Surgery on the foot, ankle, or lower leg is usually performed by podiatric surgeons and orthopedic surgeons specializing in the foot and ankle.
Surgery on the foot, ankle, or lower leg is usually performed by podiatric surgeons and orthopedic surgeons specializing in the foot and ankle.
Deformities of the ankle and foot can be extremely debilitating. Often times deformation can be caused by post-traumatic changes (i.e. old injury, arthritis), genetic predisposition (metatarsal adductus, tarsal coalition, brachymetatarsia), and medical conditions (i.e. diabetes with neuropathy, charcot osteoarthropathy, tumors of the foot/ankle, flat feet, cavus (high arch) feet). When the leg, ankle, and foot are not in anatomic alignment this can create secondary changes affecting surrounding joints and difficulties with walking or normal day-to-day activities.
Post-Traumatic Injury (i.e. old injury, arthritis)
Deformities include improper alignment from previous fractures of the leg, ankle, and foot. Once arthritis in adjacent joints begins the pathology will progress until treatment is initiated. Every joint in the foot and ankle has specific motion and alignment to allow a pain free gait. When specific joint axis and anatomy is not correctly aligned this creates stress throughout the ankle and foot. When arthritis begins in specific joints it tends to spread unless the exact issue is addressed.
Symptoms of Post-Traumatic Injury
It may take months to years to develop active symptoms.
Sequela (long term changes) of Post-Traumatic Injury
As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually rub together losing their normal contact forces leading to pain and inflammation.
An injury may also lead to osteoarthritis, causing the pathologic condition to develop over months and years. Examples include but are not limited to:
Diagnosis of Post-Traumatic Injury
In diagnosing Post Traumatic Injuries, your surgeon will examine the foot/ankle, the amount of swelling in the joint, the limited mobility, and the pain with movement will be assessed as well as your surgeon gently pressing on problem areas determine the extent of the discomfort.
X-rays will be ordered to evaluate pathology. At times a CT scan will be ordered to further evaluate the extent of the disease as well as for surgical planning should surgery be warranted.
Non-surgical Treatment of Post-Traumatic Injury
Treatment approaches for arthritic joints are based on how long the pathology has been present and the amount of damage to the joint and surrounding structures. Conservative treatment options are encouraged prior to surgical intervention.
Surgery of Post-Traumatic Injury
When Post Traumatic Injury has progressed or failed to improve with non-surgical treatment, surgery may be recommended. In some advanced cases, surgery may be the only option. The goal of surgery is to decrease pain, improve function, and alignment. Your surgeon will consider a number of factors when selecting the procedure best suited to the your condition and lifestyle.
Treats the following conditions:
What are the goals of TAR?
The goal of TAR is to improve ankle motion so the patient has less pain during activity.
What signs indicate TAR may be needed?
TAR is considered in patients that experience ankle pain and decreased function from arthritis after trying conservative management. Conservative management includes anti-inflammatory medication, bracing, physical therapy, activity modification and pain medication. Patients with rheumatoid arthritis are usually good candidates for the ankle joint replacement. Other patients that should be considered are those that need but do not want a fusion-type procedure that would eliminate the motion at the ankle joint.
When should I avoid a TAR?
TAR is not suited for patients with significant deformity or dead bone in the talus, which is the bottom bone of the ankle joint. Prior or current infections of the ankle, significant lower extremity neuropathy, inadequate or absent leg muscle function, poor blood flow of the leg, or inadequate soft tissues are also signs that TAA should be avoided.
General Details of Procedure
TAR is performed either under general anesthetic or nerve block. A tourniquet is used at the time of surgery to control bleeding and improve visualization during the surgery. The ankle is approached from the front or the side depending on the type of implant being used. Bone is then cut, allowing for placement of the metal and plastic components that re-create the ankle joint. Sometimes the patient will have a tight calf muscle or tight Achilles tendon that needs to be lengthened to improve range of motion of the ankle. The wounds are then closed using stitches or staples, and a splint is applied. A period of non-weightbearing in either a cast or cast boot is necessary to allow the implants to heal in place.
Specific Technique
Either before or after the ankle replacement is put in place, the orthopaedic foot and ankle surgeon will determine if the calf muscle or Achilles is tight. A tight calf muscle or Achilles tendon is addressed with a lengthening procedure. This is important to improve motion after the surgery, as well as to take stress off the ankle replacement.
What happens after surgery?
