Foot surgery

Your feet help you to move around, and for some they can be beauty accessories too. But they undergo daily shocks that contribute to the appearance of diseases or deformations.
Particularly vulnerable, feet and ankles support a significant weight as they need to balance the whole body!

It is important to understand that sometimes pain from other parts of the body – most often in the back, hips or knees – is closely related to your feet.
Small impacts can also cause trauma such as sprains or fractures. Bunions, calluses, deformities, or other pathologies can also occur as a result of wearing tight shoes, heels, with or without soles, running, etc. In short, there are many sources and causes of foot pathologies with a greater or lesser impact on your body’s balance. Yet many people do not declare them until the pain becomes unbearable.

It is essential to treat your pathologies and traumas quickly in order to avoid more or less serious complications in the long term.

Foot & ankle

Some examples of foot and ankle pathologies and traumas

Osteoarthritis is a disease that can affect any joint. It is important to talk about it here because osteoarthritis lesions very often occur in the ankles and feet, the parts of your body that are under different yet very regular pressure. This disease is characterised by a weakening and cracking of the cartilage around the bones of the joints. Osteoarthritis lesions often cause stiffening and pain. They occur most often in people over 50 or 60 years of age.

These lesions can be disabling for some people, and they make all movements of the foot and ankle (the driving force behind your movements) painful.

Advanced osteoarthritis lesions cause bone spurs to develop. When the cartilage around the joints erodes until it disappears, the bone will consolidate the injured joint by increasing in size and coating it to replace and consolidate the cartilage. These bone spurs can hinder movement, causing pain and stiffening, and they often lead to a decrease in the volume and strength of the muscles surrounding the joint.

It is possible to diagnose and treat osteoarthritis lesions using arthroscopy techniques.

Trauma to the foot and ankle is often characterised by fractures. A fracture is most often bony in origin, it is caused by the cracking or breaking of a bone. It can also involve fractured ligaments and tendons. There are several kinds of fractures that affect the feet. Here we will only discuss the calcaneal fracture, the fatigue fracture and the malleolus fracture.

The calcaneal fracture

This fracture, also known as the lover’s fracture, is often caused by the compression or crushing of the bone following an impact or a fall. Another common explanation is a heel fracture, where the heel bone (above the calcaneus, also known as the talus) breaks and enters the ankle bone, the spongy part of the bone.

Fatigue fracture

This fracture most often occurs when running and/or doing daily sports activities. It can affect one or more bones of the foot and/or ankle, which are the most weight-bearing bones.
It is progressive and is not necessarily the result of an impact.
It is also called a stress fracture because the bone is under physical stress, or weight pressure that weakens the bone(s) and can cause cracks and/or fractures.

Malleolus fracture

Malleolus fractures affect the ankles. They are characterised by a fracture of the internal or external malleoli. This fracture occurs either at the level of the joint itself (which often leads to severe osteoarthritis after healing) or a little higher up in the ankle. These can be bone fractures or ligament fractures. This fracture completely destabilises the ankle joint.

Other foot pain can be diagnosed as inflammatory rheumatism. Rheumatism is a disease that affects the joints and the areas around the joints: bones, muscles and tendons. Symptoms of the inflamed area are redness, increased temperature, and pain.
Inflammatory rheumatism can manifest itself in the form of many different diseases, such as rheumatoid arthritis, ankylosing spondylitis, bacterial or viral infections, and gout.
Rheumatism can be “monoarthritis” (affecting a single joint) or “polyarthritis” (affecting several joints).

As we saw earlier, rheumatoid arthritis is an inflammatory rheumatism that affects several joints at the same time. It is very painful and can make the joints swell. At an advanced stage, the inflammation can even deform the joints. Feet are very often affected by this form of rheumatism.
It is called an autoimmune disease because inflammatory rheumatism is an overreaction of the body’s immune system, which tries to repair the joint and eliminate bacterial or viral infections. With this excessive secretion of harmful antibodies, the immune system then attacks the joint instead of fighting the virus.
One of the specific characteristics of its development is that it is unpredictable. In some cases it may get better on its own, while in others it may worsen and become progressive by affecting other joints in the body or, in the most severe cases, organs.

