• Central Specialist Centre
    164 Cambridge Street
    West Leederville, WA 6007 (free parking at rear)

Foot Conditions

Bunion Deformity / Hallux Valgus

What is a bunion?

A bunion or (hallux abducto valgus) is a hard bump at the big toe joint. The bump is due a dislocation of the big toe joint with some arthritic enlargement. They can be painful for some and have been known to cause numbness along the joint. Most often they cause embarrassment and difficulty in finding shoes.

Bunions can present in adults and children. Unfortunately they are often misdiagnosed and therefore not managed appropriately. Arthritic and enlarged stiff big toe joints, known as hallux rigidus are often misdiagnosed as bunions. A true bunion deformity is known to be progressive, meaning it worsens over time.

In moderate to severe cases there may be overlapping of the second toe, corns and callous and pain under the ball of the foot. Bunions also contribute to the development of nerve impingements such as Morton’s neuroma and toe deformities. Most people with moderate to severe bunions also experience some level of knee or lower back pain associated with poor foot function. Bunions are one of the most common foot deformities managed by Dr Azarian.

Bunions can also exist on the outside border of the foot, at the 5th toe joint. This type of ‘mini’ bunion is called a Tailor’s bunion. They are often seen with a large bunion and lead to a wide foot.


What causes a bunion?

There are many causes for a bunion deformity however genetics, flat feet and arthritis play the biggest roles. They are also much more common in females. Although footwear can worsen a bunion, they are not the primary cause. The individuals’ foot anatomy and abnormality in function will determine the extent of the deformity.


Best treatment for bunions

Many patients ask, “how can I make my bunion smaller?” Unfortunately once a bunion deformity has developed the damage is irreversible. However there are conservative options available for slowing down the progression depending on the stage of deformity.

Conservative treatment is aimed at eliminating symptoms, providing protection through custom and prefabricated toe devices, providing footwear assessment and advice, conducting a thorough leg and foot assessment and prescribing appropriate custom orthotics/shoe inserts. Dr Azarian has advanced knowledge and skills in the diagnosis and management of bunion deformities at all stages. As with any medical condition, it is best to seek professional advice as early as possible.


How about bunion surgery in Perth?

Surgery is the only proven way of correcting a bunion deformity. Bunion surgery in Perth has come a long way, with all of Dr Azarian’s operations performed at a day surgery hospital. This allows faster recovery and immediate weight-bearing. No crutches or casts are used post-operatively with patients usually returning to normal supportive shoes within 4 weeks. The most commonly asked question is “How painful is bunion surgery?” Although pain tolerance varies from person to person, most patients only require mild pain medication during the first week following surgery. Elective surgery is not appropriate for everyone, so seek professional advice if you are considering surgery call for a comprehensive consultation.


What does Bunion surgery involve?

The most commonly performed procedure by Dr Azarian involves a small cut over the big toe joint, which may also be hidden for aesthetic purposes, followed by bony realignment and reshaping. A pin (K-wire) or a screw will then be used to hold the bone in its corrected position. In mild cases the bone may not require realignment and removal of the protruding bump may be sufficient. In severe cases more work may need to be done to achieve deformity correction. Dr Azarian will assess your deformity and provide appropriate advice on the best procedure for you.

Surgery for a Tailor’s mini bunion is similar to that of a large bunion.


How long does Bunion surgery take?

This depends on the complexity of the deformity and also on how many procedures are performed. On average, surgery can take as little as 20 minutes to 1 hour.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. Call for consultation.



Hammer Toe/Claw Toe

What is a hammer toe?

Hammer or claw toes curl downward, they may also tuck under adjacent toes and look retracted. Hammer toes are very common and can be present in children and adults. They can cause embarrassment, problems with footwear, skin irritation, pain, nail deformity, corns and callous. Toe deformities are one of the most complex deformities of the foot. They require accurate diagnosis with the exact cause identified. They can affect men and women and people of all ages.


What causes bent toes?

There are many causes for curled or bent toes. The most common causes are associated with abnormal foot function. Imbalance in muscle function due to poor anatomic alignment or function can move the toes in the wrong position. Continued use of unsupportive footwear can also lead to hammer toes as they bend and try to grip on to the shoe. Other causes can include muscle wasting, nerve problems, genetic deformities and trauma.