Recovery from a total ankle replacement requires a period of non-weightbearing and immobilization. The procedure is usually
Post-surgery X-ray of an ankle replacement
performed in an inpatient setting, with the patient spending one to several nights in the hospital. Strict elevation for many days after the procedure is necessary to control swelling and improve wound healing. After the surgical wounds are healed, some orthopaedic foot and ankle surgeons will allow the patient to start working on gentle range-of-motion activities even if they are non-weightbearing. Weightbearing usually begins a few weeks after surgery if X-rays show good healing.
Potential Complications
There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Fracture of bone on either side of the total ankle implant is the most common complication. Injury to tendons or nerves and blood vessels is also a possible complication of ankle replacement. Wound healing can be a problem in patients that smoke or have diabetes, or in patients that have rheumatoid arthritis. Another complication that is sometimes seen is the failure of the ankle implant to heal into the bone.
Treats the following conditions:
What are the goals of lateral ankle stabilization?
Ankle sprains are one of the most common sports-related injuries. They affect 10,000 people per day. When the ligaments on the outside of the ankle are stretched or torn, patients can have pain and feelings of instability. If symptoms persist after non-surgical treatment, surgery may be required. So the goal of lateral ankle stabilization surgery is to repair the injured ligaments.
What signs indicate surgery may be needed?
Patients that have failed physical therapy and bracing and have instability of the ankle may consider surgery.
When should I avoid surgery?
Patients should not have this surgery if they have certain medical issues or poor circulation or are unable to follow the recommended post-surgery rehab. You should discuss any medical concerns with your surgeon.
General Details of Procedures
The torn ends of the ligaments are identified. If possible, they are repaired by sewing the ends together. Commonly, the ligaments are reconnected to the fibula bone. Other tissues may be used to strengthen the repair.
Specific Technique
A general anesthetic is commonly used. Patients may have a nerve block to numb the leg along with sedative medicines given through an IV. An incision is made on the outside of the ankle over the torn ligaments. The ligaments are identified and, if possible, sewn together with stitches. Sometimes the ligaments are not strong enough on their own, and other tissue is moved from the top the foot and “tightened” to strengthen the repair. Typically tissue is re-attached to the fibula bone with stitches placed through holes drilled in the bone or with anchors placed into the bone. The incision is closed. A splint or cast is often placed. Patients typically go home the same day.
What happens after surgery?
After surgery, casting may be used for two to six weeks. Patients then go into a walking boot or brace and begin physical therapy. It is recommended that patients wear a brace for sports activities for up to a year.
Potential Complications
There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Nerve injury can sometimes occur after ligament repair. This can result in numbness or burning on the outside of the foot. Wound complications and stiffness can also occur. Recurrent ankle instability may occur.
Treats the following conditions:
Arthroscopic surgery on the foot and ankle may be used as a diagnostic or treatment procedure, or both. A small instrument, called an arthroscope, penetrates the skin through small incisions.Tiny cameras can be inserted through the arthroscope, allowing the surgeon to accurately see the area and/or damage. Other small instruments can also be inserted through the arthroscope to make surgical corrections.
Because arthroscopy is less-invasive and traumatic than traditional surgery, it reduces the risk of infection and swelling, and allows for significantly speedier healing and recovery. Most arthroscopic surgeries of the foot and ankle are performed on a same-day, outpatient basis using a local anesthetic.
Treats the following conditions:
Treats the following conditions:
Treats the following conditions:
Incidence
A fracture is a partial or complete break in a bone. Fractures in the ankle can range from stable less severe injuries to unstable injuries involving the tibia and/or fibula. Fractures include: Distal fibula or tibia avulsion fractures (typically treated non-operatively), Stable fibula fractures (typically treated non-operatively), Bimalleolar fractures (typically treated with surgery), trimalleolar fractures (typically treated with surgery), Dislocated fractures (typically treated with surgery), Tibia plafond fractures (typically treated with surgery).
Ankle fractures are the most common bone fractures and are often caused an indirect injury by the ankle rolling inward or outward or by direct trauma (i.e. motor vehicle accident, motorcycle crash, industrial injury)
Symptoms
Diagnosis
Following evaluation by the emergency department or urgent care it is important to have the ankle evaluated by a foot and ankle surgeon for proper diagnosis and treatment.
