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Foot and Ankle Surgery

Bunion Surgery

Most of the time, bunion surgery specifically involves an incision along the top or side of the big toe joint and the realignment or removal of bone and soft tissue. This surgery helps restore normal alignment to the joint while relieving pain. If the joint is extremely deformed, it may be stabilized with stitches, tiny wires, screws, or plates. The patient must understand that there are no guarantees that the bunion surgery will completely relieve pain.

A regional anesthetic (affecting only the leg or foot) is commonly used for this surgery. If necessary, the physician may also prescribe a sedative during the procedure. Depending on the type of surgery involved, the procedure usually takes an hour and is generally performed on an outpatient basis.

There are a variety of bunion surgeries. There is no general agreement as to which type of surgery is best and the physician must individualize the choice of the procedure for each foot. In fact, more than one procedure may be necessary during the same operation.

The most common types of bunion surgery are:

Exostectomy – The removal of part of the metatarsal head (i.e., the part of the foot that bulges out).
Soft tissue release – The realignment of the ligaments (soft tissues) around the big toe.
Metatarsal Osteotomy – The removal of a small wedge of bone from the foot.
Phalangeal Osteotomy – The removal of a small wedge of bone from the toe.
Resection Arthroplasty – The reshaping of both the big toe and metatarsal bones at the metatarsophalangeal joint.
Arthrodesis – The fusion of the big toe joint.
Lapidus Procedure – The fusion of the joint where the metatarsal bone joins the mid-foot.

Osteotomy

When a surgeon cuts and repositions a bone, it is referred to as an osteotomy. There are two basic techniques used to perform an osteotomy to realign the bunion or first metatarsal.

Distal Osteotomy

This type of procedure is designed to treat mild or moderate bunions. With a distal osteotomy, the far end of the bone is cut and moved outwards. This decreases the deviation between the first and second metatarsal bones. This type of procedure usually requires 1 or 2 small incisions in the foot. Once the surgeon is satisfied with the position of the bones, the osteotomy is held in the correct position with metal pins. Once the bone heals, the pin(s) is removed. The metal pins are usually removed between 3 and 6 weeks following surgery.

Proximal Osteotomy

This procedure is designed for more severe bunions. With a proximal osteotomy, the first metatarsal is cut at the middle or near end of the bone. This type of procedure usually requires 2 or 3 small incisions in the foot. The bone is realigned and held in place with metal pins or screws until it heals. This also decreases the deviation between the first and second metatarsal bones.

Soft tissue release is often combined with the proximal osteotomy. This involves releasing the tight structures on the lateral or outer side of the joint. This includes the tight joint capsule and the tendon of the adductor hallucis muscle. This muscle tends to pull the big toe inward. By releasing the tendon, the toe is no longer pulled out of alignment. The toe is realigned and the joint capsule on the side of the big toe closest to the other toe is tightened to keep the toe straight.

Once the surgeon is satisfied that the toe is straight and well balanced, the skin incisions are closed with small stitches. A bulky bandage is applied to the foot before heading to the recovery room.

Ankle Fusion

An ankle fusion is a procedure to reduce the pain associated with ankle arthritis. This does so by getting the bones around the ankle to grow together. The surgery requires the removal of the joint cartilage, proper positioning of the ankle and foot, and placement of screws, plates, rods, or pins to hold the position while the bone knits together into a solid painless structure.

Tendon Transfer

A tendon transfer involves release of one end of a tendon from bone or soft tissue and its reattachment to another bone or tendon.

A tendon transfer is used when a muscle or group of muscles are weak, torn or paralyzed. The transfer can correct a flat foot, high arch, clawed toes, a drop foot or a weak heel cord (Achilles tendon).

An example of a common tendon transfer is the Tibialis Posterior Tendon to the Tibialis Anterior Tendon. This transfer is used to correct a foot drop resulting from nerve injury.

Ankle Replacement

This procedure is also known as total ankle arthroplasty (TAA). Ankle replacement surgery is a technique that has developed in recent years to improve an ankle joint that has been severely damaged by arthritis. When nonsurgical methods of treatment are inadequate, joint replacement surgery may represent the best hope for long-term improvement to the ankle joint.

Pain relief is the most reliable potential benefit and often the major reason for surgery. For many people, ankle replacement surgery also offers better movement and coordination of the foot and leg. The goal with this surgery is to decrease pain and improve function.

Both sides of the ankle joint cartilage (tibia/fibula and talus) are removed and replaced with artificial parts or prostheses. The tibia/fibula prosthesis is made of medical- grade plastic with a titanium base plate. The talus component of the joint, which moves up and down, is replaced with a part made of cobalt chromium alloy. This metal is commonly used in prostheses for other joints of the body like the hip and knee.

 

Appointment Checklist

 Always ask a surgeon for specific preoperative preparation instructions. Typically, these may include:

  • Complete any pre-operative tests or lab work prescribed by a doctor.
  • Arrange to have someone drive you home from the hospital.
  • Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your appointment time.
  • Do not eat or drink anything after midnight.
  • In preparation of any foot/ankle surgery, upper body strengthening is encouraged in order to prepare for crutch/walker use after surgery.

Day of Surgery

  • If you currently take any medications, take them the day of your surgery with just a sip of water.
  • Refrain from taking diabetic pills or insulin, unless directed otherwise by your physician or surgeon.
  • Do not wear any jewelry, body piercings, makeup, nail polish, hairpins or contacts.
  • Leave valuables and money at home.
  • Wear loose-fitting, comfortable clothing.
  • Bring crutches or a walker.

