Surgery on the foot, ankle, or lower leg is usually performed by podiatric surgeons.
Foot and ankle surgeries address a wide variety of foot problems, including:
Sprains and fractures.
Arthritis and joint disease.
Benign and malignant tumors.
Calluses and warts.
Corns and hammertoes.
Heel or toe spurs.
Neuromas (nerve tumors).
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.
Surgery may be required to correct a serious deformity of the ankle and its bone structure.
An injury, birth defects, or changes throughout the course of life often cause ankle deformities.
Such diseases as diabetes, rheumatoid arthritis and neuromuscular conditions may cause severe foot and ankle deformities, and these ultimately result in pain and difficulty in walking.
Surgery often includes a procedure that realigns the existing deformity. Various kinds of internal and external fixation devices are often required either temporarily or permanently to maintain the foot or ankle in the appropriate alignment during the healing process.
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 severe 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.
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.
Arthroscopic surgery on the foot and ankle may be prescribed to confirm a diagnosis or perform a surgical procedure within a joint. The procedure uses a small instrument and other devices that penetrate the skin without causing major traumatic surgery.
Tiny cameras often are used during arthroscopic surgery to help the surgeon accurately find the area on which to operate. Arthroscopy reduces the risk of infection and swelling, and healing times as well.
Bunions are often painful deformities of the foot that require surgery to correct and alleviate pain.
There are many different types of bunion surgery.
In general, bunion surgery calls for an incision in the top or side of the big toe joint and removal or realignment of soft tissue bone to relieve pain and restore normal alignment to the joint.
The surgeon may insert tiny wires, stitches, or screws to stabilize a severely deformed joint.
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.
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.
Possible complications from cyst removal surgery include infection, excessive swelling, and nerve damage.
Adult acquired flatfoot or posterior tibial tendon dysfunction usually leads to a gradual loss of the arch. The posterior tibial muscle is a deep muscle in the back of the calf and has a long tendon that extends from above the ankle and attaches into several sites around the arch of the foot. The muscle acts like a stirrup on the inside of the foot to help support the arch. The posterior tibial muscle stabilizes the arch and creates a rigid platform for walking and running. If the posterior tibial tendon becomes damaged or tears, the arch loses its stability and as a result, collapses, causing a flatfoot.
Surgery is often performed to give the patient a more functional and stable foot. Several procedures may be required to correct a flatfoot deformity.
Surgical treatment can include the following kinds of procedures, depending on the severity of the problem:
Removal of inflammatory tissue and repair of the posterior tibial tendon.
Isolated bone fusion procedures, bone grafts, and/or repositioning bones through cuts called osteotomies.
Fusion procedures such as a triple or double arthrodesis, in which two or three major bones in the back of the foot are joined with screws or pins.
Many conditions can affect the rear part of the foot and ankle. Two common conditions can cause pain to the bottom of the heel and lead to surgical intervention: plantar fasciitis (an inflammation of a fibrous band of tissue in the bottom of the foot that extends from the heel bone to the toes) and heel spurs (often the result of stress on the muscles and fascia of the foot).
There are many causes of heel pain and most cases can be effectively treated without surgery. Chronic heel pain, however, often can only be corrected through surgery.
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 preformed 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.
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.