A sprain is a very common trauma affecting the ankle. A misstep, a shock, a twist, a fall, a previous injury or another circumstance can cause a tear in one or more ligaments of the ankle joint.
Ligaments are fibrous tissues that hold bones together and stabilise joints. When they tear, it causes pain and swelling in the area, which reduces the movement of the ankle and foot. A sprain can have varying degrees of severity, and the treatment will differ as a result.

Toe pathologies

Morton’s Disease, or Morton’s Neuroma, is a disease that affects a nerve in the foot. It is located between the toe bones (or metatarsals), running from the sole of the foot to the toes.
There is an interosseous nerve between each metatarsal bone (toe bones), and these nerves help to maintain the foot’s sensitivity between the toes.

Morton’s disease involves the compression of one of these nerves by one of the metatarsal bones. This compression results in numbness, tingling and pain between the base of the toes, often described as stinging, tingling or burning in these areas. The pain most often occurs when wearing shoes, or when walking long distances, etc.

Let’s first define the terms Hallux and Valgus. The Hallux is the longest toe of the foot. It is also known as the big toe. Valgus is the outward bowing of a limb or segment of a limb.

Therefore Hallux Valgus is the deformity of the big toe. This inflammatory deformity leads to severe pain, swelling, and progressive deformation of the peripheral toes.

Commonly known as a “Bunion”, it is also known as an exaggerated deviation that widens the tip of the foot. There are several possible causes of this malformation: it can be congenital, caused by an inflammatory disease, or formed by the repeated wearing of shoes that restrict the foot (heels, pointed toes) or caused by regular running. This illness/deformation mainly affects women.

Hallux Rigidus is the stiffening of the big toe. Unlike Hallux Valgus, it is not a deviation, and this disease affects men more than women.

It is commonly caused by repeated micro-traumas, such as by playing sports in bare feet (martial arts, dance, football). This stiffness is characterised by osteoarthritis of the joint in the big toe, or abnormal wear of the cartilage between the bones of the toe and those of the rest of the foot. The axis of the toe therefore remains straight, but the toe bone is still deformed due to inflammation of the joint.

You can see a bony growth above the base of the toe. The symptoms are loss of mobility of the toe, stiffening and pain when wearing shoes.

La déformation de l’orteil en griffe est visible. On peut voir l’orteil qui se replie sur soi-même. Il existe plusieurs degrés de déformations au niveau des articulations. L’orteil, avec ses 3 phalanges replie ses articulations vers l’intérieur du pied, rendant impossible de les étendre. Une des raison les plus fréquentes à cette déformation est un mauvais appui sur le pied et une chaussure contraignante pour la morphologie de votre pied et vos orteils. En effet, si le pied s’appuie principalement et surtout sur la pointe et l’avant du pied, cela force l’orteil à s’écraser et se replier. L’articulation au niveau des phalanges des orteils se fléchissent, et les premiers symptômes visibles de cette déformation, en plus du recourbement de l’orteil, est l’apparition de durillons (cors) ou de callosités à la base des orteils, sur la pointe des pieds. D’autres causes peuvent être à l’origine de ce genre de déformations comme par exemple des orteils plus longs que les autres, un mauvais équilibre musculaire, une mauvaise répartition des efforts sur le pied, des traumatismes subits par des orteils, ou autres.

