Most people with problems in their feet or ankles won’t need surgery. The decision whether to operate depends on a number of factors:
• how bad your symptoms are (pain and the effect this has on your life)
• your needs
• your response to other treatments, including drugs, orthoses and special footwear.
Discuss these with your healthcare professionals, who’ll be able to advise you on whether they think surgery would be a suitable option.
The decision to have foot and ankle surgery is usually based on lifestyle choices and the information given by surgeons rather than being essential in terms of life and death.
But if your skin is affected or your feet are quickly becoming deformed, it’s important to get an assessment for urgent surgery to avoid infection and alert your healthcare professionals to possible stress fractures.
You’ll always have the final decision on whether to have the operation.
You may feel nervous, stressed or scared if you’ve been told you need surgery.
Finding out as much as you can about the operation and understanding the process will help you feel calmer and more in control.
Hallux valgus is different to hallux rigidus, which is osteoarthritis of the big toe joint. Hallux rigidus causes stiffness in your big toe and you won’t be able to move it as far. If treated early, surgery can be used to remove painful osteophytes (overgrowth of new bone) that can develop and allow more joint movement to return. In more advanced cases, fusion surgery (joining bones together to make one stiff bone where there two) gives excellent pain relief, although it will mean that the joint will no longer bend when you walk so you won’t be able to wear high-heeled shoes.
As well as bunions, hallux valgus can also cause your other toes to become clawed or permanently bent. This condition is known as hammer toes. Damages caused by hammer toes can be eased by:
Removing the deformed joint between your toe bones (phalanges), which leaves the joint flexible
Fusing your phalanges together, which leaves your toe more stable but means you’ll only be able to wear flat shoes after the operation.
Both procedures are performed as day cases and last around an hour. Your stitches will be removed about two weeks following surgery and you’ll need another dressing for two to six weeks after that. You should limit how much you walk for the first three days.
The joints in your forefoot can be damaged by inflammation of the lining of your joint (synovitis) in some forms of arthritis, for example rheumatoid arthritis. These small joints are called the metatarsophalangeal joints (MTPJs), and they can become dislocated when damaged by arthritis. The pain and discomfort this causes is sometimes described as feeling like you’re walking on pebbles.
If your symptoms are severe and can’t be controlled by other treatment, you may need surgery. The exact surgical procedure and the follow-up you’ll need will depend on how severe the problem is, but often surgery to your big toe and removal of the heads of your MTPJs is carried out in order to make your foot more comfortable and walking easier. Your surgeon will be able to give you more information before the operation.
Ankle arthritis is usually caused by osteoarthritis. This is where the cartilage covering the ends of your bones gradually roughens and becomes thin, and the bone underneath thickens. It can also be caused by damage from other rheumatic conditions, for example if you have rheumatoid arthritis, or if you’ve had a previous injury to the area. This leads to pain, swelling and occasional deformity of the joint. You may need surgery if your symptoms are severe. There are three surgical options:
Ankle fusion involves removing the damaged ankle joint and fusing your talus bone to your tibia to form a stiff but pain-free ankle. Your foot is fused at a right angle to your leg, in the position it would be if you were standing up. Your bones are held together using screws and new bone grows across, creating one bone where there were two. It normally takes between 12–14 weeks for the fusion to be complete and your bone continues to become stronger after this.
In some cases this procedure can be performed using keyhole surgery (arthroscopy), which means it can be done through just a small cut, so your joint doesn’t have to be opened up. The procedure takes between one and two hours.
After surgery you’ll need to wear a cast for 6–12 weeks, depending on your situation. You should be able to wear normal shoes after the cast is removed, although some alterations are occasionally needed. It should be easier to walk normally or even more comfortably than you did before surgery if your other joints aren’t affected by arthritis, but running isn’t recommended
Triple fusion is the surgical fusion of three joints (the talonavicular, subtalar and calcaneocuboid joints) either as a treatment for arthritis within these joints or as a method of correcting a stiff foot deformity. A combination of plates, screws or staples is often used to do this.
An ankle replacement involves taking out the worn-out ends of your tibia and talus bones and replacing them with aman-made (artificial) ends made out of plastic or metal. Unlike an ankle fusion, a replacement allows you to move your joint after surgery.
Achilles tendon disorders
Your Achilles tendon is the largest tendon in your body,and the muscle in your lower leg puts a lot of force through it to make you move. As we get older it can start to wear, which can lead to painful swellings within the main tendon or where it attaches to your heel bone. Very occasionally surgery can be used as a method of treatment. This procedure is usually performed as a day case and you’ll need to wear a bandage and use crutches afterwards.
Morton’s neuroma is a painful condition that involves a nerve that supplies feeling to two neighbouring toes. It most commonly affects the nerve to your third and fourth toes. If your symptoms are bad, surgery to remove the painful nerve can be successful. This can be done as a day case and you’ll need to wear a bandage for two weeks afterwards.
Tibialis posterior dysfunction
The tibialis posterior is a muscle that supports the shape of your instep arch. The tendon that connects this muscle to the bone can become inflamed, leading to pain and swelling on the inside of your ankle. Continual swelling can start to cause the tendon to weaken, which can lead to a flatfooted look. Occasionally, bad cases need surgery to rebuild the instep arch. If your case is long-standing or you haven’t had treatment, three of your hindfoot joints may need to be fused (triple fusion) to ease pain.
The plantar fascia is a tough band of fibrous tissue that starts at your heel bone and stretches across the sole of your foot to your toes. Plantar fasciitis is inflammation at the site where the fascia attaches under your heel. Very rarely, bad cases may need surgery to release the plantar fascia from the heel bone.