Hammer toes are often seen with other foot deformities such as bunions, arthritic big toe joints and flat feet. Early diagnosis and management can limit further deformity.


Treatment for hammer toes in Perth

Treatment of hammer toes depends on the stage of deformity. Conservative treatments are available for flexible toes that can straighten with pressure. Treatment aims to eliminate pain, reduce deformity, prevent further deformity and protect the skin. There are also minor procedures available for straightening these toes under local anaesthetic in our consulting rooms. Dr Azarian will discuss your options with you based on the nature of your toe deformity.


How about surgery to straighten the toes?

More rigid deformities will require surgical straightening. This is one of the most commonly performed procedures by Podiatric surgeons. Hammertoe surgery can be safely performed under local anaesthetic with light sedation or under general anaesthesia. It is a day surgery procedure for most, which allows faster recovery and immediate weight-bearing after surgery. Several surgical options exist based on the nature of the deformity and its location.

Surgery involves a small cut over the toe. The bent joint will either be fused together in a straight position or the joint will be removed, allowing for some movement. If the joint is to be fused, a pin will be inserted to hold the bones in place. This pin will remain in for a minimum of 4 weeks. In more complex cases other procedures may need to be performed to achieve deformity correction.


How long does toe surgery take?

This depends on the complexity of the deformity and also on how many procedures are performed. On average, surgery can take as little as 20 minutes to 1 hour.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. Call for consultation.


Ingrown Toe Nails and Other Nail Deformities

What is an ingrown toe nail?

Ingrown toe nails also known as onychocryptosis involve a sharp spike of nail penetrating the surrounding skin. They present as swelling and redness at the edge of the nail and can be very painful. Infection of the skin is quite common, resulting in warmth, redness, yellow discharge and tenderness when walking. Recurrent ingrown nails can cause disruption to normal everyday activity and be painful in footwear.


What causes ingrown nails?

There are several causes of this painful nail problem and correct diagnosis of the cause is essential for successful treatment and prevention of recurrence. We take the time to diagnose the cause so that you will have the best results.

Some common causes include:

  • Nail shape such as curved nails
  • Tight or ill-fitting shoes
  • Cutting nails too short or leaving them too long
  • Poor foot alignment leading to excessive pressure on the side of the toe
  • Trauma to the nail or toe
  • Bony prominence underneath the nail (subungual exostosis)
  • Nail deformities such as excessive thickness (onychogryphosis)
  • Some sports that involve kicking and stop start movements


Ingrown toe nail treatment in Perth

We can get you out of pain now! Conservative treatment of ingrown toe nails can be very successful. It involves removal of the spike, a clean and appropriate dressings. We understand how tender it can be so rest assured, Dr Azarian is highly skilled and experienced in fixing ingrown toenails as gently as possible. We also offer pain relief inhalers and anaesthetics if required. In cases where there is an infection, antibiotics will be prescribed.


Can I get my ingrown toe nail fixed permanently?

Yes! In cases where ingrown nails or infection has been a recurrent problem, a permanent solution exists. We offer ingrown toenail surgery in our consulting rooms as well as day surgery hospitals if sedation is required.

The cosmetic appearance of your nail after surgery will depend on the surgeon and the technique they use. It also depends on your nail shape and thickness.

Dr Azarian takes great care to produce cosmetically pleasing results after surgery. In most cases there are no signs of surgery or scars after healing has taken place. Don’t put up with pain anymore, call us.


What to expect with ingrown toe nail surgery

Toe nail surgery is considered to be a minor procedure. As a podiatric surgeon, Dr Azarian is able to perform several minor surgical procedures to deliver the best results for you. For those who are needle shy or extremely anxious, we have options ranging from pain relief inhalers to, sedation and general anaesthesia.

Two of the most commonly performed procedures include chemically stopping regrowth of the spike or physically removing the nail root and surrounding thickened tissue. We will discuss the right type of procedure for your toe with during your consultation.

Due to the nature of the procedure you can walk immediately after and in most cases resume normal activity the following day. Many patients are surprised at how pain free they are after nail surgery.