La déformation de l’orteil en griffe est visible. On peut voir l’orteil qui se replie sur soi-même. Il existe plusieurs degrés de déformations au niveau des articulations. L’orteil, avec ses 3 phalanges replie ses articulations vers l’intérieur du pied, rendant impossible de les étendre. Une des raison les plus fréquentes à cette déformation est un mauvais appui sur le pied et une chaussure contraignante pour la morphologie de votre pied et vos orteils. En effet, si le pied s’appuie principalement et surtout sur la pointe et l’avant du pied, cela force l’orteil à s’écraser et se replier. L’articulation au niveau des phalanges des orteils se fléchissent, et les premiers symptômes visibles de cette déformation, en plus du recourbement de l’orteil, est l’apparition de durillons (cors) ou de callosités à la base des orteils, sur la pointe des pieds. D’autres causes peuvent être à l’origine de ce genre de déformations comme par exemple des orteils plus longs que les autres, un mauvais équilibre musculaire, une mauvaise répartition des efforts sur le pied, des traumatismes subits par des orteils, ou autres.

Hammer toe is based on the same idea as claw toe. If a person has poor balance or leans on the foot, the toe can be forced to curl in an unusual way. Unlike claw toe, hammer toe bends only one interphalangeal toe joint. The first phalanx is raised, and the rest of the toe is crushed onto the tip of the toe.

Wearing tight or high heel shoes contributes to this deformity, which is why this condition mainly affects women. Quite painful when wearing shoes, these deformities can worsen over time if left untreated.

Nail pathologies

In cases of deformed toes, the toenails are very often also affected. Many other factors can also affect toenails, such as poor nutrition, shock and trauma, disease or exposure to moisture. Then there are several specific pathologies or diseases of the nails (and also for the hands).

In this article we will only address nail fungus and ingrown toenails.

Nail fungus, or yeast, is small microscopic fungi that grow under or inside the nail. It is highly contagious and is most often caught in damp environments, such as swimming pools. It is also possible to catch it if the toes are not dried properly after being moistened or washed.
An affected nail can also spread the fungus to other surrounding nails.
This infection appears as a thickening of the nail, and/or an unusual colouring (the nail often turns yellow). There are several causes of this infection, including illness, age and ageing, poor maintenance, prolonged wearing of closed shoes, and many others.

Most ingrown toenails or onychocryptosis affect the nail of the big toe. In this case, the edge of the nail grows into the flesh of the toe. Ingrown toenails are very painful, and they often caused by wearing shoes that are too tight, a nail that is too short, or a nail that is too curved. This diseased nail can cause complications and infections if left untreated.

Surgical treatment of some pathologies

To treat some of the mentioned pathologies or traumas to the foot and ankle, it is often necessary to resort to surgical interventions. It is important to understand that not all the pathologies mentioned above require surgery.

In cases where surgical intervention is necessary, there are three possible techniques.

As foot surgery is evolving, several types of operations are possible. The proper procedure is selected by the physician according to several criteria such as the evolution and stage of the pathology, the size of the operation area, the purpose of the surgery, the length of hospitalisation, the speed of recovery, the possibility of complications, and many other criteria. Indeed, each case can be unique and may need different methods. In any case, there are few differences between the methods. One procedure should not be criticised compared to another.

View our sections and operating techniques for the treatment of foot and ankle pathologies:

Conventional surgery is the most common and widespread technique for an operation. It is characterised by the incision and the opening of the skin in order to provide good visibility and easy access to the area or areas to be treated. Conventional surgery is adaptable, reproducible, and reliable. It remains an essential part of surgery thanks to the good visibility it provides on the area to be treated, and to its years of practice and recognition in the medical world.

Percutaneous minimally invasive surgery is recognised for its aesthetic appeal and its less aggressive effects on the body. Indeed, this surgery reduces the healing area by introducing instruments equipped with cameras to observe the area to be treated. An instrument called an endoscope is introduced, either through a natural orifice of the body (mouth or anus), or through a small incision of a few millimetres on the skin.
The surgical instruments are then introduced through small incisions to operate on the area.
Therefore, there is no direct visual inspection, but a televised radiographic retransmission is used.
For the operation, surgeons use methods to distend the muscles instead of cutting them to facilitate access to the operating area.
This therefore reduces blood loss, postoperative pain, the frequency of infections and the duration of recovery.

Ankle prosthesis

The recent development of ankle prostheses has created a reliable and innovative solution for the treatment of worn ankle joints. They now present a serious alternative to arthrodesis.

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