Treatment Of Foot Problems |
 Reasons for Foot Surgery
The more you know about what
to expect, the more smoothly your treatment, either conservative
or surgical, is likely to be. While each problem is unique,
there are three basic goals: to relieve pain, to restore function,
or to improve the appearance of your feet.
Relieve Pain
Feet that hurt interfere with
your work, family, and your social life. Pain often signals
an underlying problem. Fortunately, in many cases, foot treatment
can correct the problem and relieve the pain.
Restore Function
If your feet are not doing
their job, it is hard for you to do yours. When simply
walking becomes a problem, your lifestyle is affected. But
accepting a life of hobbling or sitting on the sidelines can
make you old before your time. Foot surgery can be performed
at almost any age - and in most cases, surgery can restore
the normal use of your feet.
Improve Appearance
Although foot surgery is not
usually performed for cosmetic reasons alone, it can often
improve the appearance of your feet.
Anatomy of the Foot
Before you have your foot
surgery, it helps to understand how your foot works in supporting
you and carrying you from place to place. Knowing how
skin and bone heal following surgery can help you to better
understand the importance of post-operative foot care during
your recovery.
Ligaments are flexible bands
of fiber joining bone to bone. The foot has over 100
ligaments. Joints form where two bones meet. The
33 complex joints in each foot permit flexibility. Bones
form the basic supporting structure of your foot. There
are 26 bones in each foot. Tendons are tough, fibrous
cords that connect muscle to bones. Muscles help move
the feet and toes. When a muscle contracts, it pulls
on a tendon, which in turn moves the bone.
The Healing Process
All foot surgeries involve
the skin, and in some cases, the bone inside must be cut as
well. When you understand the healing process, you can
help make your foot surgery a success.
Skin heals in phases. First,
it grows together so the stitches can be removed. The
scar may look slightly inflamed; some redness and swelling
are normal. After about six months, the scar blends with
the surrounding skin.
Bone also heals in phases. A
bone-like "cement" forms, bridging the affected bone
and allowing it to bear weight. Later, the extra bone
is dissolved, and in about six months, the bone is back to
normal strength.
Bunions
A bunion is an enlargement
of bone in the joint at the base of the big toe. Bunions
are most often inherited. Tight shoes do not cause bunions,
but they can aggravate them. There are several types
of bunions and surgical treatments for each. Your surgery
may be similar to some of the common examples listed.
Positional Bunion
A positional bunion develops
when a bony growth on the side of the metatarsal bone enlarges
the joint, forcing the joint capsule to stretch over it. As
this growth enlarges, it pushes the big toe toward the others
making the tendons on the inside tighten. This, in turn,
forces the big toe further out of alignment. The bunion
presses against the shoe, irritating the skin, and causing
further pain.
Structural Bunion
Structural bunions occur when
the angle between the first and second metatarsal bones increases
to a point where it is greater than normal. The increase
angle of the metatarsals makes the big toe bow toward the other
toes. Sometimes bony growths may form. Irritation
and swelling may often follow. The tendency toward developing
this painful condition is usually inherited. A structural
bunion becomes severe when the angle between the metatarsal
bones of the first and second toes grows greater than the angle
of a mild structural bunion. Again, a tendency toward
developing this condition is usually inherited. The big
toe bows toward the others, sometimes causing the second and
third toes to buckle. Irritation, swelling and pain may
increase when tight shoes are worn.
Degenerative Disease
While not a true bunion, this
condition is often associated with bunions. Bunions,
left untreated, can increase wear and tear in the joint of
the big toe, break down the cartilage, and pave the way for
degenerative diseases such as arthritis. Pain and stiffness
are symptoms of both.
Hammertoes
A muscle imbalance or abnormal
bone length can make one or more small toes buckle under, causing
their joints to contract. This in turn, causes the tendons
to shorten. Corns (build-ups of dead skin cells where
shoes press and rub) often form on the contracted joint, and
may become irritated and infected.
Flexible Hammertoes
When hammertoes are flexible,
you can straighten the buckled joint with your hand. Flexible
hammertoes may progress to rigid hammertoes over time. Corns,
irritation, and pain are common symptoms. Function is
often limited as well.
Rigid Hammertoes
A rigid hammertoe is fixed;
you can no longer straighten the buckled joint with your hand. Corns,
irritation, pain, and loss of function may be more severe for
rigid hammertoes than for flexible ones.
Curled Fifth Toe
The little toe may curl inward
underneath its neighbor so that the nail faces outward. With
this inherited problem, the fat pad on the bottom of the toe
(normally used for walking) loses contact with the ground. Corns
and pain may result.
