Foot Problems That Require Surgery

Reasons for Foot Surgery

The more you know about what to expect, the more smoothly your treatment, whether conservative or surgical, is likely to be.  While each problem is unique, there are three basic goals in treating foot problems: to relieve pain, to restore function, & to improve the appearance of your feet.

Relieve Pain
Foot pain interferes with your work, family, and social life.  Pain is often just a symptom of a larger, underlying problem.   Fortunately, in many cases, timely treatment can correct the problem and relieve the pain.

Restore Function
If your feet are not doing their job, it is hard for you to do yours.  When simply walking becomes a problem, your lifestyle is affected.  But accepting a life of hobbling or sitting on the sidelines can make you old before your time.  Foot surgery can be performed at almost any age – and in most cases, surgery can restore the normal use of your feet.

Improve Appearance
Although foot surgery is not usually performed for cosmetic reasons alone, it can often improve the appearance of your feet.

Anatomy of the Foot

Before having foot surgery, it helps to understand the anatomy of your foot, and how it works to support the musculoskeletal structure of the rest of your body.  Knowing how skin and bone heal following surgery can also help you to better understand the importance of post-operative foot care during your recovery.

Ligaments are flexible bands of fiber joining bone to bone.  The foot has over 100 ligaments that connect 26 bones, forming 33 joints. The 33 complex joints in each foot permit flexibility and mobility.  Bones form the basic supporting structure of your foot, while ligaments & tendons are the tough, fibrous cords that connect muscle to bones.  Muscles help move the feet and toes.  When a muscle contracts, it pulls on a tendon, which in turn moves the bone.

The Healing Process

All foot surgeries involve the skin, and in some cases, bone must be cut as well.  Understand the healing process can help you know what to expect following your foot surgery.

Skin heals in phases.   First, it grows together so the stitches can be removed.  The scar may look slightly inflamed; some redness and swelling are normal.  After about six months, the scar blends with the surrounding skin.

Bone also heals in phases.   A bone-like “cement” forms, bridging the affected bone and allowing it to bear weight.  Later, the extra bone is dissolved, and in about six months, the bone is back to normal strength.

Bunions

A bunion is an enlargement of bone in the joint at the base of the big toe.  Bunions are most often inherited.   Tight shoes can also aggravate bunions.  There are several types of bunions and surgical treatments for each.  Your surgery may be similar to some of the common examples listed.

Positional Bunions develops when a bony growth on the side of the metatarsal bone enlarges the joint, forcing the joint capsule to stretch over it.  As this growth enlarges, it pushes the big toe toward the others making the tendons on the inside tighten.  This, in turn, forces the big toe further out of alignment.  The bunion presses against the shoe, irritating the skin, and causing further pain.

Structural Bunions occur when the angle between the first and second metatarsal bones increases to a point where it is greater than normal.  The increase angle of the metatarsals makes the big toe bow toward the other toes.  Sometimes bony growths may form.  Irritation and swelling may often follow.  The tendency toward developing this painful condition is usually inherited.  A structural bunion becomes severe when the angle between the metatarsal bones of the first and second toes grows greater than the angle of a mild structural bunion.  Again, a tendency toward developing this condition is usually inherited.  The big toe bows toward the others, sometimes causing the second and third toes to buckle.  Irritation, swelling and pain may increase when tight shoes are worn.

Degenerative Diseases, while not true bunions, are often associated with bunions.  Bunions, left untreated, can increase wear and tear in the joint of the big toe, break down the cartilage, and pave the way for degenerative diseases such as arthritis.  Pain and stiffness are symptoms of both.

Hammertoes

A muscle imbalance or abnormal bone length can make one or more small toes buckle under, causing their joints to contract.  This in turn, causes the tendons to shorten.  Corns (build-ups of dead skin cells where shoes press and rub) often form on the contracted joint, and may become irritated and infected.

Flexible Hammertoes can be straightened with your hand.  Flexible hammertoes may progress to rigid hammertoes over time.  Corns, irritation, and pain are common symptoms.   Function is often limited as well.

Rigid Hammertoes are fixed; you can no longer straighten the buckled joint with your hand.  Corns, irritation, pain, and loss of function may be more severe for rigid hammertoes than for flexible ones.

Curled Fifth Toe

The little toe may curl inward underneath its neighbor so that the nail faces outward.  With this inherited problem, the fat pad on the bottom of the toe (normally used for walking) loses contact with the ground.  Corns and pain may result.