The affected limb will be examined by the foot and ankle surgeon by touching specific areas to evaluate the injury. In addition, the surgeon may order additional x-rays and other imaging studies (i.e. CT scan, MRI), as necessary to further delineate the fracture pattern or for operative planning.
Non-Surgical Treatment
Treatment of ankle fractures depends upon the type and severity of the injury: If your surgeon has determined that your ankle fracture is stable and does not require surgery you will be placed in a removable boot with weight as tolerated in the boot.
Surgery
After your surgeon has determined the severity of your fracture through the clinical exam and diagnostic modalities surgery may be required to anatomically stabilize the ankle joint. The surgeon will select and discuss the necessary procedure that is appropriate for your injury.
Surgery is typically scheduled 6-14 days following the injury to allow the soft tissue swelling to subside.
A splint will be placed on your injured ankle until your surgery date. No weight to the injured ankle is advised.
The overall structure of the foot is complex, consisting of bones and an intricate network of soft tissue attachments to make the joints move smoothly throughout foot function and motion. There are 28 bones in the foot, 19 of the bones are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot that connect the toes to the foot). Fractures of the toe and metatarsal bones are very common and usually require evaluation by a specialist
Type of toe and metatarsal fractures
Traumatic fractures are caused by a direct blow or impact (stubbing toe, dropping a heavy item on the middle part of your foot). If the fracture is displaced, the bone has moved in a way that changes its position (malposition) and anatomical alignment which further jeopardizes the biomechanics of gate and ambulation.
Symptoms of a traumatic fracture include:
Stress fractures are small, hairline breaks that are usually caused by repetitive micro stress. Stress fractures often occur in athletes that increase their training; however, the can also occur in patients with abnormal foot structures, foot/ankle deformities, and/or osteoporosis/Vitamin D deficiency. Improper footwear can also lead to stress fractures.
Symptoms of stress fractures include:
Treatment of Toe Fractures
Fractures of the toe bones are most often always traumatic fractures. Treatment for traumatic fractures depends on the characteristics of the fracture may include these options:
Treatment of Metatarsal Fractures
Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain types of fractures of the metatarsal bones present unique challenges. Treatment of metatarsal fractures depends on the type and extent of the fracture, and may include:
Surgery
After your surgeon has determined the severity of your fracture through the clinical exam and diagnostic modalities surgery may be required to anatomically stabilize the fifth metatarsal fracture. The surgeon will select and discuss the necessary procedure that is appropriate for your injury.
Surgery is typically scheduled 6-14 days following the injury to allow the soft tissue swelling to subside.
A splint or non weight bearing removable boot will be placed on your injured foot until your surgery date. No weight to the injured foot is advised.
Consequences of Improper or Delayed Treatment
Talus
The talus is second largest bones in the foot. The talus is directly under the ankle joint. This bone is responsible for transitioning the motion/movement of the ankle joint to the remainder of the foot. Similar to the hip for leg motion, the talus is the center point for rotation for the foot. The talus connects the the ankle, the calcaneus, and the navicular and works in sync with these bones for smooth motion during ambulation. The joints involved are ankle joint (up and down motion), the subtalar joint (side to side motion of the rearfoot) and the talonavicular joint (inward and outward motion of the foot).
The talus is a strong/hard bone due to the the majority of bone covered in cartilage (joint connective tissue). Additionally the talus has no muscle/tendon connections and only ligament attachments. Due to the anatomy of the bone, the attachments, and the coverage of cartilage, the blood supply is often at risk with these fractures leading to necrosis of the bone. If the fracture of the talus involves the surrounding joints, there can be potential long-term consequences to include arthritis, difficulty in walking, and chronic pain.
Incidence/Mechanism
Talus fractures are the result of a traumatic event. Commonly, falling from a height, or a motor vehicle accident where the front part of the bone is wedged against the front of the ankle or where the body of the bone is wedged between the heel and the ankle joint. Talus fractures can also occur with other types
of injuries, such as an ankle fracture or ankle sprain.
Types of Talus Fractures
Fractures of the calcaneus may or may not involve the ankle, subtalar, or talonavicular joint.
The treatment and severity of these fractures depend on their size and location.
Symptoms
Diagnosis
In order to determine the diagnosis your surgeon will will ask how the injury occurred. The foot will be examined, with the surgeon gently pressing on different areas of the foot to locate the pain.
X-rays are necessary to evaluate the extent of the injury. Typically a CT scan will be ordered for further evaluation of the talus as well as for surgical planning if surgery is needed.