Bunion Surgery

Most of the time, bunion surgery specifically involves an incision along the top or side of the big toe joint and the realignment or removal of bone and soft tissue. This surgery helps restore normal alignment to the joint while relieving pain. If the joint is extremely deformed, it may be stabilized with stitches, tiny wires, screws, or plates. The patient must understand that there are no guarantees that the bunion surgery will completely relieve pain.

A regional anesthetic (affecting only the leg or foot) is commonly used for this surgery. If necessary, the physician may also prescribe a sedative during the procedure. Depending on the type of surgery involved, the procedure usually takes an hour and is generally performed on an outpatient basis.

There are a variety of bunion surgeries. There is no general agreement as to which type of surgery is best and the physician must individualize the choice of the procedure for each foot. In fact, more than one procedure may be necessary during the same operation.

The most common types of bunion surgery are:

Exostectomy – The removal of part of the metatarsal head (i.e., the part of the foot that bulges out).
Soft tissue release – The realignment of the ligaments (soft tissues) around the big toe.
Metatarsal Osteotomy – The removal of a small wedge of bone from the foot.
Phalangeal Osteotomy – The removal of a small wedge of bone from the toe.
Resection Arthroplasty – The reshaping of both the big toe and metatarsal bones at the metatarsophalangeal joint.
Arthrodesis – The fusion of the big toe joint.
Lapidus Procedure – The fusion of the joint where the metatarsal bone joins the mid-foot.

Osteotomy

When a surgeon cuts and repositions a bone, it is referred to as an osteotomy. There are two basic techniques used to perform an osteotomy to realign the bunion or first metatarsal.

Distal Osteotomy

This type of procedure is designed to treat mild or moderate bunions. With a distal osteotomy, the far end of the bone is cut and moved outwards. This decreases the deviation between the first and second metatarsal bones. This type of procedure usually requires 1 or 2 small incisions in the foot. Once the surgeon is satisfied with the position of the bones, the osteotomy is held in the correct position with metal pins. Once the bone heals, the pin(s) is removed. The metal pins are usually removed between 3 and 6 weeks following surgery.

Proximal Osteotomy

This procedure is designed for more severe bunions. With a proximal osteotomy, the first metatarsal is cut at the middle or near end of the bone. This type of procedure usually requires 2 or 3 small incisions in the foot. The bone is realigned and held in place with metal pins or screws until it heals. This also decreases the deviation between the first and second metatarsal bones.

Soft tissue release is often combined with the proximal osteotomy. This involves releasing the tight structures on the lateral or outer side of the joint. This includes the tight joint capsule and the tendon of the adductor hallucis muscle. This muscle tends to pull the big toe inward. By releasing the tendon, the toe is no longer pulled out of alignment. The toe is realigned and the joint capsule on the side of the big toe closest to the other toe is tightened to keep the toe straight.

Once the surgeon is satisfied that the toe is straight and well balanced, the skin incisions are closed with small stitches. A bulky bandage is applied to the foot before heading to the recovery room.

Ankle Fusion

An ankle fusion is a procedure to reduce the pain associated with ankle arthritis. This does so by getting the bones around the ankle to grow together. The surgery requires the removal of the joint cartilage, proper positioning of the ankle and foot, and placement of screws, plates, rods, or pins to hold the position while the bone knits together into a solid painless structure.

Tendon Transfer

A tendon transfer involves release of one end of a tendon from bone or soft tissue and its reattachment to another bone or tendon.

A tendon transfer is used when a muscle or group of muscles are weak, torn or paralyzed. The transfer can correct a flat foot, high arch, clawed toes, a drop foot or a weak heel cord (Achilles tendon).

An example of a common tendon transfer is the Tibialis Posterior Tendon to the Tibialis Anterior Tendon. This transfer is used to correct a foot drop resulting from nerve injury.

Ankle Replacement

This procedure is also known as total ankle arthroplasty (TAA). Ankle replacement surgery is a technique that has developed in recent years to improve an ankle joint that has been severely damaged by arthritis. When nonsurgical methods of treatment are inadequate, joint replacement surgery may represent the best hope for long-term improvement to the ankle joint.

Pain relief is the most reliable potential benefit and often the major reason for surgery. For many people, ankle replacement surgery also offers better movement and coordination of the foot and leg. The goal with this surgery is to decrease pain and improve function.

Both sides of the ankle joint cartilage (tibia/fibula and talus) are removed and replaced with artificial parts or prostheses. The tibia/fibula prosthesis is made of medical- grade plastic with a titanium base plate. The talus component of the joint, which moves up and down, is replaced with a part made of cobalt chromium alloy. This metal is commonly used in prostheses for other joints of the body like the hip and knee.

 

Appointment Checklist

 Always ask a surgeon for specific preoperative preparation instructions. Typically, these may include:

  • Complete any pre-operative tests or lab work prescribed by a doctor.
  • Arrange to have someone drive you home from the hospital.
  • Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your appointment time.
  • Do not eat or drink anything after midnight.
  • In preparation of any foot/ankle surgery, upper body strengthening is encouraged in order to prepare for crutch/walker use after surgery.

Day of Surgery

  • If you currently take any medications, take them the day of your surgery with just a sip of water.
  • Refrain from taking diabetic pills or insulin, unless directed otherwise by your physician or surgeon.
  • Do not wear any jewelry, body piercings, makeup, nail polish, hairpins or contacts.
  • Leave valuables and money at home.
  • Wear loose-fitting, comfortable clothing.
  • Bring crutches or a walker.