When is Surgery of the Foot Necessary?
Many foot problems do not respond to “conservative” management. Your podiatrist can determine when surgical intervention may be helpful. Often when pain or deformity persists, surgery may be appropriate to alleviate discomfort or to restore the function of your foot.
TYPES OF SURGERY
Bunion Surgery: There are many different types of bunion surgery depending on the severity of the bunion and the joint involvement. Your podiatrist can explain the bunion procedure that is most appropriate for your bunion. Depending on the surgical procedure, the recovery time can be very different—particularly if you need to be on crutches after the surgery or in a cast.
Fusions: Fusions are usually performed to treat arthritic or painful conditions of the foot and ankle. A fusion involves removing all cartilage from a joint and then joining two or more bones together so that they do not move. Fusions can be done with screws, plates, or pins, or a combination of these.
Hammer Toe Surgery: Hammer toe surgery may involve removing a portion of one of the bones in the toe to realign the toe or could involve fusing the joints in the toe (see Fusions, above). In some cases, it may involve placing a temporary wire to hold the toes straight or a permanent implant in the toe to maintain realignment.
Heel Spur Surgery: Based on the condition and the nature of the disease, heel surgery can provide relief of pain and restore mobility in many cases. The type of procedure is based on examination and usually consists of plantar fascia release, with or without heel spur excision. There have been various modifications and surgical enhancements regarding surgery of the heel. Your podiatrist will determine which method is best suited for you.
Metatarsal Surgery: Surgery on the long bones of the feet behind the second, third, fourth, and fifth toes is performed for a variety of reasons but is commonly performed to redistribute the weight bearing on the ball of the foot. In some severe cases, such as rheumatoid arthritis, surgery may involve removing the metatarsal heads (the bones in the ball of the foot area).
Nail Surgery: Toenails can become deformed, damaged, or infected. It may be determined that the best treatment may involve surgery. Surgery is typically performed in the office under local anesthetic, and many patients can walk out and return to activities. Surgery involves either partial or total removal of the nail. An avulsion is a non-permanent type of surgery that allows relief, but the nail will grow back. A matrixectomy is a permanent type of surgery, which involves destroying and/or removing the nail root so that no new nail grows.
Neuroma Surgery: Neuroma surgery involves removing a benign enlargement of a nerve, which may be causing tingling/burning/numbness to certain toes, usually between the metatarsal heads in the ball of the foot. This soft tissue surgery tends to have a shorter recovery time than bone procedures, but it leaves some residual numbness related to the removal of the piece of nerve tissue.
Reconstructive Surgery: Reconstructive surgery of the foot and ankle consists of complex surgical repair(s) that may be necessary to regain function or stability, reduce pain, and/or prevent further deformity or disease. Unfortunately, there are many conditions or diseases that range from trauma to congenital defects that necessitate surgery of the foot and/or ankle. Reconstructive surgery in many of these cases may require any of the following: tendon repair/transfer, fusion of bone, joint implantation, bone grafting, skin or soft tissue repair, tumor excision, amputation, and/or the osteotomy of bone (cutting of bones in a precise fashion). Bone screws, pins, wires, staples, and other fixation devices (both internal and external), and casts may be utilized to stabilize and repair bone in reconstructive procedures.
Skin Surgery: Lipomas, fibromas, warts, moles, and rashes can occur on any part of the foot skin surface. Some of these conditions can be painful and impact function. In other cases, they can be questionable because they are new in appearance and a biopsy may be recommended. These skin conditions may or may not be painful. Depending on the size and depth of the condition, surgery may be performed in the office under local anesthesia or take place in the operating room.
Tendon Surgery: Surgery on the tendons can be performed for acute injuries such as ruptures and can also be performed for chronic conditions to lengthen or shorten the tendon, depending on the problem. In some cases, tendons may be re-routed to improve foot and ankle function.
PREOPERATIVE TESTING AND CARE
As with any type of surgical procedure, those undergoing foot and ankle surgery require specific tests or examinations before surgery to improve a successful surgical outcome. Prior to surgery, the podiatrist will review your medical history and medical conditions. Specific diseases, illnesses, allergies, and current medications need to be evaluated. Other tests that help evaluate your health status may be ordered by your podiatrist, such as blood studies, urinalysis, EKG, X-rays, a blood flow study (to better evaluate the circulation of the foot and legs), and an examination of the structures of your feet while walking. A consultation with another medical specialist may be advised by a podiatrist, depending on your test results or a specific medical condition.
The type of foot surgery performed determines the length and kind of after-care required to assure that your recovery from surgery is uneventful. The basics of all postoperative care involve to some degree each of the following: rest, ice, compression, and elevation. Bandages, splints, surgical shoes, casts, crutches, or canes may be necessary to improve and ensure a safe recovery after foot surgery. Your podiatric surgeon will also determine if and when you can bear weight on your foot after the operation. Your podiatrist wants you to have a satisfactory and speedy recovery, and this outcome can be achieved by carefully following the postoperative instructions that you have discussed prior to and immediately after surgery.