Treatment
Treatment of the talus fractures depends upon the type and severity of the injury: If your surgeon has determined that your talus fracture is stable with minimal displacement or minimal joint involvement and does not require surgery you will be placed in a short leg cast or a removable boot to restrict motion and allow the fracture to heal as weight can cause further displacement and possible surgical intervention.
Please note: Due to limited ambulatory status, severe medical conditions, or noncompliance your surgeon may recommend non surgical treatment even though surgery would be indicated for your fracture. If this is the case you may require a surgical fusion of the ankle joint, subtalar joint and/or talonavicular joint once your medical status changes and/or you receive medical clearance for medical conditions. Arthritis may occur without surgical intervention.
Surgery
After your surgeon has determined the severity of your fracture through the clinical exam and diagnostic modalities surgery may be required to anatomically stabilize the talus and to reconstruct the ankle joint, subtalar joint, and/or talonavicular joint. The surgeon will select and discuss the necessary procedure that is appropriate for your injury.
Surgery is typically scheduled 6-14 days following the injury to allow the soft tissue swelling to subside.
A splint will be placed on your injured foot until your surgery date. No weight to the injured foot is advised.
Complications of Talus Fractures
Talus fractures can be serious injuries that may produce lifelong problems. Arthritis, stiffness, and pain in the joints frequently develop. Sometimes the fractured bone fails to heal in the proper position. Other possible long-term consequences of talus fractures are avascular necrosis (dead bone) due to the limited blood supply to the talus. This may cause decreased ankle, subtalar, and talonavicular motion and walking with a limp due to collapse of bone and loss of length in the leg. Patients often require additional surgery and/or long term or permanent use of a brace and/or an orthotic device to help manage these complications.
Fractures of the fifth metatarsal involve the long bone on the outside of the foot that connects to the little toe. Several types of fractures occur.
Symptoms
Pain, swelling, bruising, and tenderness (typically directly over the fracture) on the outside of the foot, Difficulty walking.
Diagnosis
In order to determine the diagnosis your surgeon will will ask how the injury occurred or when the pain started. The foot will be examined, with the surgeon gently pressing on different areas of the foot to locate the pain.
X-rays will be ordered. If the surgeon is concerned with a stress fracture (hairline fracture) or comminution of the joint complex additional imaging may be needed.
Non-surgical Treatment
Treatment of fifth metatarsal fractures depends upon the type and severity of the injury: If your surgeon has determined that your fifth metatarsal fracture is stable and does not require surgery you will be placed in a removable boot with the ability to weight bear as tolerated in the boot.
Surgery
After your surgeon has determined the severity of your fracture through the clinical exam and diagnostic modalities surgery may be required to anatomically stabilize the fifth metatarsal fracture. The surgeon will select and discuss the necessary procedure that is appropriate for your injury.
Surgery is typically scheduled 6-14 days following the injury to allow the soft tissue swelling to subside.
A splint or boot will be placed on your injured foot until your surgery date. No weight to the injured foot is advised.
Calcaneus
The calcaneus (heel bone) is one of the largest bones in the foot. This bone is responsible for absorbing the weight during walking/running and forms the foundation of the rear part of the foot. The calcaneus connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the subtalar joint. This joint is important for side to side motion and works in sync with other joints during the ambulation process.
The calcaneus can be compared to a hard boiled egg (hard shell on the outside and softer, spongy bone on the inside.) When the outer shell is broken, the bone tends to collapse and become fragmented. Also, if the fracture involves the joints, there can be potential long-term consequences to include arthritis, difficulty in walking, and chronic pain.
Incidence/Mechanism
Calcaneal fractures are the result of a traumatic event. Commonly, falling from a height (ladder), or a motor vehicle accident where the heel is crushed against the floorboard. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone.
Types of Calcaneal Fractures
Fractures of the calcaneus may or may not involve the subtalar and surrounding joints.
Fractures involving the joints (intra-articular fractures) are the most severe calcaneal fractures, and at times include damage to the cartilage (joint connective tissue that allows the joints to move).
Fractures that don’t involve the joint (extra-articular fractures) include:
Those caused by trauma, such as avulsion fractures (piece of calcaneus is pulled off with the achilles tendon) or crush injuries resulting in multiple fracture fragments
Stress fractures, caused by overuse or mild injury.
The treatment and severity of extra-articular fractures depend on their location and size.
