There are many structural conditions of the foot and ankle that cause complex deformities, which can cause pain and difficulty walking. They may also cause calluses and wounds or ulcerations. Deformities may be due to flat feet, high arch feet, Charcot deformity (collapse of joints of the foot), rheumatoid arthritis deformities, and post-traumatic deformities.
These sorts of deformities may cause significant disability and change in lifestyle. Foot reconstruction surgery is often a last resort when conservative treatment such as orthotics, shoe gear modifications, braces, and other modalities are ineffective. Reconstructive surgery may include shifting of bones, tendon lengthening or transfers, fusions, and external fixation.
Shifting of Bones
Injury and various foot conditions (such as flatfoot, high arch feet, Charcot foot, and arthritis) can cause one or more of the 26 bones of the foot to shift out of place, causing deformities that are often painful and destabilizing. Surgery can be undertaken to shift these bones back into place, or to make adjustments to foot structures that aren’t properly supporting the body.
Achilles tendon lengthening is a surgical procedure that aims to stretch out a contracted Achilles tendon by making small cuts on the tendons at the back of the ankle. As the wounds heal, the tendons elongate. Contracted tendons can be caused by cerebral palsy, chronic tendinitis, spinal cord injuries, strokes, birth defects, or genetics, and can cause serious pain in the Achilles tendon, flatfoot that forces the knees to bend, abnormal positioning of toes, discomfort in the feet, poor posture, and muscle spasticity (a muscular disorder characterized by stiff muscles).
Foot fusion surgery is used to join or strengthen a weak joint, which can be caused by rheumatoid arthritis, flatfoot, and wear and tear from previous foot injuries. A small incision is made to remove the damaged joint, which is then reinforced with plates and screws that will allow the bones to join together as they heal.
External fixation is a surgical treatment wherein a apparatus, which remains outside the patient’s body, is attached to healthy bone via special bolts or wires in order to stabilize a fracture or deformity while the injury heals. This method of fixation is useful for treating severe fractures, in limb-lengthening procedures, or in situations in which internal fixations cannot be used because of immune system deficiencies or because internal fixations are already present in the area.
Forefoot surgery is often an effective option for patients with advanced cases of the following conditions:
A common deformity of the foot, a bunion is an enlargement of the bone and tissue around the joint of the big toe. Heredity frequently plays a role in the occurrence of bunions, as it does in other foot conditions. When symptomatic, the area may become red, swollen, and inflamed, making shoe gear and walking uncomfortable and difficult. If conservative care fails to reduce these symptoms, surgical intervention may be warranted. Your podiatric physician will determine the type of surgical procedure best suited for your deformity based on a variety of information, which may include x-rays and gait examination.
A Tailor’s Bunion is shown in the photo to the right —it is the red area on the left of the foot. The red area to the right is an example of a bunion.
A hammertoe deformity is a contracture of the toe, frequently caused by an imbalance in the tendon or joints. Due to the “buckling” effect of the toe(s), hammertoes may become more painful due to footwear irritation and pressure. Corn and callus formation may occur as a hammertoe becomes more rigid over time, making it difficult to wear shoes. Your podiatric physician may suggest correction of this deformity through a surgical procedure to realign the toe(s).
An irritation of a nerve may produce a neuroma, which is a benign enlargement of a nerve segment, commonly found between the third and fourth toes.
Several factors may contribute to the formation of a neuroma, such asrauma, arthritis, high-heeled shoes, or an abnormal bone structure. Symptoms such as burning or tingling in the ball of the foot or in the adjacent toes and even numbness are commonly seen with this condition. Other symptoms include swelling between the toes and pain in the ball of the foot when it supports weight.
Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe.
A neuroma is shown in the image to the right—the inflamed yellow area in the middle left region.
Bunionette (Tailor’s Bunion)
A protuberance of bone at the outside of the foot behind the fifth (small) toe, the bunionette or “small bunion” is caused by a variety of conditions including heredity, faulty biomechanics (the way one walks), or trauma, to name a few. Pain is often associated with this deformity, making shoes very uncomfortable. At times even walking becomes difficult. If severe and conservative treatments fail to improve the symptoms of this condition, surgical repair may be suggested.
A bone spur is an overgrowth of bone as a result of pressure, trauma, or reactive stress of a ligament or tendon. This growth can cause pain and even restrict motion of a joint, depending on its location and size. Spurs may also be located under the toenail plate, causing nail deformity and pain. Surgical treatment and procedure is based on the size, location, and symptoms of the bone spur.