Foot Surgery

 

Types of surgery

Foot surgery can be performed on the joint of the big toe, the joints in the middle of the foot, the joints in the lesser toes, or the joints beneath the ankle.

Fusion

If damage to a foot joint is causing significant pain and immobility, your doctor may recommend a fusion (arthrodesis) of two or more bones in the toe or foot. In this procedure, surgeons bind together the bones of the arthritic joint using small metal screws and occasionally metal plates. These bones begin to grow together, resulting in one fused bone. Joint fusion has the advantage of completely eliminating painful movement between bones in the joint, though it also eliminates movement in that joint. Most people can expect to go home the same day as the surgery.

Debridement

If you have mild to moderate arthritis in the big toe, your doctor may recommend a procedure called debridement, also known as cheilectomy, in which a surgeon cleans out any pieces of cartilage, ligament, or bone interfering with joint movement. These stray pieces of bone and tissue accumulate as a result of increased friction in the joint as cartilage erodes and bones rub directly against each other. Debridement reduces pain caused by bone spurs or other irritants and may also increase range of motion in the joint. This is usually a day surgery procedure after which you’ll need to wear a supportive shoe for a few weeks during recovery.

Osteotomy

Often used for treating bunions, a painful, bony bump that can form at the first joint of the big toe, an osteotomy is a form of surgery where small cuts in the bone are made to realign the bone. Many of these cuts will be made to make the bone straight again, then the realigned bone will be fastened with pins or screws.

Hemiarthroplasty

Arthritis of the big toe joint (metatarsophalangeal joint) is a common condition. Hemiarthroplasty is a surgical option where an implant is placed in the bone to improve pain, movement and function. The synthetic implant provides a new, smooth surface for your toe to move properly and avoiding bone on bone contact.

When is foot surgery performed?

Foot surgery is usually done when pain and loss of function become severe and when non-surgical treatments such as medication, braces or orthotics haven’t been effective.  Surgery may also be considered if your feet are becoming deformed quickly.  The type, location and impact of your arthritis will play a role in determining what type of surgery you might need.  Some people may require more than one type of surgery.

How well does surgery work?

  • Fusion will effectively eliminate pain in the joint. However, fusion also eliminates any remaining motion in the arthritic joint. In most cases, when fusion is performed, the joint is stiff and does not have normal motion so a stiff and painful arthritic joint does well with fusion.  When fusion is performed in an arthritic joint that has motion, the pain is predictably treated, however, the lack of movement will lead to some functional impairment.
  • Debridement of the big toe joint will alleviate pain at the end range of motion.  However, it does not address the arthritis in the big toe joint, so there may be some ongoing pain from the arthritis in this joint.
  • Osteotomy will alleviate pain from the bunion or deformity.  It will not address any pain from arthritis and is not meant to directly treat arthritis pain.
  • Hemiarthroplasty in the big toe joint will help to preserve toe movement. Since damaged parts of the joint are being replaced, bone on bone contact is avoided, which reduces pain.

Risks

Risks from foot surgery include:

  • blood clots
  • infection of the surgical wound or in the joint
  • nerve injury
  • bleeding
  • problems with wound healing
  • lack of good range of motion (stiffness)
  • continued pain in the foot
  • instability in the joint
  • anesthesia risks and medical complications of surgery

Speak to your doctor or orthopedic surgeon if you are concerned about the possible risks of foot surgery.

Pre-operative visit

Most hospitals will ask you to come in several weeks before your foot surgery to review your status and talk about what will happen. It’s a good idea to bring a family member or friend to this visit to take notes and ask questions. You will be given lots of information, and this can be overwhelming and difficult to remember if you don’t have someone with you.

During the pre-operative visit, the team will talk about what kind of anaesthesia is best for you. This depends on many things, including your age, general health and preference. The team may suggest regional anaesthesia so you don't feel the area of the surgery - with this option you'll also have medicine that makes you feel relaxed or lightly asleep, but you will breathe on your own. Alternatively, your team may suggest a general anaesthesia that puts you completely asleep during the surgery, which requires the placement of a breathing tube down your throat and the use of a breathing machine.

