Surgery on the big toe or other toes can be necessary to correct a variety of deformities and growths, including bone spurs under the toenail, hammertoes, claw toes, bunions, and neuromas. If non-surgical treatments do not provide pain relief and improvement of the condition, a podiatrist may need to operate to fix the problem.
Neuromas are benign growths of nerve tissue, or nerve tumors, that form when the nerves are irritated by surrounding tissue rubbing against them. Improper footwear that creates pressure on the foot, as well as foot structure abnormalities and injury to the nerves can cause or worsen neuromas. Symptoms of a neuroma include intense pain, swelling, tingling, numbness, and/ or a burning sensation in the toes and forefoot area. The pain usually intensifies when walking.
Surgery may be necessary to treat neuromas that cause chronic nerve pain. Neuroma surgery involves locating the affected nerve and then cutting and removing it. To reach the nerve, incisions are made where the neuroma is located. The surgery is usually done as an outpatient procedure under local anesthesia. The patient wears a surgical shoe post-surgery to protect the area, and elevation and ice application are recommended to reduce swelling. Recovery time is around a month to six weeks.
Metatarsal surgery is mostly performed to treat bunions; it can also be done for patients with rheumatoid arthritis. Surgery on the first metatarsal is most common because the first metatarsal runs behind the big toe, which is the toe most commonly affected by bunions. A bunion is a deformity of the big toe joint that results from bone misalignment or repositioning at the joint. When the joint at the base of the big toe becomes enlarged, friction and pressure are created as it painfully rubs against footwear. Other metatarsals may need surgery if painful calluses or chronic ulcers form on the bottom of the foot due to uneven, excessive pressure.
Metatarsal surgery involves cutting a metatarsal bone, properly positioning it, and fixing it in place with a metal screw or pin. The procedure is usually done on an outpatient basis. After surgery, patients must be careful to keep weight off of the foot while the bone heals. A surgical shoe or even a cast is usually worn to protect the foot. The bone takes two or more months to heal.
Plantar fasciitis and heel spurs are common sources of heel pain that may require surgery. Plantar fasciitis is inflammation of the plantar fascia, the fibrous tissue that runs along the arch of the foot to connect the heel bone and ball of the forefoot. Heel spurs often accompany plantar fasciitis; spurs are outgrowths of bone that develop in the heel due to constant pressure. Heel spurs can become problematic when pain and other foot problems crop up as a result of footwear pressing and rubbing against the affected area, causing irritation, redness, swelling, and inflammation. As the bone spur irritates and inflames the surrounding soft tissue, acute pain and/ or a dull ache are experienced.
Heel pain is usually effectively alleviated with rest, ice application, orthotic inserts, exercises and stretches to alleviate tightness and pressure, and anti-inflammatory medications (always check with a doctor before taking any medication). However, in some cases, surgery may be necessary to remove a heel spur, release the plantar fascia ligament, and/ or stretch foot nerves.
By the age of 50, most people will have traveled 75,000 miles on their feet. In light of this, foot problems are a common occurrence that affects more than 75% of Americans at one time or another. Foot and ankle problems can develop as a result of injuries, congenital defects, degenerative diseases, impact, stress, and ill-fitting footwear; they can occur while walking, standing, working, running, and playing sports. In some cases, surgery performed by a podiatrist or orthopedic surgeon is necessary to fix the problem and reduce the pain.
Podiatrists and orthopedic surgeons may perform foot and ankle surgery in the office, a surgical center, or a hospital. Many surgeries are done under a local anesthesia; sometimes, it is accompanied by sedation.
Here are some common foot and ankle conditions that can be corrected or improved with surgery:
- Arthritis and joint diseases
- Calluses and corns
- Congenital deformities
- Flat feet
- Heel or toe spurs
- Toe deformities
- Tumors (benign and malignant)
- Sprains and fractures
After surgery, the affected area is usually immobilized and protected with a bandage, splint, surgical shoe, or cast. Any stitches must be kept clean and dry. To reduce pain and swelling, elevation and ice are required; anti-inflammatory medication may be recommended or prescribed (always check with a doctor before taking any medication). The foot or ankle should be rested and not bear weight for several weeks, in most cases. Physical therapy is performed to speed recovery, healing, and functionality. Orthotics and special footwear may be necessary post-surgery.
Flatfoot is a foot deformity involving the arch of the foot, where the entire foot rests on the ground when standing, rather than the foot having a normal mid-foot rise. Flatfoot may result from the foot’s arch failing to develop properly during childhood, when standing and walking begin. It can also result from the foot’s arch collapsing over time or due to an injury, aging, weight gain, or degenerative conditions like arthritis.
Flatfoot may cause pain in the foot, ankle, and/ or lower leg area, particularly in the middle of the foot, as well as swelling, reduced foot flexibility, and painful progressive flatfoot, or tibialis posterior tendinitis. This occurs when the tendon of the tibialis posterior is injured, causing inflammation, overstretching, or tearing. This condition, also called adult-acquired flatfoot, can cause chronic pain and may become disabling if not properly treated.
