Foot and Ankle Surgery

Why Might I Need Foot Or Ankle Surgery?

Foot and ankle surgery is a method of treatment that’s prescribed after conservative, non-surgical avenues of care are explored but do not provide major improvements to suffering individuals. The non-surgical treatment options explored prior to foot and ankle surgery include rest, inserts, braces, therapy, medications, injections, and biologic regenerative treatments.

The following is a list of conditions that affect the foot and/or ankles, as well as key surgeries and procedures that may help to address pain points that do not respond to non-surgical care efforts:

• Bunions. A bunion, also known as hallux valgus, is a bony prominence at the base of the big toe that causes pain, redness, and rubbing in footwear. A bunion can change the shape of your foot and make it difficult for you to find shoes that fit correctly. Painful bunions in particular may be treated via surgery. Dr. Prisk has taken on the advances in surgical techniques is at the top of his game in Lapidus bunionectomy results. The Lapidus bunionectomy has the ability to correct larger-sized bunion deformities and to stabilize bunions that have significant flexibility or instability. If your bunion is painless, however, we will discuss preventative care approaches (such as proper footwear) meant to reduce the risk of it worsening. 
• Hammertoe. "Hammertoe" refers to a health issue where the toes bend and elevate creating deformity and painful calluses. Hammertoes need appropriate treatment to avoid worsening symptoms and permanent deformity. If the condition is too advanced for conservative care (i.e. splints, stretching exercises, specialized shoes), or it does not respond positively to conservative care, surgery may be prescribed to correct the deformity (which presents as an unnatural bending of various toe joints).
• Ankle Fractures and Acute Injuries. Ankle pain treatment can be quite complex due to the nature of the ankle joint and the role it plays in our overall mobility. Therefore, surgery of the ankle is always specific to the nature of the patient's injury, fracture, etc.. For example, surgery may be used to realign bone fragments following a severe fracture. It may also be used in cases of severe acute injury, should the ankle and joint need to be “cleaned out” before it can begin to heal.  Repair of tendons and ligaments can be both surgical and non-surgical. Boots, braces, and casting will be explored where appropriate.
• Arthritis of the Foot and Ankle. Osteoarthritis, often called “wear and tear” arthritis involves chronic damage to the cartilage and soft tissues of the joints. In extreme cases of this health issue, surgery may be needed to properly “clean out” and help fix or even reconstruct an arthritic joint.  Joint replacements and alternatives to fusion surgery will be explored.
• Achilles Tendon Problems. The Achilles tendon is the largest tendon in the body and is prone to suffering from tendinitis - a condition associated with overuse, degeneration, and partial tears, which leads to a painful and swollen tendon. Ruptures can also occur, and both can be treated nonoperatively or operatively.  Surgery may be considered to relieve Achilles tendinitis after conservative care or repair an acutely torn tendon. 
• Plantar Fasciitis and Heel Pain.  Plantar fasciitis is the most common cause of pain on the bottom of the heel, caused by degeneration of the tissue (a ligament) supporting your foot arch. Surgery is considered only after exhausting nonsurgical foot pain treatment such as therapy, inserts, shoe changes, braces, PRP injections, and Shock Wave Therapy. Surgery is, however, an option for severe cases of this condition at earlier stages.
• Tendon Disorders of the Foot and Ankle. Every tendon around the foot and ankle can cause symptoms as the result of damage, overuse, or injury to the bone, muscle, or soft tissues. Most frequently affected are the anterior tibial, flexor hallucis longus, Achilles, peroneal, and posterior tibial tendons. Surgical care will vary depending on the nature of each disorder and each individual patient.
• Flatfoot and Cavus Foot Reconstruction. Flatfoot reconstruction is a surgery performed to correct the structures of the foot and restore the foot’s natural functionality after being lost to injury or illness. The primary objectives of flat foot reconstruction are the reduction of pain and restoration of function and appearance. This can greatly benefit patients’ medical and aesthetic needs. 
• Ankle Instability and Ligament Reconstruction. Repeated ankle injuries, such as sprains, can lead to long-term problems, including chronic ankle pain, arthritis, and ongoing instability. Instability (as caused by tearing of a ligament of dislocation of the ankle joint) is very problematic because it can make it hard to walk; can make a person feel as if their ankle is ready to “give out” at any moment; and can even result in damage to the bones and cartilage of the ankle joint. While many ankle injuries will respond to conservative care, surgery (targeting the damaged ligaments behind the instability) is sometimes needed to restore proper function to the ankle overall.
• Ankle Arthroscopy and Cartilage Surgery. Arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose, and treat problems inside a joint. This type of surgery may be used to evaluate inflammation or known injuries to the ankle; the imaging provided by this procedure allows doctors to better diagnose and target the underlying problem. Additionally, Articular Cartilage Restoration surgery may be used to repair painful cartilage damage (which can be caused by injury or normal wear and tear).
• Ankle Biological Treatments. Bone marrow aspirate concentrates (BMAC - referred to sometimes as stem cell treatments) and Platelet-Rich Plasma (PRP) are treatment methods that may be effective in healing chronically damaged tissues and improving symptoms of arthritis.  

Will Physical Therapy Be Required After Surgery?

Yes. Restoring your full range of motion, strength, and flexibility back after surgery usually takes time. That is where pre-operative exercise, education, and post-operative physical therapy programs come in – to ensure you are physically and emotionally prepared for surgery and to maximize your recovery after surgery.

What Are The Risks Associated With Surgery?

Specific risks will vary from procedure to procedure, although some general risks include reactions to anesthesia, bleeding, infection, stiffness, and nerve damage. Your doctor will always discuss the risks associated with your specific procedure.

What Can Happen If Surgery Is Avoided?

Specific complications will vary from health issue to health issue. However, some common complications of not undergoing an orthopaedic surgery for your condition include chronic pain, loss of joint motion, joint weakness, numbness, and an early onset of arthritis.

How Long Will I Need Time Off Work After My Surgery?

The post-operative recovery period varies, based on the particular surgery as well as the individual patient. Generally, it is recommended that patients take two weeks off work to recover from any surgery, and to resume light duties only when returning to work. Your surgeon will always give you specific instructions to follow for a successful recovery.

How Long Before I Can Resume Driving?

You should wait at least one week after surgery before driving. This is because anesthetic and surgery can affect post-op judgment and reflexes during the first full week following your surgery. However, your surgeon will provide more specifics for your particular situation. Adhering to these specific guidelines is important.  Right lower extremity surgery can take longer to return. 

When Can I Resume Exercise?

Your doctor will instruct you about post-treatment exercises, i.e. the type and the duration to be followed. You may be referred to a physical therapist to help with strengthening and range of motion exercises following surgery. If you have specific questions about a workout routine you used before surgery, please discuss them with your care team.

When Can I Resume Daily Activities?

This varies depending on the type of surgery you are recovery from. In general, this can range from a few days to a few months. Return to all activities, sports and exercise can take up to four to six months. Your doctor can advise you on a timeline specific to you prior to and after surgery.

Since surgical care is unique in every individual, it's impossible for us to answer every question about your care needs here. We want to help you properly, via a collaborative care process that puts you and your health needs in full focus. And it all begins with a conversation about your health, needs, and goals. To review your care options in-depth, and to prepare for your visits and/or foot and ankle surgery, please contact us at (412) 525-7692 or submit an online appointment request form.