Signs and Symptoms
Calcaneal fractures produce variable signs and symptoms, depending on whether they are traumatic or stress fractures.
The signs and symptoms of traumatic fractures may include:
The signs and symptoms of stress fractures may include:
Diagnosis
In order to determine the diagnosis your surgeon will will ask how the injury occurred or when the pain started. The foot will be examined, with the surgeon gently pressing on different areas of the foot to locate the pain.
X-rays are necessary to evaluate the extent of the injury. Typically a CT scan will be ordered for further evaluation of the calcaneus as well as for surgical planning if surgery is needed.
Treatment
Treatment of the calcaneus fractures depends upon the type and severity of the injury: If your surgeon has determined that your calcaneus fracture is stable with minimal displacement or minimal joint involvement and does not require surgery you will be placed in a short leg cast or a removable boot to restrict motion and allow the fracture to heal as weight can cause further displacement and possible surgical intervention.
Surgery
After your surgeon has determined the severity of your fracture through the clinical exam and diagnostic modalities surgery may be required to anatomically stabilize the calcaneus and to reconstruct the subtalar joint. The surgeon will select and discuss the necessary procedure that is appropriate for your injury.
Surgery is typically scheduled 6-14 days following the injury to allow the soft tissue swelling to subside.
A splint will be placed on your injured foot until your surgery date. No weight to the injured foot is advised.
Complications of Calcaneal Fractures
Calcaneal fractures can be serious injuries that may produce lifelong problems. Arthritis, stiffness, and pain in the joint frequently develop. Sometimes the fractured bone fails to heal in the proper position. Other possible long-term consequences of calcaneal fractures are decreased ankle motion and walking with a limp due to collapse of the heel bone and loss of length in the leg. Patients often require additional surgery and/or long term or permanent use of a brace or an orthotic device (arch support) to help manage these complications.
Treats the following conditions:
The Lisfranc joint is a general term for injuries in the mid foot involving the metatarsal bones (long bones that connect to the toes) and the tarsal bones (bones in the arch).
The Lisfranc ligament is a tough band of tissue that joins two of these bones. This is the most important ligament in the midfoot and is involved with maintaining proper alignment and strength of the arch.
Incidence
Injuries to the Lisfranc joint most commonly occur in motor vehicle accidents, motorcycle crashes, runners, horseback riders, contact sports, and at times something as simple as missing a a curb or step.
Lisfranc injuries occur as a result of direct or indirect forces to the foot. A direct force often involves something heavy falling on the foot. Indirect force commonly involves twisting the foot.
Types of Lisfranc Injuries
There are three types of Lisfranc injuries, which sometimes occur together:
Symptoms
Diagnosis
Lisfranc injuries are sometimes mistaken for ankle sprains or minor sprains of the foot and can commonly be missed. In order to determine the diagnosis your surgeon will will ask how the injury occurred or when the pain started. The foot will be examined, with the surgeon gently pressing on different areas of the foot to locate the pain. A stress exam may be needed to determine if the source of pain is over the Lisfranc complex.
X-rays are necessary to evaluate the extent of the injury. At times a stress x-ray will be ordered by the surgeon to determine instability of the midfoot and see if the joints move (typically these do not move unless provoked by injury). Typically a CT scan will be ordered for further evaluation of the small midfoot bones as well as for surgical planning if surgery is needed.
Non-surgical Treatment
Treatment of Lisfranc injuries depends upon the type and severity of the injury: If your surgeon has determined that your Lisfranc injury/fracture is stable and does not require surgery you will be placed in a removable boot with the ability to weight bear as tolerated in the boot.
Surgery
After your surgeon has determined the severity of your fracture through the clinical exam and diagnostic modalities surgery may be required to anatomically stabilize the Lisfranc injury/fracture pattern. The surgeon will select and discuss the necessary procedure that is appropriate for your injury.
Treats the following conditions:
Flatfoot is a complex disorder, with diverse symptoms and varying degrees of disability and deformity. Though there are several types of flatfoot, all have some form of partial or total collapse (loss of height) of the arch.
The posterior tibial tendon is one of the major supporting structures of the foot. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, affecting its ability to hold up and support the arch.This has also been referred to as Adult Acquired Flatfoot (AAFF) because it is the most common type of flatfoot developed during adulthood. This condition usually involves only one foot but has been shown to develop in both feet for some patients. PTTD is usually progressive (continues to worsen) if it is not treated early.
