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The hip joint consists of two bones – femur (thigh bone) and the pelvis (hip bone) which is ball and socket joint. The hip joint is a major weight bearing joint that is held together by muscle and ligaments. The hip joint is designed for both mobility and stability, allowing the entire lower extremity to move in three planes of motion. Cartilage is the material inside the joint that provides shock absorption func- tion to the torso and upper body as well as stability during standing and other weight bearing activities.

• Lifestyle modification like losing weight, avoiding aggravating activities
• Exercises to improve strength and flexibility
• Pain killer to provide temporary pain relief
• Glucosamine / Chondroitin to relieve arthritic pain

Arthritis in the hip joint occurs as a result of degener- ation of the cartilage in your hip joint. Due to osteo- arthritis, the cartilage in the hip joint breaks down over time and the result is severely damaged joint surface with bone rubbing on bone.
In rheumatoid arthritis, it is a chronic inflammatory disease that results in joint pain, stiffness and swell- ing. During the disease process, it causes erosion of the articular cartilage gradually and subsequent damage to the hip joint surface. The disease process leads to severe and at times rapid deterioration of multiple joints, resulting in severe pain and loss of function.

It is a surgical procedure in which damaged hip socket (acetabulum) and the ball ( femoral head) are removed and replaced with smooth artificial surfaces. The artificial socket is commonly made of metal with a high density plastic liner, and the artificial ball is made of metal or ceramic or oxinium. Each prosthesis is made up of three components. The femoral stem is made out of a metal such as titanium and is implanted down the shaft of the thigh bone or femur. The ball or femoral head, is attached to the stem and is designed to replace the arthritic femoral head. The third part, the acetabular component is a metal shell with a plastic liner. These components are implanted into the pelvis and thigh bone, and are designed to closely approximate the mobility of the natural hip joint.

Total hip replacement surgery is considered when all conservative measures have failed to provide successful intervention which helps to relieve pain, restore an active, pain free life, maximize quality of life and optimize activities of daily living.

The rehabilitation process following total hip replace- ment is very important and can be quiet painful at times. Proper rehabilitation post surgery helps you to achieve the pain free full range of movement in your operated hip joint.

In the hospital – Ambulation with walker, Range of motion exercises, edema control by ice compression

At home – Begin ambulation with a cane as tolerated and continue home exercise program

Outpatient Physical therapy – Advanced strengthening program, walking program, aquatic therapy

Long term rehabilitation goals – full range of motion and independent with all activities of daily living

• It is a condition characterised by outward deviation of great toe due to various causes and produce a bump on the inside of foot.
• Its common with people who wear high heel with narrow toe box foot wear
• More common in females
• 70% of patients will have family history of similar complaints
• Patient presents with c/o difficulty in wearing shoes, pain over the bump and deformity of the great toe. This condition can be associated with flat foot, lesser toe deformities.
• Weight bearing and oblique view xrays needed to assess the amount of great toe deviation and joint status in great toe and to plan the treatment
• Treatment – Non operative like shoe modification, pads, spacers
• Operative – soft tissue procedure, bony cuts (Osteotomy) or combined both to correct the deformity

• It is a condition in which plantar fascia (a thin layer of connective tissue) gets inflamed near its origin on calcaneum
• Affects men and women equally
• Patient presents with heel pain often when first getting out of bed may prefer to walk on toes initially and worse at the end of the day after prolonged standing, relieved by ambulation
• Xray most often normal, may show plantar heel spur
• Blood investigations to be done to rule out other causes of heel pain like gout, infection
• Treatment – Non operative like pain control, night splint, stretching therapy, short wave treatment
• Operative – Surgical release with plantar fasciotomy

• Most common reason for missed athletic participation
• Most common injury in dancers
• Grade of ankle sprain
• Xray to be done to rule out any bony injuries, ankle instability
• MRI to be considered if pain persists for 8 weeks following sprain to rule out any other cause for pain
• Treatment – Non operative RICE (Rest, Ice, Compression, Elevation), Elastic wrap to minimise swelling
• Operative – In chronic ankle sprain – Modified Brostrom procedure

• It is a condition in which the longitudinal arch in the foot, which runs lengthwise along the sole of the foot, has not developed normally and is lowered or flattened out.
• This condition can affect one or both feet
• You have this condition when your sole makes complete or near complete contact with the ground
• You can get it after an injury or because of health problem, such as rheumatoid arthritis
• Most people don’t have symptoms, although weight gain, ill fitting shoes or standing a lot may cause pain in your feet and legs
• Treatment – Non operative orthotic correction and physical therapy
• Operative : Surgical correction of deformity

• It is a condition in which protective sensation of the joint is lost which results in destruction of joints and surrounding bony structures may lead to amputation if left untreated
• Most commonly seen in diabetic patients
• Patient usually presents with swollen foot and ankle, warmth foot, redness in foot
• Patient also c/o deformed foot, bony prominences, unstable joints
• If bony prominence left untreated may lead to ulcer formation
• Xray needed to assess the amount of joint destruction, subluxation or dislocation of the joints in foot
• Blood test to rule out infection, to detect underlying pathology like diabetes mellitus
• Treatment – Non operative – total contact casting, shoe wear modifications, medications
• Operative – to achieve plantigrade (normal) foot that allows ambulation without skin ulcers
• Resection of bony prominences, Deformity correction, arthrodesis, amputation.

• Patient presents with pain backside of the heel may be due to various causes like swelling of Achilles tendon near its attachment to heel bone (calcaneum), inflammation of bursa between Achilles tendon and heel bone (Retrocalcaneal bursitis) or due to bony enlargement on backside of the heel bone (Haglund deformity)
• Patient usually c/o pain on shoe wear, bony bump on the backside of the heel, swelling on either side of the Achilles tendon
• Xray needed to assess any bony spur from calcaneum and any calcium deposit in tendon
• MRI helps to detect the amount of damage to Achilles tendon
• Treatment – Non operative – Activity modification, shoe wear modification like small heel lift
• Operative – removal of diseased portion of tendon, bony bump removal from heel bone, bursa excision

• In this condition usually baby will be brought by the parents with c/o deformity of one or both foot pointing downwards and turn inwards.
• Nothing to worry about the condition it is completely correctable
• Treatment – Non operative serial manipulative cast application
• In severe cases surgical procedures like soft tissue release. In resistant cases, ring fixator may be required to achieve full correction

• It is a condition in which joint surface of shin bone (tibia) at lower end and talus get degenerated and results in irregular joint surface which alter the load bearing mechanics of the ankle joint
• Damage to joint surface of the ankle joint may happen due to trauma, rheumatoid arthritis, osteoarthritis, haemophilia
• Patient usually presents with pain with weight bearing, loss of movement in ankle joint, swelling and deformity in ankle joint
• Xray needed to assess the amount of joint space reduction, angular deformity of the ankle joint
• Treatment option – Non operative – activity modification, pain killer, bracing
• In case of failure of conservative management, operative management required in the form of either fusion of the damaged joints (Ankle arthrodesis) or replacement of the damaged joint surface (Ankle replacement)