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Orthopaedic Foot Surgery
 

Orthopaedic Foot Surgery

Can Foot Surgery Help?
Your feet keep you on the move, allowing you to walk, run, dance, and drive. Because of the pressure put on your feet day, it's not unusual for them to develop problems that cause pain or lost mobility. If you have a foot problem, you may have tried to relieve your symptoms with ice, heat, rest, or other home treatments. If non-surgical care hasn't worked, surgery by an orthopaedic surgeon may be the treatment for you.

Your Foot May Hurt
Pain, cramps, or throbbing in your foot may make you feel tired, irritable, and just plain miserable. And because of your foot problem, you may not be able to find shoes that are comfortable. But a foot problem can be more than an inconvenience to you: It can interfere with your ability to move and to do all of the things that you need to do.

Nonsurgical Care Hasn't Worked
Your doctor may have recommended non-surgical treatments such as ice, heat, elevation, shoe inserts, foot pads, or different shoes. In many cases, these measures work to relieve foot problem symptoms, but they may not cure your foot problem.

Your Orthopaedic Surgeon Can Help
Your orthopaedic surgeon, a physician who specialises in diagnosing and treating problems of the skeletal system, can help you get back on the move. After evaluating your foot, your orthopaedic surgeon may recommend foot surgery to relive your pain and restore your foot to its full function.

Your Foot Carries All Of The Weight

Because your feet are at the base of your body, they bear the pressure of your weight. The stress of weight-bearing, combined with poorly fitting shoes, heredity, aging, or disease, may cause or add to the development of painful foot problems. If you understand what makes up a healthy foot, you'll be able to understand your own foot problem better.

A Healthy foot
Your foot is made up of soft tissue and bones that work together to form a healthy, functioning, and pain-free foot.

Soft Tissue

Nails protect the tips of the toes.
Matrix cells are the nail's growth cells.
Skin covers the underlying structures of the foot.
Nerves travel throughout the foot, providing feeling.
Muscles contract and relax to move the foot.
Tendons are tough elastic fibres that connect muscles to bones.
Ligaments are fibrous strands that connect bones.
The plantar fascia is a sheet of fibrous tissue that supports the arch and encloses muscles there.

Bones

Phalanges are the toe bones. Distal phalanges are on the tips. Middle phalanges are next. (The first toe doesn't have one.) Proximal phalanges are the bones closest to the middle of the foot.

Sesamoids, two tiny bones usually under the first metatarsal, develop in a tendon.

Metatarsals are the bones between the toes and the peak of the arch.

Tarsals are the bones under the arch.

Joints, the meeting points between two bones, are lined with cartilage, smooth tissue that allows joints to move easily.

The arch is formed by bones and held in place with ligaments.

The talus is one of the anklebones.

The calcaneus is the heel bone.

The tibia is the shinbone.

Where Problems May Strike
As you grow older, you may experience a variety of health problems. But because foot pain often seems to radiate up the body, none may seem as annoying as foot problems. Foot problems can occur on one or both feet, often in combination.

First Toe
Problems affecting the bones of the first toe include bunions and arthritis (degenerative joint disease). A common soft tissue problem in the first toe is an ingrown nail.

Lesser Toes and Forefoot
Common soft tissue changes in the lesser toes and forefoot include corns, calluses, and neuromas (irritated nerves). Bony problems include curled toes and curved toes.

Midfoot and Hindfoot
Bony problems in the mid- and hindfoot include arthritis and bone spurs. Soft tissue problems include ganglions, fallen arches, and inflammation.

Your Orthopaedic Evaluation

Your orthopaedic surgeon will evaluate your foot to make a diagnosis. Your medical history will be taken, a physical exam done, and x-rays and other tests may be needed.

Medical History
Your surgeon will ask about your past and current health foot problem, and details of your foot pain. You may be asked about the shoes you wear; since they may be causing or adding to your foot problem.

Your Foot Exam
Your surgeon will examine your foot to identify sensitive areas and assess its range of motion. The pulse in your foot may be taken to check its blood supply. Your surgeon may ask you to move your foot or walk to see your foot motion.

X-rays and Tests
X-rays may be taken to assess your current foot problem. Other tests may also be done: blood tests can rule out other medical conditions that could be the cause of your symptoms, and detailed diagnostic tests assess damaged bones and soft tissue.

Considering Surgery
Once the diagnosis is made, your surgeon will discuss your surgical options with you. Because foot surgery is usually an elective procedure make sure its right for you. Talk with your surgeon about how the procedure will be performed and what you can expect during recovery.

Preparing For Foot Surgery

Although surgery may be done at your surgeon's office, it's usually performed at a surgical centre or hospital. You may be able to go home a few hours after surgery, depending on your foot problem.

Plan Ahead
Arrange for someone to drive you home afterward. You may also want to arrange for a few days off from work for recovery. You may have to wear a special shoe or use a cane or crutches for several weeks after surgery.


