Surgical Procedures for Foot Pain
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Surgery is always reserved for conditions that haven't responded to medical treatment. This is particularly true with feet, since healing can be a problem, especially if you have diabetes. If you have diabetes and are contemplating surgery, check with the doctor who is handling your diabetes before proceeding. Consider the risks and benefits.
Surgical procedures are available for the following foot problems:
- ]]>Ingrown Toenails]]>
- ]]>Heel Pain (Plantar Fasciitis and Heel Spurs)]]>
- ]]>Haglund's Deformity (Pump Bump)]]>
- ]]>Tarsal Tunnel Syndrome]]>
- ]]>Achilles Tendinitis]]>
- ]]>Flat Feet]]>
In severe cases, more intensive treatments are needed. Surgery may involve cutting away the sharp portion of the ingrown nail, removal of the nail bed, or removal of a wedge of the affected tissue. Nonsurgical methods of treating ingrown toenails use chemicals (usually phenol), cauterization (heating), or lasers to remove the excess granulation tissue caused by the chronic infection.
If discomfort persists after conservative treatment, surgery may be necessary. Surgical procedures]]> include:
Bunionectomy —This procedure involves shaving down the prominent bone of your big toe joint. In a variation of this procedure, a very small incision is made, through which the bone-shaving drill is inserted. The doctor shaves off the bone, guided by feel or x-ray. Bunionectomy is not a cure, but people are usually satisfied with the results, which may be long lasting.
Bunion Surgery – Bunion surgery involves realigning your big toe joint and bone along with tendons and ligaments. For some people, a procedure that allows correction of the deformity without cutting or fusing the bone may be more appropriate. In severe cases, the metatarsal bone must be repositioned. Recovery takes 6-8 weeks, and you will need to wear a cast or use crutches. Patients are generally satisfied with the results at six months.
Surgery may be needed in some severe cases. If your toe is still flexible, only the tendon or soft tissue may be involved. If your toe has become rigid, surgery on the bone is necessary, but it sometimes can be performed in the doctor's office. A procedure called PIP arthroplasty involves releasing the ligaments at the joint and removing a small piece of toe bone, thus creating a new joint. This restores your toe to its normal position. Your toe is held in position with a rigid wire for about three weeks, and then the wire is removed.
Surgery]]> to remove the interdigital (between the toes) neuroma is usually successful. You will be able to walk immediately afterward, but may need a cane. Sometimes, however, the nerve tissue regrows and forms another neuroma.
Heel surgery to relieve pain may be performed for heel spurs, plantar fasciitis]]> , and ]]>bursitis]]> . Surgery is not recommended until nonsurgical methods have failed for at least six months and preferably up to 12 months. Nonsurgical treatments for heel pain are effective in 90% of patients.
Plantar Fasciotomy for Plantar Fasciitis —This procedure releases the plantar fascia from the heel bone. The deteriorating fascia where it attaches to the heel bone is the cause of pain. The standard procedure uses a large incision and requires about two months recovery time to resume normal activity. A less invasive variation called endoscopy uses small incisions and is still being tested.
Surgery for Heel Spurs —Surgery for heel spurs involves cutting and releasing the plantar fascia and removing the spurs. The heel spurs are usually caused by plantar fasciitis, and so the two problems are associated. This surgery is not always successful, but in some instances is the only recourse. Recovery usually requires immobilization of the foot and use of crutches for about two weeks. Surgery should be a last resort.
Haglund's Deformity (Pump Bump)
In severe cases, surgery may be necessary to remove or reduce the bony growth, which is on the posterior part of the heel bone. According to one study, however, surgery was not effective for over 30% of patients, and in fact, 14% were worse afterward. Experts advise you to try all conservative measures before choosing this invasive path.
Tarsal Tunnel Syndrome
Surgery is sometimes performed to relieve pressure on the nerve, but studies are mixed as to its effectiveness. Tarsal tunnel syndrome caused by known conditions, such as tumors or cysts, may respond better to surgery than when the cause is not known.
If your pain persists after conservative treatment, surgery is a possibility. The tendon is explored and the areas of degenerated tendon are removed. Rarely, there is a small rupture within the tendon, and this is repaired. Surgery requires a long incision. After surgery you will need a cast for 3-6 weeks. Most patients who need surgery for achilles tendinopathy]]> are dedicated runners, tennis players, or basketball players.
Children with flat feet often outgrow them, particularly tall, slender children with flexible joints. One expert suggests that if an arch forms when the child stands on tiptoes, the child will probably outgrow the condition. Many children and adults with flat feet have no symptoms at all.
In general, conservative treatment is recommended for flat feet acquired in adulthood. Treatment typically includes pain relief and insoles or custom-made orthotics to support the foot and prevent progression. In very severe cases, a surgical procedure called arthrodesis is used to correct misalignment of the joints. This is not a likely prospect as most adults with flat feet can be managed well with shoes, insoles, etc. If a flat foot gradually occurs during adulthood, this might require medical attention.
American Diabetes Association website. Available at: http://www.diabetes.org/home.jsp .
American Orthopaedic Foot and Ankle Society website. Available at: http://www.aofas.org/i4a/pages/index.cfm?pageid=1 .
American Podiatric Medical Association website. Available at: http://www.apma.org/s_apma/index.asp .
National Institute of Diabetes & Digestive & Kidney Diseases website. Available at: http://www.niddk.nih.gov/ .
Last reviewed April 2009 by ]]>Robert Leach, MD]]>
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