Foot Surgery

General

The foot surgery is intended to correct all anatomical alterations and deformities, both congenital and acquired, of the foot. The purpose of this is to restore functionality, from the point of view of movement, allowing normal gait, support, stabilization and adequate support of the skeleton, in addition to improving pain in many cases.

As in other areas of medicine, in foot surgery, surgical techniques have been modified over time to obtain an optimal result with minimal tissue damage and simpler procedures. The ultimate goal is a better and faster recovery of the patient, a quick return to their activities and normal life without physical limitations.

In this sense, percutaneous foot surgery or also called minimally invasive surgery (MIS) has developed rapidly due to its excellent results.

 

 

This type of surgery requires a careful process of training and practice, so it is very important to select an expert surgeon and an institution with the instrumental and surgical capacity that is at the forefront of technological advances.

At the San Roman Clinic we are medical surgeons and podiatrists pioneers in Europe in performing minimally invasive techniques, with a long experience that began in 1979 with excellent results thanks to a constant technical and academic updating.

MIS is a surgery done through small incisions, it is not necessary to make a larger scar, as in the case of traditional open surgeries. This requires specific surgical material designed for this purpose. Fluoroscopy (radiology) is also needed to guide the surgeon in deep planes where he does not have direct visibility.

MIS has several comparative advantages over open surgery:

• Direct exposure of the internal tissue is avoided.
• Tissue damage due to the effects of surgery or ischemia is also avoided.
• It is the surgery of choice if the patient has a history of circulatory problems and diabetes, since it does not cause significant vascular damage.
• There is no need for tourniquet placement to decrease blood flow to the foot, as in the case of open surgeries to decrease the risk of bleeding. As it is a surgery with minimal incisions, the risk of bleeding is very low.
• The approach of incisions within the joint capsules and functional dressings allows for rapid ambulation. Prolonged immobilization is avoided, which in addition to being uncomfortable for patients, can become a risk factor for deep vein thrombosis.

Not all types of foot pathology can be solved surgically by this technique, however, there are a variety of types of surgery for common foot problems.

 

 

The most common surgical pathologies of the foot are:

• Hallux valgus or bunions:

It is the most common deformity of the forefoot. 90% occur in women.

Its basic characteristic is the deviation of the first finger greater than 15 degrees, showing a lateral prominence of bone. It is mainly caused by inadequate footwear. Although there is a genetic component when it appears in young individuals. It may occur on one side or be bilateral.

There are different degrees: mild, moderate or severe, according to the angles of deformity or associated foot pathologies. Depending on the clinical and radiological evaluation, the appropriate surgical technique is chosen for each case. Most hallux valgus can be resolved under minimally invasive surgery.

Finger deformities:

• Claw toes (proximal or distal)
• Hammertoes
• Clinodactyly (transverse deviations)
• Fifth varus – deformity of the fifth toe
• Plantar fasciitis
• Metatarsalgia
• Interdigital helomas
• Hallux rigidus
• Soft tissue surgery: some tendon and capsule repairs can be performed under this technique.

Type of anesthesia in minimally invasive surgery of the foot.

The type of anesthesia used for these surgeries is called locoregional: neurological ankle block. That is, general anesthesia is not required. Recovery is much faster and there are fewer risks.

This block allows the patient to ambulate after surgery. It also allows the evaluation of the motility of the different tendons during surgery and the immediate postoperative period.

It is performed with local anesthetics, through 2 to 3 injections with minimal discomfort to the patient. This ensures pain-free surgery and recovery with full ankle and foot motion integrity.

Complete block is achieved by infiltrating the following nerves: sural, superficial and deep peroneal, and posterior tibial.

 

Complications of percutaneous foot surgeries

The surgeon’s experience is fundamental to have a greater range of safety and minimal complications in this type of very precise surgery.

However, the number of complications is much lower than in traditional open surgeries. Complications can be:

• Ostomy complications

This refers to the fact that in minimally invasive surgeries no means of fixation or synthesis are used to keep the bone in place during the surgical procedure. In minimally invasive surgeries, clinically relevant ostomy mobilization has been reported in less than 5% of cases.

• Vasculonervous complications

There may be rupture of vessels during surgery, which does not affect blood flow to the foot or the operated area. Being small blood vessels, bleeding is usually scarce and easy to control.

