoes at all. They can also affect mobility and cause calluses on other areas of your foot. Sufferers usually notice a hard, bony swelling and redness around the big toe joint. Advanced or severe bunions may result in a crossing over or overlapping of the second toe and stiffness in the big toe joint.
What are the bunion surgery options?
Unfortunately, bunions do not go away on their own, and they tend to worsen over time. Conservative treatments like anti-inflammatory medication, bunion splints and pads, and changing to wide toe footwear can ease the pain. However, these steps don’t correct the deformity or slow its progression.
Performing early bunion correction via the “keyhole” method leads to improved outcomes, when compared to late intervention with traditional open surgery. Advantages of this technique include less post-operative pain and wound complications. Severe bunions require open surgery to remove the bony bump and re-align the big toe joint. Therefore, I recommend an early assessment for symptomatic bunions before it reaches this stage.
# Swollen or painful ankles
The ankle is an incredibly fine and interconnected area of the body – and one that is prone to injury. If you have a swollen, bruised or persistent painful ankles, it’s best to see an experienced orthopaedic specialist to regain comfort and mobility more quickly.
What is an ankle sprain and how is it sustained?
Ankle sprains and fractures are among the most prevalent injuries seen in emergency rooms worldwide. More often than not, they occur from playing sport or as a result of a fall. The ligaments supporting the ankle bones become overly stretched or torn. This happens when a sudden rolling or twisting motion of the foot causes the joint to be displaced.
What should someone do if they sprain an ankle?
It’s important to take immediate action with RICE (rest, ice, compression, elevation). Rest the ankle, apply ice every 20 minutes to decrease pain and swelling, compress the area with a bandage to reduce swelling and elevate the leg slightly.
However, self-treatment alone may not be enough. Delaying treatment for moderate to serious sprains may result in complications and worsening discomfort. Over time, this may cause recurring sprains and injuries such as ankle joint instability, chronic tendon inflammation, cartilage damage and even irreversible joint arthritis.
What’s the treatment for sprained or painful ankles?
At an initial consultation, I perform a physical examination, and arrange for imaging tests such as an X-ray, CT scan or MRI to determine the details and extent of the injury. For mild to moderate injuries, pain medication is given and orthotics may be used to reduce the load on the foot. I also recommend physiotherapy to help strengthen the ankle and restore its mobility.
For those who still can’t resume normal activities after physiotherapy, surgery may be necessary. Arthroscopy is a minimally invasive keyhole procedure that involves assessing the ankle joint with a tiny lens, removing inflamed or damaged tissue, and treating cartilage injury. At the same time, torn ligaments can also be repaired.
If you’re having recurring knee pain or need surgery, ligament repair can now be done via an innovative breakthrough “keyhole” method called the ArthroBrostrom repair. This is less painful, has less wound complications and leads to quicker recovery compared to the open traditional method.
# Looking after your knees
As a crucial joint supporting much of our weight, it’s no surprise that knee pain and injuries are common. These problems can be caused by natural wear-and-tear from ageing, overuse, illness or injury due to trauma or sports.
What are some common knee condition symptoms?
Swelling, warmth and redness are all good indicators of a knee condition. While symptoms will vary depending on the severity and type of ailment, other signs to look out for include joint stiffness or locking.
What are some of the causes of common knee pain or conditions?
I see many patients who have sustained injuries while playing sport. A tear in the anterior cruciate ligament (ACL) is common in athletes who participate in high-intensity contact sports.
Another knee injury I treat is a torn meniscus. This often happens when the knee is subjected to excessive pressure or twisting. Cartilage injuries, on the other hand, can be caused not just by trauma, but also by wear and tear. The articular cartilage provides a smooth lubricated surface for joints to move and also facilitates proper transmission of loads across these joints; this can be degraded over time.
What are the available treatments for knee conditions?
The first thing to do when you hurt your knee is to follow the RICE method. Regardless of severity, if knee pain or symptoms are persistent, you should see a specialist. I start the treatment of all these types of conditions conservatively with medications, braces and/or physiotherapy. In cases of persistent pain, injections such as platelet-rich plasma, hyaluronic acid or corticosteroids may be considered.
If the above treatment fails to alleviate the patient’s symptoms, then surgery may be performed. This can be in the form of joint-preserving surgery (the arthroscopy “keyhole” method or a realignment osteotomy) or joint-replacement surgery.
About the doctor
Dr Kevin Koo is a senior consultant orthopaedic surgeon who specialises in foot and ankle surgery, bunion surgery, joint replacements, sports and minimally invasive surgery. He’s the founder of The Bone & Joint Centre, where he provides personalised treatments and orthopaedic surgeries to all parts of the body.
#14-15 Mount Elizabeth Medical Centre, 3 Mount Elizabeth
9898 7781 | bjc.sg
This article on knee pain, toe and bunion surgery, and painful ankles appeared in our April 2025 issue. You can purchase the latest issue of Expat Living or subscribe so you never miss a copy!
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