Preparation

Physical activity

Your surgeon may recommend that you do some regular pre-operative exercises. Some are aimed at strengthening your arms and shoulders, which will help you manage the use of crutches or a walker after surgery. You will also want to practice using a walker or crutches without putting weight on the operative foot.

Other exercises will help maintain the strength of your leg muscles to help with recovery. The exercises should take about 20 minutes to complete, and if possible, you should do them twice a day.

Your home

Your house or apartment may need certain changes to meet your needs after your operation. Look around to see what can be done beforehand.

  • Remove small mats and area rugs. Tape down the edges of larger rugs so you won’t trip over them.
  • Keep rooms and hallways well-lit so you can see obstacles.
  • Make sure all stair railings in and outside your home are secure.
  • Keep cords out of the way.
  • Getting in and out of bed can be difficult after foot surgery. It’s important that your bed isn’t too low.
  • Get a rubber (non-skid) mat for your bathtub or shower stall so you don’t slip while bathing. A tub bench is also helpful.
  • Put all your bathroom utensils, such as toothbrush, comb, hair dryer, make-up, and razor in a single area so you can reach them without moving around.

What to expect after surgery

Right after surgery

Most patients will go home right after surgery.  The surgeon will advise you whether you need to be non-weightbearing or partial weightbearing on your affected side.  It will be painful for the first couple of weeks.

Moving around

On the day of surgery or the day after, you’ll be encouraged to get out of bed with help. You’ll also be taught how to walk safely using crutches or a walker. You will be non-weight bearing for the first two weeks—this means you must NOT put any weight on the affected foot. You may be able to be weight-bearing sooner if you have surgery on your heel.

You can expect some discomfort right after surgery which should gradually improve over the coming days, weeks and months. Your physiotherapy will begin in the hospital where you’ll be encouraged to do some simple exercises in bed during the first day or two.

Leaving the hospital

You’ll be sent home wearing a protective splint, which you’ll need for 10 to 14 days. After this time, once your foot has been examined and appears to be healing normally, you’ll use a removable supportive boot. You may still require crutches for several weeks, and, in certain circumstances, the boot will need to be worn for three months or longer.

Continued recovery

Call your surgeon or family doctor if:

  • you develop a temperature higher than 38 C (101 F)
  • you notice any change in the amount, colour or odour of drainage from your incision or a sudden increase in pain around the incision
  • you notice increased pain, swelling or tenderness in the ankle area of either leg
  • you notice that either leg appears pale or bluish in colour
  • you notice that either leg feels unusually cool to the touch
  • you suddenly have trouble walking

The skin covering your foot and ankle, including the area over your incision, will remain sensitive for a while after your surgery. This means the skin could break down easily, which can sometimes lead to an infection. Try to avoid walking in bare feet or open-toed sandals to avoid skin breakdown.

Wearing the right shoes is important, both before and after foot surgery. Wearing proper shoes after surgery helps put the foot in correct alignment, ensuring that you walk properly—meaning you don’t over-stress the affected joint or put extra stress on other parts of your body (your knees, hips and lower back). Even if you purchased and wore special shoes and orthotics (shoe inserts) before surgery, as you recover you may find that they no longer fit in the same way.

Depending on the type of surgery performed and the issues being addressed by the surgery, you may be required to wear a custom orthotic shoe to assist in recovery.

Title goes here!!

Contributors

This information was reviewed in September 2019 with expert advice from:

Dr. Johnny Lau
Orthopedic Surgeon, UHN – Toronto Western Hospital
Assistant Professor, University of Toronto
 
Dr. James Rofaiel
Orthopedic Surgeon
 
Dr. Joyce Fu, MD, MSc, FRCSC
Clinical Fellow, Foot and Ankle Surgery
University of Toronto

Sources

https://www.ahni.com/Specialties/Foot+and+Ankle/Articles/Common+Disorders/Surgical+Correction+of+Arthritis+in+the+Big+Toe+Joint.html
https://nyulangone.org/conditions/foot-ankle-arthritis-in-adults/treatments/surgery-for-arthritis-in-the-foot
https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-foot-and-ankle/
https://www.versusarthritis.org/about-arthritis/treatments/surgery/foot-and-ankle-surgery/