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Foot Surgeries

There are a lot of various surgical methods which are widely used for correcting different types of foot deformities and diseases. Some most common foot surgeries are described in this article. 
Some problems can be solved non-surgically. When conservative treatment is ineffective, a surgery is inevitable. Surgical operations on feet and ankle joint are distinguished in a separate branch of medicine – podiatry. 

Arthrotic surgeries 

Toes and ankle joints are under maximum load of our weight and that’s why they are apt to arthritis. Constant static loads lead to pain, swelling and rigidity and in some cases deformities in leg joints. There are three different approaches to surgical treatment of arthrosis.

One of them is resection of exostises:

  • Bone callosities are removed and thus the injured joint is less loaded.
  • The second is arthroplasty which implies removing the injured part of the articular surface or the entire joint surface of one of the two bones forming the joint.If movements in the joint are limited and quite painful and the integrity of the articular surfaces is damaged, then endoprosthetic replacement is performed: replacement of the injured joint with an artificial one. Thanks to this surgery, the patient gets rid of the pain and the joint mobility is restored. 
  • The third procedure is called arthrodesis. It is performed if both articular surfaces have lost their tendons due to erosion. In this case the damaged articular surfaces are resected. The ends are confronted and interconnected by means of fixators (screws and plates). The interfragmental compression leads to fusion.  

Surgical treatment for foot bumps and bones 

«Foot bumps» bump are foot deformities characterised by protrusion of the interior foot surface at the head of the first toe between the first toe and first metatarsal bone. Due to non-physiological rotation of the first toe, ligaments and cartilages of the foot become rigid in this region and independent from the each other. Foot bumps are formed by soft tissues and bones. The degree of foot deformities mainly depends on the footwear. Other causes are accompanying diseases such as poliomyelitis or arthritis and sometimes genetic predisposition. If bumps don’t hurt, then conservative methods of treatment can stop the pathologic process, e.g. constant wearing of individual orthotics might help. 

Conservative methods can also be used as an addition to surgical correction of deformities during the postoperative period. One of surgical methods of treating foot bumps is tenotomy – transection of muscular cartilages – which makes the first toe deviate outwards. Due to lack of mobility in these muscles, the first toe is set into the physiological position. In case of more serious deformities, surgeries on soft tissues are performed in addition to various types of osteotomies. 

Osteotomy is a surgery on the foot implying bone transection which corrects the deformity by means of interfragmental compression of fragments. If the articular surfaces of the first metatarsophangeal joint are highly modified, an arthrodetic procedure is performed. It implies blocking the joint in the given position. When the metatarsal bone increases the protrusion of the first metatarsophalangeal joint, the exostosis is removed. However, this method is not really effective in correcting deformities. More detailed information can be found in the section “Surgical Correction of Foot Deformities”. 

Surgeries on ankle joint 

Instability of the ankle joint can appear as a result of an injury or sprain in its ligamentous apparatus. The function of the ligamentous apparatus is stabilization of the bones forming the ankle joint. Thus, the ligaments prevent bone dislocation in any irregular direction. Any injury or excessive stretching can cause a rupture in the ligament and as a result lost stability of the ankle joint can be regained only surgically through restoring the integrity of ruptured ligaments. There are various surgical methods which are used for solving this problem. It is almost impossible to stitch the rupture together, that’s why in such cases the ligament is reconstructed i.e. the ruptured ligament is replaced by another cartilage taken from muscles which don’t take part in performing regular movements. The new ligament is fixed by means of small titanium or dissolvable fixators. 

Surgical treatment of ingrown nail 

An ingrown nail — is a condition when a nail plate of the great toe grows into the soft tissues of the nail fold. It can be either inherited or acquired as a result of an injury or constant wearing of uncomfortable, tight model footwear. Formation of an ingrown nail plate results in toe swelling and aching. The surgery implies partial resection of the nail plate together with its head. The surgery is performed under local anesthesia. Patients can set to work right after surgery. In recent years orthonixy – correction of the nail plate shape – has been widely used. Correction is achieved through placing a rigid wire staple, plastic or metallic plate which is firmly fixed to the nail plate, thus correcting it by forcing the ingrown edges out of the nail folds. 

Flat foot surgeries 

Flat-footedness is a foot deformity characterized with collapse of arches and loss of the cushioning function. This leads to pain in feet, unsteadiness and hampered walking. If conservative methods turn ineffective, surgical treatment is performed. Foot surgeries can solve the problem forever. These surgeries are usually performed in adolescence. The methods are aimed at restoring the foot arches. Surgical treatment is only to be used in exceptional cases as it requires a long rehabilitation period and besides it is quite expensive. 

Surgical treatment of hammer-toes 

A hammer toe is a fixed crouched toe deformity. Hammer deformities form as a result of wearing tight model shoes including high-heeled shoes or shoes smaller than the actual person’s shoe size. At the top of the deformity there appears a painful callosity as a result of constant compression and rubbing. 
Conservative treatment of the deformity is ineffective. Surgical treatment allows eliminating the deformity and cause of painful callosities. 
Most surgical methods are performed for outpatients and they don’t require hospitalisation. During the post-operational period, it is necessary to wear special footwear which allows reducing the load on the operated region. The duration of the restoration period depends on the degree of a foot deformity. 

Surgical treatment of verrucas 

Verrucas are soft tissue formations which appear due to a viral infection. Their surgical removal is not at all complicated and is performed under local anesthesia. However, it can leave a lot of tiny wounds which require a long restoration period. After the surgery there is a great risk of contamination of post-surgical wounds and thus it is important to keep the feet dry within two to three weeks which means if the verruca is big or if there are a number of verrucas on a small region then surgical treatment is not the best decision here as it can lead to skin defects. Beside that surgical treatment cannot prevent repetitive formation of verrucas and thus they are to be treated medicamentally. Verrucas can also be removed by liquid nitrogen. 

Possible post-surgical complications 

Less than 7% of patients have complications in the front part of the foot after surgery. Possible complications include chronic pain and swelling of feet, damage of small nerve-twigs, exacerbation of the deformity and surface infection. 

These complications can be treated but they prolong the restoration period. Your orthopedic surgeon will tell you about various treatment methods. 

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