| Surgery of the Foot or Ankle |
General Information |
Foot and ankle surgeries address a wide variety of problems,
including:
• Achilles Heel (tendinitis)
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Ankle
• Bunions
• Flatfeet
• Hammertoes
• Neuromas (nerve tumors)
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Many kinds of foot surgeries require you to have your foot immobilized
after the procedures with such devices 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.
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In addition, many patients need additional treatments/therapies after
surgery in order to aid in the healing and recovery process. These
may include physiotherapy, orthotic devices (foot supports), and special
footwear. |
Achilles Surgery |
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.
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The Achilles tendon is the largest tendon in the human body and can
withstand forces of 1,000 pounds or more. But it also the most frequently
ruptured tendon.
Both professional and weekend athletes can suffer from Achilles
tendinitis, a common overuse injury and inflammation of the tendon.
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Events that can cause Achilles tendinitis may include: |
• Hill running or stair climbing.
• Overuse resulting from the natural lack of flexibility in
the calf muscles.
• Rapidly increasing mileage or speed.
• Starting up too quickly after a layoff.
• Trauma
caused by sudden and/or hard contraction of the calf muscles when
putting out extra effort such as in a final sprint.
Achilles tendinitis often begins with mild pain after exercise or
running that gradually worsens.
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Other symptoms include: |
• Recurring localized pain,
sometimes severe, along the tendon during or a few hours after running.
• Morning tenderness about an inch and a half above the point
where the Achilles tendon is attached to the heel bone.
•
Sluggishness in your leg.
• Mild or severe swelling.
• Stiffness that generally diminishes as the tendon warms up
with use.
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Treatment normally includes: |
• A bandage specifically designed
to restrict motion of the tendon.
• Non-steroidal anti-inflammatory
medication.
• Orthoses, which are devices to help support
the muscle and relieve stress on the tendon such as a heel pad or
shoe insert.
• Rest, and switching to another exercise,
such as swimming, that does not stress the tendon.
• Stretching,
massage, ultrasound and appropriate exercises to strengthen the weak
muscle group in front of the leg and the upward foot flexors.
In extreme cases, surgery is performed to remove the fibrous tissue
and repair any tears.
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Ankle Surgery |
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.
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Bunion Surgery |
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.
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Flatfoot Correction |
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.
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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.
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Hammertoes |
Hammertoe is a deformity of the second, third or fourth toes. In this
condition, the toe is bent at the middle joint, resembling a hammer.
Left untreated, hammertoes can become inflexible and require surgery.
People with hammertoe may have corns or calluses on the top of the
middle joint of the toe or on the tip of the toe. They may also feel
pain in their toes or feet and have difficulty finding comfortable
shoes.
Causes of hammertoe include improperly fitting shoes and muscle
imbalance.
Treatment for the condition typically involves shoes with soft,
roomy toe boxes and toe exercises to stretch and strengthen the
muscles. Commercially available straps, cushions or non-medicated
corn pads may also relieve symptoms.
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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.
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