Dr Mark Nelson
Foot & Ankle
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Foot Medical Information
Surgery of the Forefoot
Information From The American Podiatric Medical
When is Foot Surgery Necessary?
Many foot problems do not respond to “conservative”
management. Your podiatric physician can determine when surgical
intervention may be helpful. Often when pain or deformity persists, surgery
may be appropriate to alleviate discomfort or to restore the function of
A common deformity of the foot, a bunion is an enlargement of the
bone and tissue around the joint of the big toe. Heredity frequently plays a
role in the occurrence of bunions, as it does in other foot conditions. When
symptomatic, the area may become red, swollen, and inflamed, making shoe
gear and walking uncomfortable and difficult. If conservative care fails to
reduce these symptoms, surgical intervention may be warranted. Your
podiatric physician will determine the type of surgical procedure best
suited for your deformity, based on a variety of information which may
include X-rays and gait examination.
Bunion - the red area on the right.
Tailor’s Bunion - the red area on the left.
A hammertoe deformity is a contracture of the toe(s), frequently
caused by an imbalance in the tendon or joints of the toes. Due to
the “buckling” effect of the toe(s), hammertoes may become painful secondary
to footwear irritation and pressure. Corn and callus formation may occur as
a hammertoe becomes more rigid over time, making it difficult to wear shoes.
Your podiatric physician may suggest correction of this deformity through a
surgical procedure to realign the toe(s).
An irritation of a nerve may produce a neuroma, which is a
benign enlargement of a nerve segment, commonly found between the third and
fourth toes. Several factors may contribute to the formation of a neuroma.
Trauma, arthritis, high-heeled shoes, or an abnormal bone structure are just
some of the conditions that may cause a neuroma. Symptoms such as burning or
tingling in the ball of the foot or in the adjacent toes and even numbness
are commonly seen with this condition. Other symptoms include swelling
between the toes and pain in the ball of the foot when weight is placed on
Those suffering from the condition often find relief by stopping their walk,
taking off their shoe, and rubbing the affected area. At times, the patient
will describe the pain as similar to having a stone in his or her shoe.
Your podiatric physician will likely X-ray the affected area to determine
the size and severity of the neuroma and suggest a treatment plan. If
conservative treatment does not relieve the symptoms, then your podiatric
physician will decide, on the basis of your symptoms, whether surgical
treatment is appropriate.
is shown above --
inflamed yellow area in the middle left region.
Bunionette (Tailor’s Bunion)
A protuberance of bone at the outside of the foot behind the fifth
(small) toe, the bunionette or “small bunion” is caused by a variety of
conditions including heredity, faulty biomechanics (the way one walks) or
trauma, to name a few. Pain is often associated with this deformity, making
shoes very uncomfortable and at times even walking becomes difficult. If
severe and conservative treatments fail to improve the symptoms of this
condition, surgical repair may be suggested. Your podiatric physician will
develop a surgical plan specific to the condition present.
A bone spur is an overgrowth of bone as a result of pressure,
trauma, or reactive stress of a ligament or tendon. This growth can cause
pain and even restrict motion of a joint, depending on its location and
size. Spurs may also be located under the toenail plate, causing nail
deformity and pain. Surgical treatment and procedure is based on the size,
location, and symptoms of the bone spur. Your podiatric physician will
determine the surgical method best suited for your condition.
Preoperative Testing and Care
As with anyone facing any surgical procedure, those
undergoing foot and ankle surgery require specific tests or examinations
before surgery to improve a successful surgical outcome. Prior to surgery,
the podiatric physician will review your medical history and medical
conditions. Specific diseases, illnesses, allergies, and current medications
need to be evaluated. Other tests that help evaluate your health status may
be ordered by the podiatric physician, such as blood studies, urinalysis,
EKG, X-rays, a blood flow study (to better evaluate the circulatory status
of the foot/legs), and a biomechanical examination. A consultation with
another medical specialist may be advised by a podiatric physician,
depending on your test results or a specific medical condition.
The type of foot surgery performed determines the length and
kind of after- care required to assure that your recovery from surgery is
rapid and uneventful. The basics of all postoperative care involves to some
degree each of the following: rest, ice, compression, and elevation.
Bandages, splints, surgical shoes, casts, crutches, or canes may be
necessary to improve and ensure a safe recovery after foot surgery. A
satisfactory recovery can be hastened by carefully following instructions
from your podiatric physician.
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Your Feet Aren’t Supposed to Hurt
Remember that foot pain is not
normal. Healthy, pain-free feet are a key to your independence and need
regular attention. At the first sign of pain, or any noticeable changes in
your feet, seek professional podiatric medical care. Your feet must last a
lifetime, and most Americans log an amazing 75,000 miles on their feet by the
time they reach age 50. Regular foot care can make sure your feet are up to
the task. With proper detection, intervention, and care, most foot and ankle
problems can be lessened or prevented. Remember that the advice provided in
this pamphlet should not be used as a substitute for a consultation or
evaluation by a podiatric physician.
Reprinted with permission from the American Podiatric Medical Association.