What about thick or fungal nails?

Fungal nail infections known as onychomycosis can effect one or all toe nails. They are unsightly and embarrassing for anyone affected by them. They are also very difficult to treat and can take many months or years to clear. Treatment options involve topical liquids, tablets and lasers. In cases where treatment has failed and the entire nail is affected, a minor surgical option exists. Dr Azarian can remove the infected toe nail and make room for a new nail to grow in its place. Call us today on 9341 77 70 for advise of your nail deformity.



Neuromas/ Morton’s Neuroma

What is Morton’s neuroma?

A neuroma is a term used to describe and enlarged nerve. Morton’s neuroma is the most common nerve entrapment in the foot leading to numbness and shooting pain under the ball of the foot and between the toes. Most of our patients describe the feeling of a ‘pebble’ under their foot and notice symptoms when in shoes or walking. Neuromas are most commonly found between and 3rd – 4th toes but can present between any two toes. We often find patients with neuromas also have 2nd and 3rd toes that are very close to each other. Bunions/enlarged big toe joint, clawing of toes and hard skin under the ball of the foot are also common findings.

Do I have a neuroma?

Unfortunately neuromas are often undiagnosed or misdiagnosed. The accurate diagnosis of a Morton’s neuroma requires extensive experience in the clinical assessment and history taking of patients. In some cases an ultrasound or MRI diagnostic imaging may be necessary to determine the exact location and size of the neuroma. Dr Azarian is highly skilled and experienced in the diagnosis and management of neuromas.

What causes a neuroma?

Many factors can contribute to the development of Morton’s neuroma. Some identified causes include:

  • Entrapment due to pressure from bones on either side of the nerve
  • Poor foot alignment and function
  • Bunion deformity
  • Arthritis of the big toe joint
  • Long metatarsal bones
  • Flat feet
  • High arch feet
  • Trauma
  • Certain conditions
  • Excessive wearing of high heel shoes
  • Tight/pointy footwear

Neuroma treatment in Perth

Dr Azarian advises on non-surgical treatment for most patients. The success of these treatments depend on the size of the neuroma and how long it has been present. We provide several treatment options that are effective not only in reducing discomfort but also reducing the size of the neuroma over time. These include, custom orthotic inserts, therapeutic injections, special pads for taking the pressure off the nerve, exercises, footwear modifications and assessment and dry needling. Dr Azarian may also refer some cases for ultrasound guided injections and radifrequency treatment.


Surgery for removing Morton’s neuroma

Removal of the nerve (neurectomy) is reserved for large neuromas and chronic cases that are not responding to treatment. This is due to a small risk of regrowth of a stump neuroma and numbness between the toes. Dr Azarian will be able to advise you of your suitability for surgery and customise a plan accordingly.

The surgical removal is done under local anaesthesia with light sedation or under general anaesthesia at a day surgery hospital. This allows faster recovery and immediate weight-bearing. No crutches or casts are required.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. Call 9341 77 70 for a consultation.



Arthritic big toe joints/ Hallux rigidus

What is Hallux rigidus?

Arthritis in the big toe joint also known as hallux rigidus, causes stiffness, pain and an enlargement of the joint. This deformity can cause pain with walking, running and squatting. The bony bump at the big toe joint results from an arthritic growth due to joint destruction and reduced the movement available in the toe.

The big toe joint is one of the most common joints to be effected and can also be the first joint in the body to develop rheumatoid arthritis. The accurate assessment and diagnosis of this condition is critical to successful management. Hallux rigidus is often misdiagnosed as a bunion deformity due to the enlarged bump at the big toe joint. Bunion deformities and hallux rigidus can also coexist in moderate to severe cases.

Call us on 9341 77 70 for a thorough assessment and diagnosis.

What causes a bump and stiffness in the big toe joint?