Flexible flatfoot is one of the most common types of flatfoot in childhood and continues into adulthood. It typically occurs in both feet and progresses in severity throughout the adult years. As the condition worsens, the soft tissues (tendons and ligaments) of the arch may stretch/tear and can become painful and inflamed.
Flexible refers to the foot position when standing, meaning the foot is flat during weight bearing and returns to normal when non weight bearing.
Rigid refers to the foot staying in a flat position during weight bearing and non weight bearing with little to no movement of the joints. This is the end stage of flatfoot and usually encompasses arthritic joints throughout the foot and sometimes the ankle.
Other characteristics seen with flatfoot include:
Causes of Flatfoot
Symptoms of Flatfoot
Diagnosis of Flatfoot
In diagnosing flatfoot (Flexible, PTTD, Rigid) your surgeon will examine the foot and observes how it looks when you stand as well as when you sit. Your surgeon gently press on areas of the foot and ankle to determine areas of discomfort.
X-rays are usually taken to determine the severity of the disorder. If PTTD or flexible flatfoot is determined an MRI may be ordered to determine the extend of the pathology as well as evaluate the joints and soft tissues in the foot. If rigid flatfoot is determined a CT scan may be ordered to evaluate the extent of the arthritis in the foot/ankle. The advanced imaging will also assist in surgical planning should surgery be warranted.
If you are diagnosed with flexible flatfoot but you do not have any symptoms, your surgeon will explain what you might expect in the future.
Nonsurgical Treatment of Flatfoot
If you experience symptoms with flexible flatfoot, your surgeon may recommend nonsurgical treatment options.
Due to the progressive nature of PTTD, early treatment is advised. If treated early sometimes your symptoms may resolve without the need for surgical intervention and further progression of your condition. However, untreated PTTD could leave you with an extreme flatfoot, painful arthritis in the foot and ankle, and severe limitations with daily activities. Often times if no treatment has been initiated conservative and non surgical approaches may assist in the limitations.
Rigid flatfoot develops secondary to progressive flexible flatfoot or PTTD symptoms. Severe flatfoot and arthritis of the foot and ankle is the result which limits daily activities. Often times if no treatment has been initiated conservative and non surgical approaches may assist in the limitations.
Surgery of Flatfoot
If non-surgical approaches fail to adequately relieve the pain and other symptoms, surgery may be necessary. Your surgeon will select the best procedure to repair the flexible flatfoot, PTTD, or Rigid flatfoot. A variety of surgical techniques are available to correct these conditions and improve foot and ankle function.
Bunions are progressive bone deformities of the foot that often cause recurring or chronic inflammation, irritation, and pain that require surgical correction. Surgical removal of a bunion is called a bunionectomy. However, there are multiple types of bunionectomies, each designed to resolve different structural changes caused by the deformity.
Bunion surgeries fall into two major categories:
There are three important factors that impact the success of bunion surgery:
What To Expect
Most bunions surgeries today are performed on an outpatient basis at a surgical center or hospital. Set aside the entire day for the surgery, although you may only be at the facility for a half day.
Prior to the surgery, patients will need to make some preparatory arrangements. These include:
The night before the surgery, you will not be able to eat or drink anything after midnight. You should also wash your foot the night before and morning of the procedure to help reduce surrounding bacteria and prevent infection.
Bunion surgery is usually performed with a local anesthetic and is administered by an anesthesiologist. This may be combined with sedation medication to put you into “twilight” so that you are fully relaxed. After the surgery, patients are often given a long-acting anesthetic and pain medication, which is why someone else must drive the patient home.
The type of procedure you have will determine the degree to which you can put weight on the foot immediately after the surgery. Some patients, particularly those having base procedures, may have to use crutches; others may be sent home wearing a surgical shoe. The foot will be covered in a dressing, which you will need to keep dry for up to two weeks or until the sutures are removed.
During the first week after surgery, you will need to keep the foot elevated as much as possible. Ice packs also should be applied for the first three to four days to reduce swelling. Limited ambulation or walking is required over the first two weeks to promote healing. Most patients also are instructed on some basic exercises that need to be performed daily.
Sutures are generally removed about two weeks after the surgery in the doctor’s office. Once the sutures are removed, you can bathe and shower normally, but will still need to wear a dressing over the wound to keep it clean and prevent infection.