Flatfoot surgery that corrects the foot deformity can provide improved function and stability. There are several types of flatfoot corrective surgeries. A tenosynovectomy removes inflamed tissue surrounding the tibialis posterior tendon. An osteotomy removes part of the heel bone so the foot can be moved into proper alignment. A tendon transfer involves taking tendon fibers from elsewhere in the body and transplanting them into the tibialis posterior tendon. Lateral column lengthening transfers a small piece of hip bone to the heel bone to improve alignment and rebuild the arch. An arthrodesis fuses bones to eliminate joint movement, which stabilizes the foot.
Ganglion cysts that form along the tendons and joints in the ankle and foot sometimes must be removed by surgery if the cyst does not shrink on its own or draining the cyst is not successful. During a cyst removal, the cyst is cut from the tendon or joint and taken out. Usually, the procedure is performed on an outpatient basis with local anesthesia. Recovery time and post-surgery treatment vary based on the size and location of the cyst. Nerve, blood vessel, and/ or tendon damage can occur as a result of the surgery, but this is not common. Some cysts recur.
A bunion is a deformity of the big toe joint that results from bone misalignment or repositioning at the joint. Although bunions occur most frequently at the base of the big toe, they can also arise on the outside of the foot at the base of the small toe. Bunions can occur due to conditions such as overpronation, flat feet, neuromuscular foot problems, ill-fitting footwear, recurring stress to the foot, previous foot injuries, congenital defects, and arthritis.
When the joint at the base of the big toe becomes enlarged, friction and pressure are created as it painfully rubs against footwear. Eventually, the big toe may press inward against the smaller toes, even overlapping as far as the third toe in some cases, a condition called hallux valgus. With some bunions, the big toe also rotates or twists inward, which is called hallux abducto valgus. Bunions can cause chronic pain and discomfort when walking, especially as the bunion becomes larger and rubs against footwear; swelling, redness, and tenderness at the site and thickened skin on the bottom of the affected area are also recurring problems with bunions.
Surgery to remove a bunion is called a bunionectomy. There are several types of bunionectomies due to the various structural changes of the foot caused by bunion deformities. Head procedure bunionectomies fix bunions and structural changes at the big toe joint by cutting the bone behind the joint, repositioning the joint, and fixing it in place with a pin.
Base procedure bunionectomies also treat the big toe joint; the procedure can vary based on the type of deformity being addressed and may involve toe ligaments as well. Wedges of bone can be removed from near or behind the big toe joint to allow the bone to be separated and repositioned. Semi-circular cuts can also be made so the bone can be rotated into proper position. Also, the joint can be fused.
Bunionectomies are usually performed as outpatient procedures under local anesthesia. The patient may have to walk with crutches to keep weight off of the affected foot, and a surgical shoe may be necessary for a few weeks.
Be sure to choose an experienced podiatrist or surgeon skilled specifically in bunionectomies due to the complexity of the procedure. Realize that bunions may return and foot structure may not be able to be fully returned to normal. Through removing bunions, deformities, structure alignment, and function can be greatly improved, but they may not be made perfect. Recovery after surgery can be a long process involving physical therapy and wearing orthotics on a permanent basis.
Arthroscopy, or arthroscopic surgery, can be used to diagnose and/ or treat ankle and foot problems using a less invasive procedure. During arthroscopy, the doctor makes tiny incisions at the site and inserts an arthroscope and tiny surgical instruments through the incisions. The arthroscope is a fiber-optic camera that allows the doctor to view and diagnose internal damage. The procedure makes it possible to view and assess the problem as well as perform surgical corrections, such as removing cartilage and repairing damaged joints and tissue. Arthroscopic surgery reduces trauma to surrounding tissue and cuts down on swelling, healing time, and the risk of infection. It is usually done as an outpatient procedure under local anesthesia.
Arthritis can cause joint deformities in the foot and ankle. Severe deformities can require surgery. One cause of arthritis in the foot is Charcot foot.
Charcot foot occurs when the foot bones weaken due to conditions such as arthritis and nerve damage. Diabetics who have neuropathy can suffer from Charcot foot. The weakened bones become susceptible to fractures in the feet or ankles, which can cause bone deformities that alter the shape and form of the foot. Fallen arches and collapsed joints result in changes in foot shape; this can lead to wounds and ulcers as pressure causes friction on the misshapen areas. Charcot foot can affect one or both feet as well as the ankles. The onset of Charcot foot occurs at the average age of 40.
Charcot foot can be treated through rest, elevation, and immobilization to halt pain and allow the fractures and wounds to heal. However, many cases require surgery to correct the deformities and fix the fractures, particularly in patients that have chronic or significant deformity alongside instability, extreme pressure, and/ or severe ulcers. The surgery may involve hindfoot, ankle, and midfoot realignments to improve stability and reduce the pressure that can cause wounds and ulcers. Internal fixation devices can be inserted within the foot, and ostectomies can be performed to remove bony protrusions on the bottom of the foot.