Pre-Op Instructions
You may be advised to stop smoking and taking aspirin the week before surgery to prevent complications. Don't eat or drink anything, including water, after midnight the night before surgery, and bring crutches or a cane if recommended.

Possible Risks
Possible risks and complications of foot surgery include bleeding, swelling, pain, infection, and nerve damage (tingling or numbness). Before surgery, your surgeon will discuss the risks and complications of your procedure with you and will answer any other questions you may have.

Your Surgical Experience
Your doctor will discuss the type of anaesthetic you will receive for surgery. You may be given an anaesthetic to numb your foot (local) or the lower half of your body (spinal or regional). In some cases, anaesthesia helps you "sleep" through surgery (general).

Problems In Your First Toe

Your first toe, also called the hallux or "big" toe, is the hardest-working toe on your foot because it pushes you off the ground as you walk and run. Because your first toe does so much work, problems there may seem especially inconvenient to you. Listed are some of the most common problems for the first toe and their surgical treatments.

Bunion
A bunion, also called a hallux valgus, is a bony bump at the side of the first toe caused by a misalignment of its main joint. Bunions are often painful and can limit shoe wear. To remove your bunion and straighten the toe, your surgeon may take one or more of the following steps: shift the soft tissue around the joint, remove the bony bump and other excess bone, or remove the joint and connect (fuse) the bones on the two sides of the joint. There are many surgical techniques for treating bunions.

Degenerative Joint Disease
With degenerative joint disease (arthritis or hallux rigidus), your toe is stiff and painful. The cartilage in your joints wears out, causing bones to rub together and create bone spurs. Your surgeon may remove the spurs, fuse the rubbing bones, or replace the joint.

Ingrown Nails
An ingrown nail, usually on the first toe, is a nail that is too wide for the toe. The nail grows into the skin, causing pain, swelling, and, oftentimes, infection. If trimming the nail straight across hasn't helped the problem, the nail can be surgically repaired.

Shifting Soft Tissue
To realign the joint, soft tissue is released, the bunion is trimmed, and the metatarsal may be cut and repositioned. If so, a screw or pin is inserted into the first metatarsal to stabilise the bone. Then sutures and a dressing are applied. Healing may take three months or more.

Shifting the Bone
Another common treatment for a bunion is to remove the bunion, cut and shift the metatarsal, trim off the excess bone there, and tighten up the soft tissue. A pin may be inserted to stabilise the bones before sutures are applied. Healing may take three months or more.

Removing the Bone Spurs
A common way to treat degenerative joint disease is to trim off the bone spurs that prevent the toe from moving smoothly. Your surgeon will apply sutures and a dressing on the forefoot. Healing may take six weeks or longer.

Narrowing the Nail
Surgical treatment for ingrown nails involves narrowing the nail and removing the source of the too-wide nail: its growth cells. Sutures may be applied, and a dressing is placed over the first toe. Your toe may be healed in two weeks or longer.

Problems In Your Lesser Toes And Forefoot

Your lesser, or "little" toes back up your big toe and help propel you when you walk, dance, and run. Problems in the lesser toes may inconvenience you because they can be painful and limit the shoes that you wear. Here are some common lesser toe problems and some of their surgical treatments.

Curled Toes
Curled toe problems include hammer toe (the middle toe joint can't straighten), mallet toe (the end toe joint cant straighten), and claw toe (when the joint closest to the arch can't straighten). Your surgeon may remove part of the raised bone, release the soft tissue, or fuse the bones.

Corns and Calluses
Corns and calluses, areas of thickened skin, grow in response to pressure from a nearby or underlying bone. Corns grow in between (soft corns) or on top of toes. Calluses (hard corns) grow on the bottom of the foot or on the heel. Your surgeon may remove the bone causing the problem.

Neuromas
A neuroma is a painful thickening of the nerve, often between the third and fourth metatarsal bones. You may not be able to see it, but you or your surgeon can feel the lump under the skin. Your surgeon may remove the neuroma, which leaves the foot without part of the nerve.

Curved Toes
When a toe crosses over or under an adjacent toe, it's a curved (deviated) toe. Your surgeon may release the soft tissue to reposition the toe or reconstruct the toe joint. These treatments are often done at the same time.

Straightening the Toes
Removing part of the raised bone helps straighten the curled toe. A pin may be inserted to keep the remaining bones straight as they heal. (The pin is later removed.) Sutures close the incision, and a dressing is applied to the forefoot. Healing may take four weeks or longer.

Removing the bone
Part of the bone that is rubbing the corn is removed. (Sometimes a pin is used to connect the remaining sections of the bone. It is removed during recovery.) Afterward, sutures are applied, and a dressing is put into place. Healing may take six weeks or longer.

