The foot is a complicated part of the anatomy, consisting of 26 bones, 33 joints and numerous tendons, ligaments and muscles. Many conditions affecting the foot can produce discomfort and without strong and healthy feet, we are often limited in our mobility. Sometimes the structure and mechanics of our feet and/or ankles change—for any number of reasons—and surgery may be required to address these changes.
Foot surgery is usually only considered when all conservative approaches to dealing with foot problems have been exhausted (e.g. physical therapy, corrective devices, etc.) Surgery is typically performed to reduce pain, improve or correct deformity or to restore or increase the function of your foot. Your podiatrist can determine when surgical intervention may be helpful.
There are many types of foot surgery, some of which are outlined briefly below.
1. Bunion Surgery
There are many different types of bunion surgery, depending on the severity of the bunion and the joint involvement. In fact, there are over 100 different surgeries for bunions. Research does not show which type of surgery is best—surgery needs to be specific to your condition. More than one procedure may be done at the same time.
This surgery generally involves an incision in the top or side of the big toe joint and the removal or realignment of soft tissue and bone. This is done to relieve pain and restore normal alignment to the joint. Small wires, screws, or plates may be used to hold the bones in place.
2. Hammer Toe Surgery
Hammer toe can be corrected by surgery if conservative measures fail. Conservative treatments usually start with finding shoes with soft, roomy toe boxes that will accommodate the hammer toe. Additional treatments may include the use of commercially available straps, cushions or nonmedicated corn pads to relieve symptoms.
If surgery is necessary, the actual procedure will depend on the type and extent of the deformity. It may involve removing a portion of the toe bone to realign the toe or could involve fusing the to joint (as discussed in Fusion Surgery above). Additionally, it may involve the use of an implant to help maintain the realignment of the toe.
3. Heel Surgery
Plantar fasciitis and heel spurs are problems that can develop in the area of the heel on the sole of the foot, causing chronic pain and interfering with the ability to walk normally or comfortably. Heel surgery can often provide relief from this pain and the restoration of mobility, in many cases.
The type of surgical procedure required is of course, based on the condition and the nature of the problem, but usually consists of plantar fascia release, with or without heel spur excision. There have been many modifications and surgical enhancements regarding heel surgery. As with all of the foot surgeries listed here, a podiatrist will need to determine which method is best suited for your condition.
4. Metatarsal Surgery
The most common metatarsal surgery is performed on the first metatarsal for correction of bunion deformity, which is discussed below. Surgery on the lesser metatarsals is less common, but is most often done to redistribute the weight bearing on the ball of the foot. This is generally for the treatment of painful callouses on the bottom of the foot or for the treatment of non-healing ulcerations on the ball of the foot.
5. Neuroma Surgery
Neuroma surgery involves the removal of a benign enlargement of a nerve, usually between the metatarsal heads in the ball of the foot. The nerves in this area (between the toes) can become painful and inflamed for a number of reasons, including improper footwear, repetitive activity and excessive pressure. In addition, heredity and genetics may also play a role.
This surgery generally involves making an incision on the top of the foot so the nerve can carefully be removed. This also requires ensuring removal of the nerve far enough back so that the nerve doesn’t continue to become impinged at the ball of the foot.
Typically fusions are used to treat arthritic conditions of the foot and ankle. These procedures involve the removal of cartilage and any diseased bone from a joint to produce a fusion of at least two bones to create one bone. This removal of cartilage exposes the underlying bone on both sides of the joint. These joints surfaces are then compressed together with some form of fixation to create the fusion. Fusions can be done with screws, plates or pins or a combination of these.
7. Tendon Surgery
Tendon repair is surgery done to treat a torn or otherwise damaged tendon due to injury, but is also commonly done to lengthen or shorten the tendon, depending on the problem. Tendons are the soft, band-like tissues that connect muscles to bone. When the muscles contract, the tendons pull the bones and cause them to move.
When tendon damage occurs, movement may be seriously limited in the area of the damage. The damaged area may feel numb, weak, or painful. Tendon repair surgery may be useful for patients who have tendon injuries that make it difficult for them to move, or are very painful.
8. Reconstructive Surgery
Reconstructive foot and ankle seeks to relieve the pain and discomfort caused by injury, congenital abnormalities, infection, arthritis and even improperly fitting footwear. It aims to restore or improve function and stability and/or prevent further deformity or disease.
Reconstructive surgical procedures are complex and can involve repairing or transferring tendons, implanting joints, removing tumors, and cutting, grafting, or fusing bone. Bone screws, pins, wires, staples or other fixation devices—both internal and external—may be used for repair and stabilization of bone in reconstructive procedures.
The type of foot surgery performed will determine the length and kind of follow-up care to ensure a rapid and uneventful recovery.
The basics of all postoperative care will involve, to some degree, each of the following
In addition, bandages, splints, surgical shoes, casts, crutches or canes may be necessary to ensure a safe recovery after foot surgery. Of course, your podiatrist will determine if and when you can bear weight on your foot after the surgery and a satisfactory recovery can be hastened by carefully following his or her instructions.
Note: If you’re going to be required to wear a post-op or recovery shoe following your surgery, you may want to ask your doctor about the AdaptaStep® Recovery Shoe from Propét Preferred. This comfy, washable, nano-silver lined shoe features adjustable flexibility achieved through the use of ‘flex rods’ inserted in the outsole. The fully removable top and heel panels are designed for easy on-and-off and accommodation of bandages. In addition, these panels help provide compression, without constricting and potentially creating additional swelling or edema. All of this adds up to a more comfortable recovery period and a speedier return to your normal gait. What more could you ask for?