The cause of arthritis in the big toe joint can include one or several reasons listed below:

  • Trauma
  • Any type of systemic arthritis such as rheumatoid, osteoarthritis and gout
  • Anatomically long or short 1st metatarsal bone
  • Excessive flexibility of foot joints
  • Abnormal foot function
  • Ill-fitting shoes
  • Sport and dance that lead to trauma such as football and ballet
  • Genetics
  • Previous surgery


Treatment for stiff toe joint

Arthritic changes to the joint are irreversible. However several treatment options are available for restoring normal activity and reducing pain. Dr Azarian is highly skilled and experienced in the management of such deformities and conditions. In most cases, lifestyle changes, customised orthotic inserts with specific modifications and a change in footwear make a big difference. In other cases Dr Azarian utilizes anti-inflammatory injections to provide relief. Severe cases can also be managed through non-surgical options to reduce pain. Management of underlying systemic arthritis may require care by a rheumatologist. If you are undergoing specialist care, Dr Azarian will contact your health providers to optimize management.


Surgery to fix toe arthritis

The surgical correction of an arthritic big toe joint aims to eliminate pain, reduce the size and restore functional movement. The surgical approach taken will depend on the stage of deformity. At the early mild stages a joint ‘clean up’ and removal of excess growth is sufficient and quite successful. In moderate cases a clean up and some repositioning of the bones and joint are performed to increase movement. In severe cases the joint is destroyed through the arthritic process and will either be partly removed, replaced or fused together. Dr Azarian will discuss your options with you based on the stage of your deformity.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. Call 9341 77 70 for a consultation.



Flat feet / Pes Planus

Do I have flat feet?

Flat feet, also known as pes planus is a common condition. It is characterised by a flattening and collapse of the middle arch. People with flat feet often experience aches and pains with activity or when standing for long periods. Flat feet are very unstable and subject the joints to excessive pressure. They are also associated with heel pain (plantar fasciitis), ankle, knee, hip and lower back pain. If you are experiencing any foot pain call for a consultation with Dr Azarian to see how she can eliminate your pain and prevent further damage to your joints.

Painful flat feet in children require attention and should not be ignored. In some children the little bones in the foot may not have developed properly.

Flat feet can be flexible or rigid and require assessment by a trained health professional such as a podiatrist or foot specialist. Flat feet are also associated with many deformities such as bunions, claw toes, ingrown toe nails and problems of the Achilles and plantar fascia.

Although it is most common for both feet to be flat, it may only affect one foot. In these cases the underlying cause must be established by your foot health professional. One-sided pes planus can be due to leg length difference, a damaged tendon, trauma or other issues relating to leg alignment.

If you are experiencing pain in your joints, it may be due to your foot posture. Dr Azarian is highly skilled and experienced in the assessment, diagnosis and management of flat feet in all ages.

Can you fix flat feet?

The management of flat feet is very successful if it is diagnosed and assessed accurately. In almost all cases, individuals benefit from custom made orthotic shoe inserts. Podiatrists are health professionals that undergo extensive university training on foot function and are the best people to provide custom devices. A fully customized insert for your feet and the type of shoes you wear will be created to give you an instant ‘foot lift’ and support.

In some severe cases surgery is required to create better foot posture and eliminate pain.



Heel pain/ Plantar Fasciitis


What is plantar fasciitis?

The most common type of heel pain is referred to as plantar fasciitis. In the majority of cases, the pain is worst first thing in the morning after getting out of bed. Most people find the pain gets better after a few minutes of walking. The pain is often described as an ache or a pulling sensation. If left untreated the pain can become chronic and may take longer to fix.

There are other types of heel pain that can be sharp in one spot or can shoot down the foot. Other types of heel pain also cause swelling and bumps on the sides of the heel. In some cases the pain gets worse with activity.

It is important to have your foot assessed by a foot specialist who will carry out the necessary tests. In some cases Dr Azarian will refer you to have an X-ray, ultrasound or MRI for the most accurate diagnosis.


What causes heel pain?

There are many causes of heel pain such as

  • Poor foot posture and alignment
  • Arthritic heel spur
  • Muscle imbalance
  • Systemic conditions
  • Trauma
  • Fracture of the heel bone
  • Nerve entrapment
  • Tendon problems
  • Extra bones


Treatment for heel pain in Perth

There are many treatment options available for heel pain. Dr Azarian will customize the type of management based on the type of heel pain, its cause and how long it has been present. In most cases with the right exercises and treatment plan, pain relief can be achieved very fast.

