Before Surgery

Will I have to go to the hospital for my surgery ?
Foot surgery occurs in one of three settings :

• Your podiatrist’s office
• An ambulatory surgery center
• A hospital

Your podiatrist will recommend the best setting based on the surgery you will have, your age, medical history and health plan. Your doctor also will determine the type of anesthesia (local anesthesia, local anesthesia with sedation or general anesthesia) you will need.

Will I need any special tests beforehand ?
As with any surgery, you may need tests or examinations, such as blood and urine screenings, chest x-rays or an EKG. Your podiatrist will review your personal medical history and current medical condition and may consult with other medical specialists, depending on your test results or current health status.

Should I take any special precautions ?
If you feel ill, have a fever or other physical symptoms within a week before your surgery, contact your doctor.

A Look at Foot Surgery

Surgery for bunions

Positional bunionectomy.

A positional bunion is a bony growth on the base of the big toe. It enlarges the joint. In a positional bunionectomy, a surgeon removes the bump and may release soft tissue that has tightened. Afterward, your podiatrist may recommend that you wear a special surgical shoe or a splint.

Metatarsal head Osteotomy.
Structural bunions occur when the angle between the first and second toe bones increases beyond normal. Sometimes bony growths may form, resulting in irritation and swelling. A surgeon performs a metatarsal head osteotomy to cut and reposition the bone. Any bumps are remolded. Afterward, your podiatrist may recommend that you wear a surgical shoe or cast for about six weeks until the bone heals.

Metatarsal base Osteotomy.
Severe structural bunions result when the angle between the first and second toe bones is excessive. To treat these, a surgeon may conduct a metatarsal base osteotomy. A wedge of bone is removed from the base of the first metatarsal (large toe) bone and the bone is repositioned. Wires or screws may be inserted to stabilize the bone. Afterward, your doctor may put your foot in a cast.

Surgery for hammertoes
In treating a flexible hammertoe, the surgeon repositions the tendons to allow the toe to lie flat. Afterward, your podiatrist may recommend that you wear a surgical shoe for several weeks.

For a rigid hammertoe, several types of treatments are available:

Arthroplasty – The doctor removes a portion of the joint and straightens the toe.

Fusion – Cartilage between the two toe bones is removed and the bones fuse to form one longer bone.

Implant – In some situations, a portion of the bone is removed and replaced with an implant.

Surgery for arthritis
Arthritis is a condition characterized by inflammation and swelling of the joint lining and degeneration of the cartilage. Fluid usually accumulates in the joints. Arthritis can affect the big toe join, causing pain and reduced motion. A bunion-like protrusion also may be present. There are a variety of surgical procedures to treat this condition. They include:

Keller bunionectomy
In this surgery, the base of the bone is removed and fibrous tissue fills in the space. You may have to wear a splint or special shoe for several weeks.

Anthroplasty with joint implantation
In some cases, the surgeon can repair the join. With severe joint degeneration, a procedure called arthroplasty with joint implantation is required. The joint is removed and replaced with either a one-piece or two-piece implant.

Surgery for neuromas
When the nerves are compressed between two toe bones, the nerve becomes enlarged. A benign growth, called a neuroma, results. When a neuroma is removed, or “excised”, a small portion of the nerve is cut out. Often a small area is left without feeling, but this is usually preferable to pain.

Surgery for ingrown toenails
A nail is ingrown when it curves down at the sides and grows into the skin. With a partial surgical matricectomy, your doctor removes a section of the toenail and the underlying nail matrix (cells that make the nail). This can be done through surgical excision, chemical or laser destruction.

Surgery for heel spurs
A heel spur is a bony growth on the underside of the heel bone. Some heel spurs are painless. Others cause chronic pain. A heel spur often accompanies inflammation of the plantar fascia – the band of connective tissue that runs from the hell to the ball of the foot.

Treatment options for heel spurs may include removal of the spur, releasing the plantar fascia or additional noninvasive treatments. Afterward, your foot may be in a cast and crutches may be necessary. Be sure to discuss these options with your podiatrist beforehand.

Surgery for bone spurs
A bone spur is an overgrowth of bone that can cause pain and reduced motion. It can occur on the side of a bone, the top of a bone or underneath the nail.

Minimal incision surgery involves making a small incision and smoothing the bone. A stitch may be required to hold the incision closed while it heals.

After Surgery

To ensure a rapid and successful recovery following foot surgery, it is important to follow your podiatric surgeon’s advice. Your doctor will issue post-operative instructions describing post-surgery care, including ice, bandages, elevation, walking aids and medications.

How long will recovery take ?
You will need to schedule an appointment with your podiatrist soon after your surgery. How soon you resume your normal activities depends on the type of foot surgery and the extent of your activities. Discuss this with your podiatrist before the surgery so you can reduce your responsibilities until you have had time to heal. Your doctor may recommend physical therapy or special exercises following surgery.

When to Call the Doctor

Follow your doctor’s instructions for continued care of your foot and remember that every individual recovers differently. Call your doctor if you have any of these symptoms :

• Blood appears on the bandage (a small amount is to be expected).
• Your dressing becomes tight or your foot is cold or numb
• You develop a temperature of 101° or more.
• Your cast or bandages get wet.
• You experience persistent pain.

Footnote
When foot problems occur, your feet deserve your full attention and often the care of your podiatrist. Prompt foot care may help prevent the later onset of painful knee, hip and lower back problems.

Six steps to healthier feet.
Taking good care of your feet is a daily investment in your lifelong health and comfort. You can prevent or minimize most problems by adopting a routine of daily foot care and following these simple guidelines.

1. Wear comfortable shoes and socks that fit your feet.

2. Wash and dry your feet thoroughly, especially between the toes.

3. Keep your toenails trimmed short and straight across.

4. Apply cream or lotion to feet to keep skin smooth and supple.

5. Wear clean socks or stockings and avoid wearing the same shoes two days in a row.

6. See your podiatrist for any sever or persistent foot problems.

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