Foot and Ankle Surgery

Warning Signs you may need for Foot or Ankle Surgery

Patients may develop arthritis or deformities in the foot or the ankle for many reason. Warning signs that you may be developing or have already developed significant arthritis in either your foot or ankle will include pain particularly with weightbearing or walking on an uneven ground, significant deformity to the foot or ankle, difficulty in wearing standard footwear, and decreased performance or increased discomfort during sporting activity.

Although there are numerous causes for all of the aforementioned symptoms and signs, they could be a sign that you have developed significant arthritis in the foot or ankle and it is best to consult with a specialist orthopedic surgeon who will take a full history and perform a physical examination as well as obtain plain film radiographs to determine possible diagnoses that may mean that you require foot and/or ankle surgery.

Who is a good candidate for Foot and Ankle Surgery?

Patients who have developed the aforementioned symptoms and have ideally tried (and subsequently failed) nonoperative treatment strategies such as footwear modification, orthotics or bracing, anti-inflammatory and other over-the-counter pain medications, injections of various types or physical therapy and periarticular strengthening.

Due to the complex nature of the anatomy of the foot and ankle, patients may experience some of the aforementioned symptoms but may not require any foot or ankle surgery at all. Conversely, patients may have more minor symptoms and still be good candidates for surgery.

In order to determine which category you fall into, your treating orthopedic surgeon will need to complete a full and complete history and physical examination and likely obtain special plain from radiographs and possibly even cross-sectional imaging in the form of CT or MRI scans.

Alternatives to Foot and Ankle Surgery

Although many patients who are good candidates for surgery do eventually end up requiring it, this is not the only option for treating numerous complaints within the foot and ankle and, as previously mentioned, there are a number of nonoperative modalities that can be trialed before reaching a point at which surgery is the only remaining effective option.

These include, but are certainly not limited to, physical therapy, over-the-counter analgesics and anti-inflammatories, footwear modification and/or orthotics, taping or bracing of the foot and ankle, intra-articular injections and even manual and massage therapy.

It is important to remember that while the most nonoperative treatment modalities will be at least partially effective for sometime, their effectiveness of any and all of these can diminish over time and patients may have to accept that surgery will be the best option for addressing their symptoms.

Ankle Surgery Procedure

Depending on the exact type and anatomical location of arthritis that the patient experiences, there are a number of different options for addressing this unique and often troublesome medical problem. If the arthritis is confined to the tibiotalar joint, the patient may be considered a good candidate for a total ankle arthroplasty and although this procedure is still in its infancy, it is demonstrating some good results in early research studies. If the patient’s arthritis is predominantly in the subtalar joint then the patient will most likely be a good candidate for a subtalar fusion. If the patient has arthritis in the subtalar and tibiotalar joints then fusion of a different type may be indicated and indeed if the patient has subtalar, tibiotalar, and talonavicular arthritis then the procedure of choice will be what is known as a triple fusion (fusing all three joints in the same procedure).

If you are unsure as to which type of arthritis you have and which is the most suitable procedure for you then consult with any of our orthopedic surgeons who will be able to guide you to the most appropriate procedure for your arthritis.

Foot Surgery Procedure

Foot surgery is quite a bit more complex than surgery in other areas of the body and as such there are a great deal of surgical procedures that a surgeon can choose from to perform depending on the exact nature of the presenting complaint. For example, hallux valgus (more commonly known as bunions) can be treated in a number of different ways depending on the severity of the deformity and whether or not the metatarsophalangeal joint contains any arthritic change. There are a great deal of different types of osteotomy that can be used to correct the bunion deformity and if arthritis is present then fusion at this joint is also a good option.

For more specific information and advice on your foot condition, we recommend that you speak to our specialist orthopedic surgeons who can assess you with a full history and physical examination as well as plain film radiographs and we will be happy to guide you through explanations of your diagnosis and the most appropriate surgical procedure for you.

Foot and Ankle Surgery Success Rates

It is important to maintain clear expectations of each surgery that one is considering having. For the most part, the goal of surgery is to improve pain, correct deformity or even in some cases both. Ultimately success rates for correcting deformity are quite high in foot and ankle surgery with the only major complication that may affect the success rate being recurrence of the deformity. This complication rate is minimized by selecting the appropriate surgical procedure in appropriate patients and this will be explained in more detail by your surgeon.

Ankle surgery also has high success rates, however, a detailed discussion may be needed with patients should they prefer certain surgeries over others. For example, if a patient is keen on pursuing a total ankle arthroplasty as opposed to an ankle fusion for the ankle arthritis, they must be willing to accept that there is a high rate of failure of this procedure in the medium term, and although the advantage to choosing ankle arthroplasty over fusion is maintenance of a good range of motion postoperatively, they may be facing repeated surgical procedures in their lifetime.

More detailed discussion surrounding the pros and cons of each surgical procedure can be had with your specialist orthopedic surgeon and we will be happy to explain success rates specific to each procedure to you in detail as well as the main signs of complications to watch out for postoperatively.

Foot and Ankle Surgery Risks and Complications

Although there are some surgical risks that are common to most procedures in the foot and ankle (for example, infection, neurovascular injury, and bleeding) each procedure carries its own set of specific potential complications that patients need to be made aware of. For example, the most common complication in bunion surgery is recurrence of the bunion deformity after the surgery. Total ankle arthroplasty patients must be counseled with regards to the likelihood of aseptic loosening of the components around the 8 to 12-year mark. Fusion patients must be informed of the risk of nonunion, or failure of the fusion, in each specific type of fusion that exists.

Patient factors will also affect the potential risks and post-op complications – for example, infections post foot and ankle surgery are known to be a particular problem in certain types of patient population (e.g. diabetics, peripheral vascular disease patients) and it is important to remind patients of this when counseling them preoperatively for any types of surgery that they wish to undergo.

Recovery and Timeframe

Each surgical procedure in and around the foot & ankle has its own specific postoperative recovery protocol and as such each procedure comes with its own proposed time frame for recovery. Given that the goal is slightly different in each case – for example, in total ankle arthroplasty patients can be weightbearing much sooner after the surgery than patients who undergo fusion procedures – these need to be stressed to each patient based on the surgery type and as such there is no “one size fits all” rule for every foot and ankle surgery patient.

Given the area around foot and ankle is one of the least well perfused areas in the body in terms of blood flow, infection is certainly an important complication to discuss with patients and every step should be taken to ensure that the risk of this is minimized.

Management of expectations is also very important particularly with fusion patients. Patients may feel they are not fully recovered given that they feel stiffness after the procedure and it should be stressed to them that the range of motion in the fused joints will decrease significantly (and, if the fusion is successful, ultimately be eliminated) and so feeling new areas of stiffness is normal and that the goal of surgery is not to improve or maintain the range of motion but specifically to relieve the pain.

Conclusion

There are a myriad of surgical procedures in the area of foot and ankle surgery and they are each appropriate for different patient populations and done for specific indications that are distinct from one another. For guidance and information on your particular foot and ankle complaint, please contact our office and arrange to see one of our specialist orthopedic surgeons who will perform a full assessment and will be happy to discuss your diagnosis with you and answer any questions you may have, including the most appropriate management and which surgical procedures, if any, are most appropriate in your case.