Foot and Ankle Surgery
Foot and Ankle Surgery is a specialized area of orthopaedics that focuses on the diagnosis, treatment, and management of conditions and injuries affecting the foot and ankle. Foot and ankle issues can arise due to trauma, degenerative diseases, congenital deformities, or overuse, and treatment options vary based on the severity and type of condition.
Common Conditions Requiring Foot and Ankle Surgery
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Bunions (Hallux Valgus):
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A bunion is a bony bump that forms on the joint at the base of the big toe, causing it to deviate outward.
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Surgical Treatment: Bunionectomy is the surgical removal of the bunion. The procedure may involve realigning the bones of the big toe, correcting soft tissue structures, or fusing joints to restore normal foot alignment.
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Hammer Toes:
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A deformity where the toe bends abnormally at the middle joint, resembling a hammer.
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Surgical Treatment: Involves releasing the tendon that’s causing the abnormal bend or fusing the affected joints. Tendon transfer or joint resection can also be performed to straighten the toe.
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Plantar Fasciitis:
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Inflammation of the plantar fascia (a thick band of tissue that runs across the bottom of the foot), causing heel pain.
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Surgical Treatment: Plantar Fascia Release is done when conservative treatments fail. The surgeon releases part of the plantar fascia to reduce tension and alleviate pain.
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Achilles Tendon Rupture:
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A tear or rupture of the Achilles tendon, often caused by a sudden increase in physical activity or trauma.
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Surgical Treatment: Achilles Tendon Repair involves suturing the torn ends of the tendon together. In chronic or severe cases, a tendon graft from another part of the body may be needed to reconstruct the tendon.
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Ankle Fractures:
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A break in one or more bones of the ankle joint, often caused by trauma, falls, or sports injuries.
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Surgical Treatment: Open Reduction and Internal Fixation (ORIF) is often required for unstable fractures. The bones are realigned and fixed using screws, plates, or rods to stabilize the joint for proper healing.
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Ankle Arthritis:
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Degeneration of the cartilage in the ankle joint, leading to pain, stiffness, and decreased mobility.
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Surgical Treatment:
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Ankle Fusion (Arthrodesis): Fuses the bones of the ankle joint to eliminate movement and pain.
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Ankle Replacement (Arthroplasty): Replaces the damaged ankle joint with a prosthesis to preserve movement and reduce pain, similar to knee or hip replacement.
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Flatfoot (Pes Planus):
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A condition where the arch of the foot collapses, causing the foot to flatten.
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Surgical Treatment: Flatfoot Reconstruction involves tendon transfers, osteotomies (cutting and repositioning bones), and sometimes fusing joints to restore the arch of the foot.
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Tarsal Tunnel Syndrome:
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A condition similar to carpal tunnel syndrome, but in the foot. It involves compression of the tibial nerve as it passes through the tarsal tunnel near the ankle.
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Surgical Treatment: Tarsal Tunnel Release involves releasing the ligament that’s pressing on the nerve to relieve pain and restore normal sensation.
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Morton’s Neuroma:
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A painful condition caused by the thickening of tissue around the nerves leading to the toes, often between the third and fourth toes.
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Surgical Treatment: Neuroma Excision is performed to remove the affected nerve, relieving the pain and discomfort.
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Hallux Rigidus:
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Arthritis of the big toe joint, leading to stiffness, pain, and limited motion.
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Surgical Treatment:
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Cheilectomy: Removal of bone spurs around the big toe joint to increase mobility.
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Joint Fusion (Arthrodesis): Fusion of the joint to eliminate pain while sacrificing movement.
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Joint Replacement: Replacing the joint with an artificial one to maintain some movement.
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Tendinitis:
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Inflammation of the tendons around the ankle or foot (e.g., Achilles tendonitis, posterior tibial tendinitis).
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Surgical Treatment: Tendon Repair or Tendon Transfer surgeries are performed if the tendon is severely damaged or torn.
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Lisfranc Injury:
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A complex injury involving the ligaments and bones of the midfoot, often caused by twisting or falling.
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Surgical Treatment: ORIF or fusion may be needed to repair damaged ligaments and stabilize the bones of the midfoot.
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Minimally Invasive and Advanced Techniques
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Arthroscopy:
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A minimally invasive surgical technique using a small camera and instruments inserted into the joint through tiny incisions.
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Used for cleaning out scar tissue, removing bone spurs, or treating cartilage injuries in conditions like ankle arthritis or impingement.
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Cartilage Restoration Procedures:
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For younger, active patients with localized cartilage damage, techniques like microfracture (stimulating cartilage growth), autologous chondrocyte implantation (ACI), or osteochondral grafting are used to repair and regenerate cartilage in the ankle.
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Ligament Reconstruction:
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Used in cases of chronic ankle instability, where the ligaments around the ankle are repaired or reconstructed using grafts to restore stability and prevent future sprains or injuries.
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Minimally Invasive Bunion Surgery:
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Some bunions can be corrected using smaller incisions, reducing recovery time and scarring. These procedures use special instruments to cut and reposition the bones through tiny incisions.
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Post-Surgical Recovery
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Immobilization: After surgery, the foot or ankle is often immobilized in a cast, boot, or splint to allow healing. Weight-bearing is typically restricted for several weeks, depending on the procedure.
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Physical Therapy: Rehabilitation is essential for restoring strength, flexibility, and range of motion after surgery. Therapy may include exercises to improve balance and coordination, especially after ankle surgery.
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Gradual Return to Activity: The timeline for returning to normal activities or sports varies depending on the surgery. For example, it can take 3-6 months to recover fully from Achilles tendon surgery, while recovery from bunion surgery may take 6-8 weeks.
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Pain Management: Pain is managed with medications, and ice or elevation can help reduce swelling and discomfort during the recovery period.
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Complications and Risks
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As with any surgery, there are risks and potential complications, including:
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Infection
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Nerve damage
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Blood clots
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Delayed healing or poor wound healing
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Failure of the surgery (e.g., recurrent deformity in bunions, nonunion in fractures)
Non-Surgical Treatments and Alternatives:
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In many cases, conservative management can prevent the need for surgery or delay it:
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Orthotics: Custom shoe inserts can provide support and alignment for conditions like flatfoot or bunions.
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Bracing: For ankle instability or tendonitis, braces or ankle supports can help stabilize the joint.
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Physical Therapy: Strengthening exercises, stretching, and modalities like ultrasound or electrical stimulation can alleviate symptoms.
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Injections: Corticosteroid or platelet-rich plasma (PRP) injections may reduce inflammation and promote healing in certain conditions like plantar fasciitis or tendinitis.
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Foot and ankle surgery offers a range of treatments for both common and complex conditions. If you’d like to explore a particular surgery in more detail or understand non-surgical alternatives, feel free to ask!