Plantar Calluses
Second Metatarsal Plantar Callus
When the second metatarsal
bone is longer or lower than the others, it hits the ground
first - and with more force than it is equipped to handle at
every step. As a result, the skin under this bone thickens. Like
a rock in your shoe, the callus causes irritation and pain. The
treatment for this is an osteotomy. The second metatarsal
bone is cut, and the end of the bone is then "lifted" and
aligned with the other bones.
Heel Spurs
A heel spur is a bony overgrowth
on your heel bone (see Plantar
Fascitis). It may be stimulated by muscles that pull
from the heel bone along the bottom of the foot. High-arched
feet are especially apt to have too-tight muscles here. Heel
spurs may cause pain when the foot bears weight. They
can be treated first with an injection, anti-inflammatory medication,
as well as arch supports if indicated. If this fails,
they can then be treated with surgical excision and a plantar
release. The band of tight muscles is released to relieve
the abnormal stress. The bone spur is surgically removed.
Neuromas
When a nerve is pinched between
two metatarsal bones (usually the third and forth metatarsals),
enlargement of the nerve may occur. Abnormal bone structure
contributes to the cause, but too-tight shoes can aggravate
the condition. You may experience sharp pain in your
toes that may become severe enough to keep you from walking.
Treatment
Excision: A small portion
of the nerve is removed. As a result of this, a small
area is usually permanently numbered, but this is preferable
to pain.
Follow-up Care
You can usually bear weight
right away, but you must return to have your dressing changed. Keep
your incision dry until the stitches are removed.
High-Arched Feet (Pes Cavus)
The shape of your foot often
determines the kinds of foot problems you will have. Your
feet may have unusually high arches due to an imbalance of
muscles and nerves, which is usually inherited. Too
high arches can cause various problems - tired or aching feet;
and calluses. High arches are not usually investigated
with surgery but most often treated with arch supports.
Flat Feet (Pes Planus)
Flat feet can be hereditary
and are caused by a muscle imbalance. Feet with low,
relaxed arches may bring on such problems as hammertoes and
bunions; arch, foot, and leg fatigue; calf pain; and an overly
tight heel cord (which makes the foot even flatter). Loose
joints move to freely, causing pain and instability. Flat
feet are also usually treated with arch supports.
Orthotics
Orthotics (also called orthoses
or orthotic devices) are prescribed, custom0made arch supports. They
fit inside most shoes and "bring the floor up to your
feet."
A podiatrist may prescribe
them to help correct such problems as high arches and flat
feet. Also, following some foot surgeries, orthotics
can help support the correction that was achieved.
To be fitted with orthotics,
your podiatrist will first take an impression of your feet. Your
orthotics are then fashioned from leather, plastic, or other
materials. Their fit is checked at an office visit and
adjustments can be made as you wear them. Expect an initial "breaking-in" period;
you may need to build up wearing time gradually (as you would
with contact lenses).
Surgery Decision
If your bunions or hammertoes
are bad enough, they may need surgical correction. This
is a gratifying operation that can provide both pain relief
and improved appearance.
Risks
All surgery carries risks
including stiffness, persistent pain and swelling, recurrence
of problem, damage to nerves, hardware breakage, blood clots
in the legs, anesthetic problems, inability to correct the
problem, etc. Make sure you understand the risks and
alternatives prior to surgery.
Post-Operative Tips
Your recovery, like your foot
problem and surgery, is as unique as you are. In addition
to the previous tips given on follow-up care for each surgery,
here are some pointers that can help you recover quickly and
without complications, and help get you back on your feet again.
Pain: To
help relive pain and reduce swelling in the first 24 to 48
hours after surgery, apply an ice pack to the affected area
and elevate your foot above heart level, as recommended. Pain
is usually most severe the second and third days after surgery,
and after you first begin to walk again.
Bathing: You
will need to keep your foot dry. Getting the stitches
wet can lead to infection, so be sure to keep your foot outside
the shower or bath.
Weight-Bearing: Bearing
weight and walking can stimulate circulation and promote healing. But
overtaxing a healthy foot can detract from the results of your
surgery.
Shoes: Our
team may give you a wide surgical shoe to wear on the affected
foot. A surgical shoe stabilizes and protects the foot
as it heals.
Returning to Work: How
soon you can return to work depends on the type of surgery
you had and the activities you job requires. You can
generally return earlier to a desk job than to physical labor. Consider
beforehand how much time you can take off from work until you
are back on your feet.
REPORT TO EMERGENCY
IMMEDIATELY IF YOU NOTICE REDNESS, DRAINAGE, INFECTION,
CALF PAIN, SHORTNESS OF BREATH, OR HAVE ANY CONCERNS. |
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