By the third or fourth week post surgery, swelling generally subsides enough for the patient to begin wearing a wide athletic shoe. It is important to continue daily exercises. If recommended, physical therapy may be initiated at this time. Once the wound has completely closed, you can use lotions to soften the skin in the surgical area.
By week five after the surgery, you will be able to walk short distances and do mild fitness activities. Continue following your surgeons instructions for increasing exercise and activities until you are back to normal.
Hammertoe is a deformity of the second, third, or fourth toes. In this condition, the toe is bent at the middle joint, causing it to resemble a hammer. Left untreated, hammertoes can become inflexible and painful, requiring surgery.
Hammertoe surgery can be done on an outpatient basis in the doctor’s office or a surgery center using a local anesthetic, sometimes combined with sedation. The surgery takes about 15 minutes to perform. Up to four small incisions are made and the tendons are rebalanced around the toe so that it no longer curls. Patients usually can walk immediately after the surgery wearing a special surgical shoe. Minimal or no pain medication is needed following the surgery.
Icing and elevation of the foot is recommended during the first week following the procedure to prevent excessive swelling and promote healing. It is also important that the dressing be kept clean and dry to prevent infection. Two weeks after the surgery, the sutures are removed and a wide athletic shoe can replace the post-operative surgical shoe. Patients can then gradually increase their walking and other physical activities.
Treats the following conditions:
Treats the following conditions:
Treats the following conditions:
Treats the following conditions:
What are tendon transfers?
Some tendon transfers allow the ankle and foot to move up and down and regain some motion. Others bring the foot into a position where it is easier to walk, stand and wear shoes, but will not increase range of motion.
What are the goals of a tendon transfer?
What signs indicate a tendon transfer may be needed?
When should I avoid surgery?
There are three requirements for tendon transfers to be successful. First, the muscle that the tendon is attached to has to be functional. It must contract at the proper time during walking to do what it needs to do. Second, the soft tissue through which the tendon is to be transferred needs to be as normal as possible. Large areas of scarring or skin damage can make it difficult to transfer the tendon. It can also prevent the tendon from gliding along the path it must travel in order to function as planned. And third, the joints that the tendon crosses need to be both mobile and stable.
General Details of Procedure
What happens after surgery?
Patients are typically non-weight bearing for six weeks after surgery to allow the transferred tendon to heal to its new attachment. This can be longer or shorter depending on what is seen during surgery. After six weeks, patients usually start to bear more weight on the leg and are placed in a boot if they aren’t in one already. Patients are out of the cast or boot by 12 weeks after surgery.Physical therapy is usually needed to regain the strength of the transferred muscle and to help the patient learn to walk more normally. The transferred muscle is weaker than it was in its original functional position because of the transfer. There may be some limitations in motion of the foot due to the tendon transfer, but the function regained by the transfer should outweigh the function lost.
Potential Complications
Sometimes the tendon transfer does not heal into its new position. The implant could break or loosen, or there could be progression of the original neurologic condition needing further surgery.
Treats the following conditions:
Treats the following conditions:
Treats the following conditions:
Treats the following conditions:
Surgery to repair a torn (ruptured) Achilles tendon is conducted on an outpatient basis using a local anesthetic. It 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.
Treats the following conditions:
Surgery to repair a torn (ruptured) Achilles tendon is conducted on an outpatient basis using a local anesthetic. It 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.
Treats the following conditions:
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 be corrected only through surgery.
A surgical procedure, called an osteotomy, is performed to relieve the pressure on the bone from heel calluses. The procedure involves cutting the metatarsal bone in a “V” shape, lifting the bone and aligning it with the other bones. This alleviates the pressure and prevents formation of a heel callus.
Treats the following conditions:
Midfoot fusion is a procedure in which the separate bones that make up the arch of the foot are fused into a single mass of bone. Fusion is also referred to as arthrodesis. Fusion eliminates the normal motion that occurs between two bones.
Midfoot fusion can involve all of the midfoot joints. More commonly just one or a few of the joints are fused. The joints of the midfoot do not bend and move like your knee or elbow. They are designed to be relatively stiff to give your foot strength and support your body. Midfoot fusion does not generally produce much noticeable loss of motion because there is fairly little motion to begin with.
Treats the following conditions:
Hindfoot fusion is considered to relieve severe pain from arthritis or to correct a foot deformity, such as clubfoot or grow defects due to conditions such as Spina Bifida. The number of joints fused depends upon the severity of the arthritis or defect of the foot.
Treats the following conditions: