If you are experiencing recurring foot pain and non operative treatment has failed to improve your quality of life, then you may need to consider a surgical option. At Footmed Foot and Ankle Clinics, we diagnose your foot condition and provide a variety of surgical procedures to address your specific condition. Book a consultation with our Podiatric surgeon for a specialist opinion. Make Footmed Foot & Ankle Clinics your first step to recovery.
We’re proud to have an experienced, specialised and qualified podiatric surgeon on staff. Performing a variety of surgeries and procedures, our podiatric surgeon Mr Angelo Salerno welcomes patients in Adelaide, Elizabeth Vale and Murray Bridge. With over 30 years of experience, Angelo brings a wealth of knowledge to his practice. For consultations and more information, chat with our friendly clinic staff.
Minimally invasive surgery
Our minimally invasive foot surgery (MIS) involves small incisions using special surgical instruments that minimise damage to tendons and surrounding structures. This allows for faster recovery and minimal postoperative pain. Incisions are then closed with a simple suture and surgical tape.
A great benefit of MIS is that the treatment of hammertoe, mallet toe and claw toe deformity can be completed without the need for K-wires – resulting in a quicker return to enclosed footwear.
Some conditions treated using MIS include:
- Hammer toes
- Prominent bone
- Toe deformities
- Corns and calluses
As with any surgical procedure, there are risks involved. Complications may include infection, bleeding, nerve injury, nonunion or delayed union of bone cuts and prolonged swelling. MIS can be performed safely using your anaesthetic of choice, which includes one or a combination of the following:
- Local anaesthetic or ankle block
- Inhalational Methoxyflurane sedation
- Intravenous sedation with specialist anaesthetist
All foot surgery is performed at Adelaide Ambulatory Day Surgery, a dedicated facility for foot surgery that offers patients the convenience and the affordability of having surgery and procedures performed safely outside the hospital setting. The facility is accredited and licensed to the highest standards that ensure patient safety.
Surgery for mild to moderate arthritis of the big toe
Your big toe has a bony enlargement or bone spur across the top of the joint often referred to as a dorsal bunion, hallux rigidus or osteoarthritis. The big toe joint remains in a straight position but has progressively become stiffer and stiffer over time. It is now very stiff and unable to bend very well during walking. This causes you to walk on the outside of your foot or to walk with your hip turned outwards in an attempt for your body to compensate.The skin and tissue on the bump can become inflamed, swollen, and painful (bursitis). This joint is already arthritic and is likely to get worse still over time.
Dorsal bunions are most often caused by faulty mechanics of the foot. If the dorsal bunion deformity is hereditary, then other family members are also likely to have the same problem. A certain foot type makes a person prone to developing arthritis in the big toe joint. Research is pointing to a long first metatarsal and long proximal phalanx of the big toe as a possible cause. One in 40 people over 50 is effected, mostly men. Injury is a common cause amongst men, especially if just one foot is involved.
In the early stages pads, rigid footplates, foot orthoses, manipulation under anaesthesia (MAU), extra depth shoes, rocker bottom shoes and avoiding high-heeled shoes can be beneficial. Studies show that MAU relieves pain fort about 6 months. Anti-inflammatory and pain medication can also relieve pain temporarily. Studies revealed that foot problems are a risk factor for falls as you get older. If your big toe joint continues to interfere with daily activities and your quality of life, it’s time to discuss surgical options.
The degree of arthritis affecting your big toe joint is considered mild to moderate. This means that less than 50% of the joint cartilage has been worn away down to the level of bone. This is usually the top half of the joint. A ‘V’ cut is made to remove the top half of the arthritic joint. This allows more movement at this previously stiff joint. Unfortunately, full range of motion is unlikely to be regained. It is sometimes difficult to determine the real extent of damage to the joint until it is opened up and visible. Both feet can be operated on at the same time, but this does further limit your mobility after surgery.
Surgery is an alternative to having the joint completely stiffened or fused (arthrodesis). The Valente Cheilectomy provides some movement in the joint and patient satisfaction varies from 72% to 100%. It will take about three months before you feel the real benefits of the procedure. To ensure success it is important that you exercise the joint early in your recovery. The surgeon will discuss this in more detail with you.
- Swelling (for up to 6-9 months)
- Infection (smoking increases risk by 16X)
- Wound problems (slow to heal)
- Scar sensitivity
- Nerve Injury (nerves can be bruised which resolves but you can be left with permanent numbness)
- CRPS = Complex Regional Pain Syndrome (Rare <1%)
- Deep vein thrombosis (clot in deep vein in the legs)
- Continuing symptoms (if the toe still remains a problem, other surgical options may need to be considered)
Following surgery, allow the foot a good 12 months to fully settle down. The surgeon will explain any particular individual risks that you may have.
The operation is usually day surgery but you may need to stay overnight – the surgeon will discuss this with you. You will be given a special shoe to wear over your bandages and whenever you want to walk. If you have a cheilectomy or interpositional arthroplasty, we prefer you to return to activity as early as possible and begin exercising the big toe joint. The surgeon will discuss this with you in greater detail.
You may begin increasing your activity to tolerance almost straight away and rest/elevate the foot as required on two pillows. Let how your foot is feeling judge how long you remain on it. You should be able to return to normal footwear in about 2-4 weeks
The bandages need to be kept dry. You will be given an appointment to have the foot redressed in one week. You may be able to return to work from 4-6 weeks after the operation, depending on whether you need to stand or walk around for your job. You will not be able to drive until you come out of the post-operative shoe.
Anaesthesia for foot & ankle surgery has come a long way, with intravenous sedation (IV) and inhalational sedation providing significant safety benefits over general anaesthesia. Anaesthesia for your foot surgery involves one or a combination of the following to ensure you are sleepy and very relaxed during surgery.
At Adelaide Ambulatory Surgical Suite, we engage a registered specialist anaesthetist who work in conjunction with your podiatric surgeon. Your anaesthetist gives you medicine in the vein of your arm (IV) to relax you (sedation). An injection to block the region that you are having surgery on is administered. You will not be aware or recall that this has occurred because of the sedative effects of the IV medicine.
IV sedation is safe as it is controlled and produces a deeper level of anaesthesia, providing a comfortable experience with minimal level of memory afterwards. The level of sedation can be customised to each individual’s needs.This helps you have minimal memory of the procedure while at the same time you are controlling your own breathing, can follow simple commands and be responsive when needed.
With IV sedation most patients:
- Feel less drowsy after surgery
- Experience a clean faster recovery for same day discharge
- Have excellent pain control both during and after the surgery
- Are less likely to have nausea, vomiting or a sore throat
Prior to appointing patients for IV sedation, a thorough medical review is done by the surgeon and the specialist anaesthetist to determine your suitability and medical fitness for the procedure.
Penthrox is often referred to as the ‘green whistle’ and is also used by ambulance officers to provide immediate anti anxiety and analgesic effect in case of emergencies and accidents. The drug used is called Methoxyflurane and is delivered via inhalation through the specially designed green device. It is safe to use in pregnancy and for young children who can self-administer as it is a single use, one-off medication, which is quickly eliminated from the body.
Patients with mild anxiety benefit from the use of Penthrox as it is easy to use, non-threatening and provides you with control. This allows you to moderate how much you use. Pain relief begins after 6–8 breaths and continues for several minutes after stopping inhalation. Continuous use of Methoxyflurane 3 mL provides analgesia for up to 25 minutes.
A regional or ankle nerve block that numbs the foot and prevents pain during and after the surgery can be performed with or without IV sedation or the use of the Penthrox inhaler.
You will be discharged home on the day of your operation and remain comfortable due to the nerve block. The effects of the block will start to wear off during the evening or overnight, depending on the time that the block was performed. For optimal pain control, begin taking pain pills prescribed before going to bed or as you begin to regain sensation. Be sure to take the medication with a light snack, as nausea is a common side effect of pain pills.