Surgical Treatment Overview
No matter what your foot problem is, the purpose of podiatric treatment is to reduce the amount of pain you’re experiencing with your condition. Surgery is one method used to improve the foot’s functionality and reduce your pain.
Surgery isn’t always necessary. Foot problems, particularly mild ones, often respond to more conservative treatments such as making changes to the types of shoes you wear, using orthotics (prescription shoe inserts), or taking medication to reduce pain and inflammation. However, if these treatments fail to adequately improve your condition, or if your condition is more serious, your podiatrist may recommend surgical treatment.
With any treatment you undergo, be sure to approach your doctor with any questions or concerns you might have. Doing so will help you avoid undue anxiety and confusion. Whatever your concerns are, you should certainly never feel that any question you have is irrelevant, since it’s your right and responsibility to share in all decisions about the care you will receive. Being an informed patient will greatly aid you as you seek to make decisions about the care that’s best for you.
Previous Medical Conditions
Before you undergo any type of surgery, you’ll want to discuss your full medical history with your doctor. Certain conditions may make you a poor candidate for surgery, including diabetes, poor circulation, excessive bleeding, a history of smoking, or if you react adversely to anesthesia or other medication. Please make your doctor aware of any previous conditions that may affect your ability to undergo and recover from surgery. This will make your doctor more able to recommend the type of treatment that is right for you.
Part of being informed about surgery is knowing the risks that are associated with it. While many surgeries are performed successfully, complications are known to arise. Some common complications include pain, scarring, infection, swelling, loss of or changes in sensation, and a recurrence of the original deformity.
More rare complications (usually seen in less than 5% of surgical cases) might be an over or under correction of the deformity, highly prominent or enlarged scars that restrict your motion, deep-vein blood clots that form after your surgery, swelling that persists beyond the normal period, bones that fail to reunite (non-union), or tissue or bone death. Very rarely a patient may experience Complex Regional Pain Syndrome, characterized by debilitating, unremitting pain.
Let’s discuss a couple of these complications in a little greater depth.
The most common complication of surgery is excessive swelling at the surgical site. Swelling is the body’s natural response to an injury. Extra blood rushes to the area in order to promote healing, but it’s not always able to drain easily. The tissues can become swollen with fluid, which can put pressure on nerves and become quite painful. Feet are especially prone to swelling since they lie farthest from the heart, and fluids have to contend against the pull of gravity to make their way out.
Excessive swelling in response to surgery occurs in approximately 20% of surgical patients. Being too active after your surgery, or wearing shoes or bandages that are too tight may contribute to this problem. If you experience excessive swelling, you can assist your body by elevating your foot and staying off of it as much as possible. Your doctor may also recommend special compressive bandages or medication to reduce swelling. In some cases, swelling is present for more than a year after the operation.
Pain, or discomfort, is not uncommon after surgical treatment, but it’s usually not severe, and will most likely be manageable by use of pain pills prescribed by your doctor. However, if you experience severe pain immediately or a few days after your surgery, there may be some cause for concern. Pain experienced right after surgery may be due to bandages that are too tight, or it may be caused by putting weight on your feet too soon after your operation, or in other ways failing to give the area adequate rest.
You may develop pain a few days after surgery. While this is often due to an infection developing in the surgical area, it may be due to other causes as well and should be investigated by your doctor.
You may also experience aches that last for quite a while after your surgery, often due to failure to follow physical therapy exercises to maintain or improve your range of motion, or again, due to being too active after surgery. Talk to your doctor if you experience moderate or severe pain after surgery.
Infection is a concern any time the skin is cut open. Many different kinds of bacteria live on the surface of our skin, although not all are harmful. Although your skin at the incision site is cleaned thoroughly prior to surgery, it’s impossible to remove every bacterium that lives there. Some bacteria from your skin may penetrate the surgical wound and multiply, causing an infection which usually shows up a few days after surgery takes place. Such infections are quite rare (somewhere around 1% to 3% of surgical patients), but they do occur.
When you develop an infection at the site of your surgery, you’ll likely be able to treat it using an oral antibiotic. However, if the bacteria infecting the site are resistant to treatment, or are located deep inside your body (such as in the bone), it may be necessary to receive antibiotics intravenously (which are often more potent than oral types). Talk to your doctor if you show any sign of infection, including redness or discharge from the surgical site, or if you develop fever, chills, sweats, or are excessively tired.
Because surgery cuts through small nerves (and occasionally larger ones), you may experience a change or loss of sensation around the surgical site. Having skin that’s rather numb after surgery is actually normal, and usually goes away in a few days. However, some patients experience extreme sensitivity (often an increase in pain or other sensation), or burning, tingling, or sensations of coldness in the area. While these changes in sensation may (rarely) be permanent, most patients experience a return to normal after a few days, weeks, months, or sometimes a year or two.
Scarring is often a cosmetic concern, although there may be some increased sensitivity in scar tissue. Unfortunately, feet (particularly the sole area) are rather more prone to scarring than some other parts of the body, mainly because they’re under such pressure as we walk on them. However, your surgeon will, if possible, attempt to make incisions in areas that are less prone to scarring, and will make incisions that reduce the tension on your skin in order to reduce the amount of scarring that may take place.
While a delay in healing may happen to anyone, this complication is more frequently seen in patients with healing or circulation issues. This group includes diabetics, those with heart or other circulatory problems, and smokers.
In some cases, bones may be slow to knit back together (they normally take about six to eight weeks to do so), or may fail to come back together at all (non-union). Or, your soft tissue may refuse to heal. The surgical site might ulcerate, weep, discharge, or may pull apart before it heals. In less than 1% of patients, tissue may die, although this is slightly more common with patients with circulatory problems (diabetics, etc.).
Recovery time after surgery varies a great deal, and will depend on the type of surgery performed, and even on your own general health. Most patients feel about 75% better by ten to sixteen weeks after surgery. However, full healing may take up to twelve to eighteen months.
Your doctor will likely have specific instructions to aid your foot in recovering after your operation. These may include resting the area, applying ice to reduce swelling and pain, compression (often by use of compression bandages), and elevating the foot. You may also need special equipment or accessories post-surgery, including crutches, canes, casts, braces, bandages, surgical shoes, or splints. Whatever your doctor’s instructions are, it is vital that you precisely follow them after your surgery. Doing so will significantly reduce your risk of developing complications. A failure to do so may result in major problems, including the need to perform the surgery again, the development of moderate to severe complications, or even loss of a limb.
Surgery is something to be serious about, but you don’t have to be afraid of it. Although there are no guarantees that surgery will correct all the problems you may be experiencing with your foot, surgery is usually quite successful at reducing pain and improving quality of life. Again, please discuss any questions or concerns you may have with your doctor. Be sure you understand your procedure and feel confident in your doctor. It is, after all, your health you need to consider.