Nerve structures can also be injured, which in many cases are partial injuries that can temporarily affect sensitivity in areas of the foot and are reversible.

• Transfer complications (metatarsalgia due to transfer)

They occur in less than 5% of cases. They are contiguous lesions, outside the area where surgery was performed.

This occurs because after the repositioning of the bones, other nearby structures may be affected when starting to walk in the usual way. They may be small fractures or metatarsalgia of the second or third toe.

• General complications

Such as local infections and phlebitis, which are very rare compared to open surgeries.

Hallux valgus postoperative period

The main advantage of these surgeries is the rapid recovery, with the possibility of early ambulation and minimal pain.

• Immediate postoperative period:
  • Use of postoperative footwear (rigid sole).
  • Wandering.
• Average postoperative period: (7 days)
  • Removal of stitches.
  • Change bandages.
  • Placement of metatarsal band.
  • Placement of interdigital separator between first and second fingers.
• Late postoperative period. (6 weeks)
  • Remove metatarsal band and interdigital separator.
  • Radiology control.
  • Usual use of footwear according to tolerance.

Special shoes

For 4 to 6 weeks it is the only footwear that can be worn. It is called “post operative talo shoe”, which allows the force and weight not to be exerted on the first toe, favoring proper consolidation and healing.

 

 

Bandage

It should be used for 4 weeks, with weekly changes unless there are any complications. Avoid getting the bandage wet and keep it well cared for. It performs the function of maintaining the new position of the toe in the case of hallux valgus and claw toes.

Exercises

Flexion and extension movements of the first toe can be performed for at least 15 minutes and up to 3 times per day after removing the bandages. Helps the recovery of joint mobility. The movement is performed with the help of the hand without causing pain. Your doctor will give you the exact instructions.

Local ice

Apply local cold with cold gel packs or ice, avoiding wetting the bandage.

Analgesics

Analgesics can be taken for the first 72 hours, only if there is pain. After that time they are usually not required.

Position

It is advisable to keep the foot up as long as possible during the first 48 hours after surgery.

Controls or revisions

The first check-up should be performed 7 days after surgery.

Percutaneous Hallux Valgus Surgery

• Techniques:

The choice of technique will depend on the correct preoperative assessment, through physical examination as well as radiological and biomechanical studies.

In these cases, it is necessary to measure the different angles of deviation and determine the size of the exostosis.

The coexistence of associated deformities also plays a role: metatarsalgia and claw or hammertoes, which often occur together with hallux valgus.

• Unilateral or bilateral hallux valgus

This pathology can be in one foot or more frequently in both feet. When both feet are deformed, the procedure can be performed on the same day. It is also possible to operate on contiguous days when the lesion is bilateral.

Do not wait too long between one foot and the other (1 to 2 days), since the post-operative period will be longer and it is also important that the body is balanced for walking.

• Hallux valgus recurrences

Recurrence or recurrence of hallux valgus or bunions after minimally invasive or percutaneous surgery is very rare, if performed by an experienced surgeon and using the proper techniques and material. Likewise, the patient’s own postoperative care is important in the final result of the operation.

It is important to make a proper evaluation of all foot deformities associated with hallux valgus prior to surgery. Failure to correct adnexal deformities is one of the causes of hallux valgus recurrence after surgery.

Recurrences may also occur if there are postoperative complications.

Both open and percutaneous surgical techniques offer a satisfactory result of more than 90% in the long term.

Percutaneous foot surgery protocols

All patients must comply with the basic requirements previously established for this type of surgery:

• Basic preoperative laboratory or analytical tests.
• Previous radiological studies: conventional radiology, MRI, fluoroscopy, etc.

 

• • Non-invasive vascular assessment in all cases. If there are physical alterations, proceed to an invasive evaluation with a specialist.
  • Physical examination and medical history.
  • Preoperative and preanesthetic assessment in case of sedation.

 

• Biomechanical assessment: examination of the range of motion of the limb to be operated on.

• Informed consent.

 

Frequently Asked Questions

Minimally invasive or percutaneous foot surgery

Where should percutaneous or minimally invasive foot surgery be performed?

Not all centers have the trained personnel and equipment necessary to perform this type of procedure. In the San Roman Clinic we have more than 35 years of experience with excellent results.