Some options include:

  • Orthotic shoe inserts based on your foot posture
  • Specific exercise and stretching regime for the foot
  • Footwear assessment and advice
  • Special strapping and padding techniques
  • Medications
  • Anti-inflammatory injections
  • Dry needling
  • Lifestyle changes
  • Surgical shoes or splints
  • Weightloss
  • Management of underlying systemic condition


Surgery for fixing chronic heel pain

Surgery is performed for those who have tried all other treatments and have had no success. In chronic cases the constant heel pain can be debilitating and can have a big impact on everyday activities. Dr Azarian is able to offer a surgical procedure for helping these patients. Known as plantar fasciotomy the surgery is often carried out under local anaesthesia. A small incision is made under the foot and the tight band of the plantar fascia is released.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. Call 9341 77 70 for a consultation.



Children’s foot Problems

What are some common paediatric foot problems you treat?

Foot problems in children can have a long lasting effect on their joints and adult foot type. Children undergo rapid growth and are also very active, these changing conditions can lead to injury that can impact their entire body. Any pain or discomfort should not be ignored, in particular those experienced at night.

Some of the most commonly treated paediatric foot and leg problems that we see are listed below.

  • Flat feet in children
  • Heel pain in children- Severs disease
  • Pigeon toes
  • knock knees or bow legs
  • Toe walking
  • Ingrown toe nails
  • Knee pain in children- Osgood-Schlatters disease
  • Sport injuries
  • Warts
  • Muscle problems
  • Growing pains
  • Leg length differences
  • Curly toes
  • Problems with footwear

Dr Azarian is highly skilled and experienced in the diagnosis and management of children’s foot conditions. Call for a consultation.


Plantar Warts / Verruca

What is a wart?

A wart on the foot, also known as verrucae is a viral infection of the skin with the Human Papilloma Virus (HPV). Warts have a cauliflower appearance and are often mistaken for a corn. A wart will be painful when pinched on either side. It also disrupts natural skin lines and has little dark spots in the centre. Warts are contagious and survive best in wet areas. The combination of bare feet around swimming pools and hotel or public bathrooms can lead to infection. They can be on their own or form a cluster.


Fast wart treatment in Perth

The body’s natural immune system often fights this viral skin infection and leads to resolution in most cases. However treatment is required in cases where there is pain, embarrassment or if the wart is getting bigger.

There are many topical treatment options with some available over the counter. It is advised that you seek professional advice if the wart is bigger than 0.5cm in size, is painful or if it has been present for more than 3 months. Dr Azarian also urges patients to seek treatment if the wart is on the heel or ball of the foot as these areas are more difficult to treat should they spread and enlarge. If a wart is treated too aggressively a permanent scar can form in its place even after it has healed. Many patients ask for the fastest way to treat plantar warts.

Some effective treatments for warts on feet include:

  • Salicylic acid– not painful during treatment, aimed to burn off blood supply to wart and kill the virus
  • Cryotherapy– freezes the wart and blood vessels that feed it
  • Needling– acupuncture needles used to stimulare immune response
  • Medications– help fight the virus from the inside
  • Lifestyle changes and diet– to strengthen immune system
  • Laser treatments
  • Important for patient to not disrupt the wart and to cover it when possible to prevent spread

Treatment of warts requires several sessions and can rarely be fixed with one application, therefore it is important to be patient.

If you are unsure about the best treatment for your skin condition please consult with a specialist. A misdiagnosed skin lesion could be wrongly treated with strong acids that can cause great harm. Home treatments are also not recommended in immune compromised or diabetic individuals.

Call for a consultation with Dr Azarian.


Surgical removal of plantar warts in Perth

Surgery to remove the verruca is performed in cases where other treatments have failed. Surgical removal can be performed under local anaesthesia with the use of an inhalation pain relief if required. The procedure involves a cut to remove the wart and sutures to close the skin.

It is important to note that HPV is very contagious and can also remain in the body for up to 2 years. This makes recurrence a possibility regardless of the treatment.

Dr Azarian is currently on leave. Existing patients may contact the clinic via email.