Surgery on the foot, ankle, or lower leg is usually performed by orthopedic surgeons.
Foot and ankle surgeries address a wide variety of foot problems, including:
- Sprains and fractures.
- Arthritis and joint disease.
- Benign and malignant tumors.
- Birth deformities.
- Calluses and warts.
- Corns and hammertoes.
- Heel or toe spurs.
- Ingrown toenails.
- Neuromas(nerve tumors).
Many kinds of foot surgeries require you to have your foot immobilized after the procedures with such things as a bandage, splint, surgical shoe, cast, or open sandal. Most surgeons will encourage post-operative exercise of the foot and legs to speed recovery. After sufficient healing time, most patients can resume wearing their usual footwear.
In addition, many patients need additional therapy or treatments after surgery in order to aid in the healing and recovery process. These may include physiotherapy, orthotic devices (foot supports), and special footwear.
Surgery to repair a torn (ruptured) Achilles tendon involves making an incision or cut in the back of the leg above the heel to access the torn tendon. The tendon is then sewn back together. Surgery may be delayed for about one week after the rupture to let the swelling go down.
After surgery, a cast or walking boot is usually worn for six to 12 weeks. At first, the cast or boot is positioned to keep the foot pointed downward as the tendon heals. The cast or boot is then adjusted gradually to put the foot in a neutral position (not pointing up or down).
Specific gentle exercises (restricted motion) after surgery can shorten the time needed in rehabilitation.
Patients who undergo surgery to correct arthritis in the foot often are diabetics with a type of arthritis known as Charcot foot. The average age of patients developing a Charcot foot is 40 years. About one-third of patients develop a Charcot foot in both feet and/or ankles. This form of arthritis can develop suddenly and without pain. Quite suddenly, the bones in the foot and/or ankle can spontaneously fracture and fragment, often causing a sever deformity.
The arch of the foot often collapses, and pressure areas develop on the bottom of the foot, leading to open sores or ulcers.
While many of these deformities can be treated with non-surgical care, surgery may be required. Such instances may include:
Chronic deformity with increased plantar pressures and risk of ulcers.
Chronic deformity with significant instability that cannot be corrected by braces.
Significant deformity that may include ulcers that don't heal or respond to therapy.
Types of surgical procedures include:
Hindfoot and ankle realignment. This kind of procedure is usually prescribed when there is significant instability resulting in a patient being unable to walk. Various types of internal fixation are placed within the foot during this kind of procedures.
Midfoot realignment. This kind of procedure is usually prescribed when there is significant instability of the middle portion of the foot. During a midfoot realignment, various types of internal fixation are placed within the foot.
Ostectomy - in which a portion of bone is removed from the bottom of the foot. This procedure is usually performed for a wound on the bottom of the foot that is secondary to pressure from a bony prominence.
Removal of corns is typically performed during an office visit. During the procedure, the corn is trimmed by shaving the dead layers of skin off with a scalpel. People with poor circulation or eyesight are discouraged from performing this kind of procedure themselves. The corn is usually just a symptom of the underlying problem. A more permanent resolution of corns typically involves surgery to realign the toe or remove enlarged or arthritic portions of bone from the toe.
Ganglion masses, or cysts, are normally removed through surgery. Most cyst removal surgeries are performed on an outpatient basis. Contact our office to have this procedure performed.
During the procedure, the cyst is dissected from the surrounding soft tissues and removed. The recovery period depends on the location of the ganglion and the amount of dissection required during surgery. In many cases, patients receive a splint or below-the-knee cast. The surgeon may require the patient to use crutches for several days to up to three weeks. This level of protection may be necessary if the ganglion is near the ankle joint.
Painful calluses on the ball of the foot are caused by an abnormal alignment of the metatarsal bones. There are five metatarsal bones in each foot, each consisting of the long bones behind each toe. The metatarsal bone behind the big toe is called the first metatarsal, and so on.
The most common metatarsal surgery is performed on the first metatarsal for the correction of bunions.
Surgery on the second through fifth metatarsal bones is performed infrequently, and is usually done to treat painful calluses on the bottom of the foot or non-healing ulcers on the ball of the foot. Patients with rheumatoid arthritis may also need metatarsal surgery.
During surgery, the metatarsal bone is cut just behind the toe. Generally, the bone is cut all the way through, and then manually raised and held in its corrected position with a metal pin or screw. Following the surgery, the patient's foot may be placed in a cast.
In some instances, a surgeon will also cut out the painful callous on the bottom of the foot, but most prefer to do the procedure in an outpatient setting.
Nerve Surgery (Neuroma)
A neuroma is an abnormality of a nerve that has been damaged either by trauma or as a result of an abnormality of the foot. Neuromas most often in the ball of the foot, causing a pinched and inflamed nerve.
During neuroma procedures, an incision is made on the top of the foot in the location of the neuroma, usually between the second and third toes or between the third and fourth toes. After the nerve is located, the surgeon cuts and removes it.
There are many kinds of toe problems requiring surgery. These include removal of:
- Bunions, an enlargement of the bone and tissue around the joint of the big toe.
- Hammertoes, which are frequently caused by an imbalance in the tendon or joints of the toes.
- Neuromas, an irritation of a nerve between the third and fourth toes.
- Bone spurs, an overgrowth of bone under the toenail plate, causing nail deformity and pain.