Information on Surgery

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.

Complications


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.).

Post-operative Care


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.