Plantar Calluses

Second Metatarsal Plantar Calluses develop when the second metatarsal bone is lower than the others & hits the ground with more force than it is equipped to handle.  As a result, the skin under this bone thickens.   Like a rock in your shoe, the callus causes irritation and pain.  Treatment for this condition usually takes the form of an osteotomy.  The second metatarsal bone is cut, and the end of the bone is then “lifted” and aligned with the other bones.

Heel Spurs

A heel spur is a bony overgrowth on your heel bone (see Plantar Fascitis).  It may be stimulated by muscles that pull from the heel bone along the bottom of the foot.  High-arched feet are especially apt to have too-tight muscles.  Heel spurs may cause pain when the foot bears weight.  They can be treated with injections, anti-inflammatory medication, or arch supports if indicated.  If these fail, heel spurs can also be treated with surgical excision and a plantar release.  In a “plantar release”, the band of tight muscles is released to relieve the abnormal stress.  The bone spur is then surgically removed.

Neuromas

When a nerve is pinched between two metatarsal bones (usually the third and forth metatarsals), enlargement of the nerve may occur.  Abnormal bone structure contributes to the cause, but too-tight shoes can aggravate the condition.  You may experience sharp pain in your toes that may become severe enough to keep you from walking. Neuromas are treated by removing a small portion of the nerve.  As a result of this, a small area is usually permanently numbed, but this is preferable to pain. You can usually bear weight right away, but must return to have your dressing changed.  Keep your incision dry until the stitches are removed.

High-Arched Feet (Pes Cavus)

The shape of your foot often determines the kinds of foot problems you will have.  Your feet may have unusually high arches due to an imbalance of muscles and nerves, which is usually inherited.   High arches can cause various problems from tired or aching feet to calluses.   High arches are not usually investigated with surgery, but most often treated with arch supports.

Flat Feet (Pes Planus)

Flat feet can be hereditary and are caused by a muscle imbalance.  Feet with low, relaxed arches may bring on such problems as hammertoes, bunions, fatigue, pain, and an overly tight heel cord (which exacerbates the issue).  Loose joints move too freely, causing pain and instability.  Flat feet are also usually treated with arch supports.

Orthotics

Orthotics (also called orthoses or orthotic devices) are prescribed, custom-made arch supports.  They fit inside most shoes and “bring the floor up to your feet.”

A podiatrist may prescribe them to help correct such problems as high arches and flat feet.  Also, following some foot surgeries, orthotics can help support the correction that was achieved.

To be fitted with orthotics, your podiatrist will first take an impression of your feet.  Your orthotics are then fashioned from leather, plastic, or other materials.  Their fit is checked at an office visit and adjustments can be made as you wear them.  Expect an initial “breaking-in” period; you may need to build up wearing time gradually (as you would with contact lenses).

Surgery Decision

If your bunions or hammertoes are bad enough, they may need surgical correction.  This is a gratifying operation that can provide both pain relief and improved appearance.

Risks
All surgery carries risks including stiffness, persistent pain and swelling, recurrence of problem, damage to nerves, hardware breakage, blood clots in the legs, anesthetic problems, inability to correct the problem, etc.  Make sure you understand the risks and alternatives prior to surgery.

Post-Operative Tips

Your recovery, like your foot problem and surgery, is as unique as you are.  In addition to the previous tips given on follow-up care for each surgery, here are some pointers that can help you recover quickly and without complications, and help get you back on your feet again.

Pain:  To help relieve pain and reduce swelling in the first 24 to 48 hours after surgery, apply an ice pack to the affected area and elevate your foot above heart level, as recommended.  Pain is usually most severe the second and third days after surgery, and after you first begin to walk again.

Bathing:  You will need to keep your foot dry.  Getting the stitches wet can lead to infection, so be sure to keep your foot outside the shower or bath.

Weight-Bearing:  Bearing weight and walking can stimulate circulation and promote healing.  But overtaxing a healthy foot can detract from the results of your surgery.

Shoes:  Our team may give you a wide surgical shoe to wear on the affected foot.  A surgical shoe stabilizes and protects the foot as it heals.

Returning to Work: How soon you can return to work depends on the type of surgery you had and the activities you job requires.  You can generally return earlier to a desk job than to physical labor.   Consider beforehand how much time you can take off from work until you are back on your feet.

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