Foot Surgery

Forefoot surgery procedures help fix the front foot deformity, where conservative management fails, bringing back the correct foot alignment.

About Foot Surgery

Different forefoot problems can occur where pain or discomfort persists despite conservative management. The front part of the foot is the forefoot which contains metatarsals and phalanges, i.e., your toes and the area before them, partway up your foot.

Detecting the forefoot issues before the foot damage is alleviated is vital for healthier living. Here your consulting specialist Orthopaedic foot and ankle surgeon will examine the state of the defect and recommend treatment measures or forefoot surgical intervention, if necessary, to restore the function of your foot.

What are the most common types of foot issues?

The big toe and joint problems:

The big toe joint pain occurs due to an injury or minor underlying medical conditions, including arthritis, fractures, and gout, causing diseases like a bunion, sesamoiditis, etc. The treatment to these depends on the cause of pain and may include non-operative remedies or surgery.

The typical big toe joint conditions that affect people are as follows:

• Bunion ( Hallux valgus)

Hallux valgus or bunion is often hereditary, where a bump is formed on the outside of the big toe joint, eventually causing the toe joint to get out of alignment, and a bony bump forms. This is a gradual progression resulting from the pressure from the way you walk or foot structure, and the pain worsens dues to long hours of standing wearing improper-fitting. People with foot injuries, inflammatory diseases and those with a family history of bunions are at risk. The deformity in some cases may include anatomical abnormality of big toe ( Hallux valgus interphalangeal).

Big toe joint Arthritis ( Hallux rigidus)

Stiffness and pain cause significant limitations of foot function. Arthritis of the big toe joint is a common problem that can be successfully treated with both non operative and operative treatment with an excellent outcomes. Clinical and radiological assessment is key to managing this problem effectively. Non operative and operative modalities of treatment offer effective treatment of this problem. Operative options include joint preservation procedure with Cartiva implant and fusion.

• Sesamoiditis

This is an inflammation and pain of the tendons, i.e., sesamoid bones, occurring in the ball of the foot. It usually happens to dancers, runners and athletes, caused due to frequently transferring weight to the ball of the foot during activities like running, dancing, and walking in high heels, which overstress these tendons and bones.

• Turf toe

This defect in the big toe joint occurs when you bend your big toe forcefully too far. The motion stretches, tears or sprains the soft tissues and ligaments in the big toe joint that connect your bones. Athletes and those active in various sports and activities are prone to this injury caused due to the wearing of flexible or rigid shoes and turf or flat surfaces.

• Small toes problems:

Small toe deformities may occur due to injuries to the toes, their neighboring tissue, and tendons. This happens because of improper fitting shoes or a bunion on the big toe, which puts extra pressure on the small toes or other congenital nerve disorders, causing pain, infection, or discomfort.

The most prevalent small toes problems are as follows:

Toe deformity

Toe deformities commonly seen are hammertoe and mallet toe that occurs due to imbalance in the muscles, tendons or ligaments that support the toe straight. The condition is usually seen in the second, third, and fourth toes, wherein hammertoe happens due to an unusual bend in the middle joint of a toe and mallet toe affecting the joint nearest the toenail. This may be caused by wearing high-heeled shoes, a foot structure, trauma, or some disease processes that lead to such toe deformities.

Ingrowing toenail

This foot condition causes the corner of the toenail to curve and grows into the skin, generally at the nail borders. It mainly occurs after cutting the toenails; tapering the toenail corner curves it and extends into the skin, usually at the nail borders. This nail irritates the skin, resulting in pain, redness, swelling, and warmth in the toe. Infection may occur if the ingrown nail causes a break in the skin, often marked by drainage and a foul odor. People with diabetes, poor blood circulation, severe nerve damage in the leg or foot, or an infection around the nail are at higher risk.

Toe injuries

Multiple types of toe injuries can lead to pain and discomfort in the foot like cuts, scrapes, and bruises, and jammed toe causing traumatic arthritis. Most of these may cause only mild pain, but in some instances where there is throbbing pain will need the pressure under the nail to be released to relieve the pain and prevent loss of the nail. Even a crushed or smashed toe happens when a heavy object falls on the toe or nail might enter, causing a blood clot or an infection.

Bunionette

This condition also called tailor's bunion, forms a painful bump on the outside base of the little (pinky) toe. This state is hereditary that happens when the bone and tissue around the big toe joint become enlarged - red, swollen, and inflamed, causing difficulty in wearing shoes and walking.

Most of the conditions are painful, causing deformities that are initially treated with conservative treatments like modifying your footwear or using shoe inserts (orthotics) to relieve the symptoms. But where these measures do not work, a consultant doctor might recommend a forefoot reconstructive surgery performed under general anesthetic based on your condition and damage.

Types of forefoot surgery are:

Bunion correction surgery

This surgical technique is used for correcting painful or severely deformed bunions. The operation involves shaving the prominent bone. Then, realign the bones with an osteotomy (cut) of the metatarsal and repair the joint capsule and ligaments. This procedure will help lessen the pain and deformity, improve the big toe alignment, make it straighter and reduce callus/corn formation. Options of surgical treatment to treat this pathology include minimally invasive and open surgery to address pain and correct deformity.

Chevron Osteotomy

This surgery is performed to treat a bunion. It corrects the misalignment of the knuckle of the big toe that causes a bump at the base of the big toe to turn toward the smaller toes. The procedure involves the surgeon cutting the end of the long bone leading to the big toe and rotating it to straighten it. It relieves pain by restoring normal straightness to the first toe joint. This procedure will also require soft tissue adjustments around the joint and helps rectify mild to moderate bunion deformity.

1st MTPJ arthrodesis

The first MTPJ arthrodesis procedure is done to treat hallux rigidus or a severe bunion deformity, where an Orthopaedic foot and ankle surgeon removes the articular cartilage from both sides of the joint. The big toe position is rectified to its correct position, fixing the first metatarsal head to the base of the proximal phalanx, allowing patients to have earlier weight-bearing and quicker recovery.

Lapidus procedures

This procedure is done to fix a bunion deformity, known as hallux valgus, realigning the bones in the foot, thereby easing the patient's pain and discomfort. It requires fusing the joint between the first metatarsal bone and the small bones in your midfoot, allowing the first toe to stay straight and decreasing the bunion's risk of coming back.

Weil osteotomy

This procedure is done for forefoot pain (pain under the ball of the foot), requiring osteotomy (cut) or shortening the end of the metatarsal placed at the base of the affected toe. It helps the toe have space to relax and allows it to return to its normal position. and to treat dislocated Metatarsophalangeal joints. It is done in isolation or in addition to other procedures to correct toe

Small toes deformities

Toe deformities are common and cause pain and difficulty with wearing shoes comfortably. Toe deformities include Hammer toe, Mallet toe, and Claw deformities. Clinical assessment is essential to diagnose the type of deformity and ways to treat this problem using non-operative and operative methods

Morton’s Neuroma

This is a painful condition that affects the ball of the foot and is commonly associated with a tingling and burning sensation in the affected toes. It most commonly affects the area between the third and fourth toes but other toes can be affected. Patients commonly feel as if they are standing on a pebble. Non-operative and operative treatments are available to treat these conditions.

Your stay at the hospital post any forefoot surgery usually depends on how you can move around after the procedure. It may vary from a Day case procedure to one-night admission based on your condition, and you will need to request someone to take you home on the day of discharge as you will not be able to drive.

Doctors Panel of Foot Surgery

Nazzar Tellisi

Consultant General Trauma and Orthopaedic

Arabic, English

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