Removing the Neuroma
To relieve your symptoms, the section of the nerve containing the neuroma is removed. Sutures and a dressing are put into place, and healing may take three weeks or more. After surgery, a small portion of your foot may remain numb, but your pain will be relieved.

Repositioning the Toe
To straighten the toe, your surgeon releases tight ligaments and tendons around the toe. After surgery, a pin may be inserted to hold the bones together, but it is later removed. Sutures and dressing are placed on the forefoot. Healing may take eight weeks or more.

Problems In Your Midfoot And Hindfoot
If you have a problem in your midfoot or hindfoot, walking may be unbearable. Every time you set your foot down, you may experience pain. Problems in your midfoot and hindfoot can throw your walk off balance, resulting in pain in your legs and spine. So, treatment of the following foot problems can help preserve the health of other parts of your body.

Degenerative Joint Disease
Degenerative joint disease (arthritis) can result in joint pain and stiffness in your foot or ankle. Cartilage lining the joints wears out, allowing bones to rub together. Your surgeon may join them with staples, screws, or pins to fuse them together.


Ganglions
A ganglion, a fluid-filled sac near a joint or tendon, feels like a small, sometimes painful, bump on your foot. Often, before surgery is attempted, your surgeon may remove the fluid from the ganglion to reduce swelling. If you continue to experience symptoms, the ganglion is removed.

Bone Spurs
A bone spur, a small bony outgrowth, may irritate nearby soft tissue and cause pain. Bone spurs usually develop in the midfoot and hindfoot, but can occur anywhere in the foot. Your surgeon may remove the bone spur causing your symptoms.

Fallen Arch
A fallen arch, often caused by a ruptured (torn) tendon, may be the result of an injury or aging. The tendon wears out, the arch flattens over time and may become inflamed, painful, and weak. Your surgeon may transfer a tendon or fuse bones in your hindfoot to stabilize your arch.

Connecting the Bones
Bones in the hindfoot may be smoothed, then fused so they don't rub together. Staples or screws may be used (later removed) to connect the bones while they heal, and sutures and a dressing are applied. A cast may be used to immobilize the foot. Healing may take three months or more.

Removing the Sac
To eliminate your pain and other symptoms, the ganglion is removed. Sutures are put into place, and a dressing is placed over the forefoot and, depending on the location of the ganglion, the ankle. Healing usually takes three or more weeks.

Removing the Spur
The bone spur is removed to eliminate the source of irritation. After surgery, sutures are put into place, and a dressing is applied to the foot and ankle. Healing may take a month or more.

Stabilising the Arch
A healthy tendon from your heel is moved to your midfoot. The tendon is looped through a hole (made in a midfoot bone) and reattached to itself to raise your arch slightly. Sutures, a dressing, and splints are applied (a cast is used later). Healing takes eight weeks or more.


Caring For Your Foot

Your feet need special attention, especially alter surgery. The better you care for your foot, the faster you may heal. And the faster you heal, the sooner you can resume your normal activities. Follow your surgeon's instructions about how to care for your foot after surgery

Bearing Weight
For the first few days, your surgeon may recommend that you not bear weight on your foot and that you use a cane, clutches, or a walker to help you move around. Gradually, you may work up to putting more weight on your foot.

Relieving Pain
Take pain medication to relieve discomfort and antibiotics to prevent infection as instructed. To protect your foot, wear your surgical (post-op) shoe as recommended. To relieve pain and swelling, apply a bag of ice to your foot as suggested and elevate your foot above heart level ("toes above the nose") the first few days.

Driving Your Car
Depending on the type of surgery you had, which foot was surgically treated, and your car's transmission (automatic or standard), your surgeon may allow you to drive within a week or so.

Follow-up with Your Surgeon
You may visit your surgeon the first week or two after surgery so he or she can remove your dressing, assess your incision, and apply a fresh dressing. Your sutures and, if applicable, your cast may be removed in two or more weeks. To make sure you're healing properly, you may see your surgeon regularly for three months. Talk to your surgeon about when you can wear your own shoes.

Strengthening Your Foot
Your surgeon may suggest ways to get your foot back in shape. You may be instructed to do exercises, possibly using weights. Start out slowly, then increase repetitions as recommended. Walking straightens your foot because of the weight you put on it, but go short distances the first few weeks. Physical therapy may also be recommended to help you strengthen your foot and increase its range of motion.

Call Your Doctor If:
You experience side effects from your medications.
Your dressing loosens, comes off, or gets wet.
You notice excessive blood on your dressing.
You experience increased or lingering pain.
The area around your dressing becomes hot or looks red.
You develop a fever.
The calf above your treated foot swells.
You have trouble with your pins, staples, or screws.


Treat Your Feet Right
Having orthopaedic foot surgery may be the most effective treatment for your foot problem. After your foot has healed, take good care of it by buying shoes that support and protect your feet and ankles. Once you're back on your feet, you can get back to work and back to enjoying your life.








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