What is laser foot surgery called?

In the past, minimally invasive surgeries were referred to as such. It is important to note that lasers are NOT used in this type of foot surgery.

Should I have any preparation for day of foot surgery?

You must complete the preoperative care protocol. Go with a companion who can stay in the waiting area of the clinic.

Minimally invasive foot surgery does not require hospitalization. They are ambulatory and the patient walks out wearing his postoperative shoe and without assistance. It is recommended to wear comfortable clothing that is easy to remove.

How long should I stay in the clinic after foot surgery?

You should stay 2 to 3 hours maximum, until you are discharged by the surgeon. These surgeries are completely ambulatory. During the postoperative period, you will be able to contact the surgeon and Clínica San Román 24 hours a day.

What home adjustments are necessary after foot surgery?

It is important to keep the house clean and tidy to avoid tripping.

At night when walking around the house, the lights should be on so as not to trip over anything.

In the bathroom, toiletries should be readily available without being in cabinets that are too high.

If you take an immersion bath you should not submerge the operated leg in the bathtub and if you take a shower you should put on the foot protector (anatomical plastic cover) and keep the post-surgical bandage dry and clean. While showering the patient can use a stool or chair to sit on and have the leg relaxed. Foot protectors will be delivered to the clinic for comfort and safety.

When dressing, the operated leg should be put into the clothes before the non-operated leg. And at the time of undressing it should be done the other way around, taking out the non-operated leg before the operated one.

In the kitchen, utensils and food should be placed at a low height. It is important to maintain a healthy and balanced diet.

When resting, it is recommended to put ice on the operated foot to reduce the possible pain of the intervention. For this purpose, a cold gel pack or ice can be used, avoiding wetting the bandages.

You should keep the operated leg elevated while resting to reduce swelling for the first few days. If possible, use firm pillows under the patient’s leg when lying down.

It may be difficult to go up or down stairs after surgery so using handrails will help support the body. In case of climbing stairs, the non-operated leg should be climbed first, followed by the operated leg. When lowering, it should be the other way around, lowering the operated leg first and then the non-operated leg.

When does the patient have to see the surgeon again?

You should usually return for a check-up 1 week after surgery.

What complications can I have from anesthesia?

The anesthesia used in minimally invasive foot surgeries are local, called ankle blocks. It does NOT affect the mobility of the foot and has no general side effects. You should warn your physician in advance if you are allergic to any anesthetic medication.

It is a very safe and easy way to perform the surgery without any pain.

How many days can I have pain from minimally invasive or percutaneous foot surgery?

You may have pain for 2 to 3 days after surgery. Very rarely, there is pain for a longer period of time. You may not experience pain at any time and may not need pain medication. This is one of the virtues most appreciated by patients in this type of surgery.

When can I do sports again after percutaneous foot surgery?

After 6 weeks following hallux valgus or bunionette surgery, a progressive sporting activity can be initiated, initially avoiding sports with high impact or pressure on the first toe. For claw or hammer toe surgeries as well as hallux rigidus and other minor deformities, sports activities can be started 3 weeks after surgery.

When can I drive vehicles again after minimally invasive foot surgery?

Do not drive while wearing the postoperative shoes. It is usually 3 to 6 weeks depending on the type of intervention performed.

When can I return to work after foot surgery?

You can return to work 2 weeks after surgery, as long as there is no strenuous physical activity or long walks. However, if the work activity is performed in a sitting position, the patient may be able to sit up earlier.

Can my bunion get better without surgery over time?

No, what can happen over time is that the deviation and pain may worsen.

Will I have difficulty moving my toes after bunion surgery?

No. Difficulty in mobilizing the first toe occurs in the first few weeks, so the patient is properly trained to initiate mobility early after the bandages are removed.

Can both feet be operated on at the same time?

There are no drawbacks from a medical point of view. Both feet can be operated on the same day with local anesthesia and in selected cases with sedation for patients who request it. It is not recommended that a long period of time elapses between one foot and the other.

What other treatments do you do at Clínica Podológica San Román?

Several types of foot surgeries are performed: for skin conditions, nail problems and deformities. The clinic also has a complete chiropodology service performed by expert podiatrists.

 

Article prepared by Clínica San Román

Date of Publication 28-11-2018

Date of revision: 11-02-2020