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Surgery Foot and ankle surgery for arthritis Foot and ankle surgery for arthritis This booklet provides information and answers to your questions about foot and ankle surgery. Arthritis Research UK produce and print our booklets entirely from charitable donations. What do I need to know about foot and ankle surgery? For most people with arthritis- related problems in the feet or ankles, surgery is unnecessary. But if you’re considering foot or ankle surgery you’ll probably have lots of questions. In this booklet we’ll explain when surgery might be needed and what you can expect from the process. We’ll also look at what happens before and after surgery and suggest where you can find out more. At the back of this booklet you’ll find a brief glossary of medical words – we’ve underlined these when they’re first used. www.arthritisresearchuk.org Page 2 of 28 Foot and ankle surgery information booklet Arthritis Research UK What’s inside? 2 Foot and ankle surgery at a glance 18 How should I prepare for surgery? 4 How do the feet and – Pre-admission clinic ankles work? 18 What will my recovery involve? 7 Do I need surgery? – After the operation 7 What are the possible – Getting back to normal advantages of foot and 19 What are the possible ankle surgery? complications of foot and ankle surgery? 8 What are the possible disadvantages of foot 20 Glossary and ankle surgery? 22 Where can I find out more? 8 What are the alternatives 24 We’re here to help to surgery? 9 What conditions might need surgery? – Bunions – Hammer toes – Metatarsal damage – Ankle arthritis – Achilles tendon disorders – Morton’s neuroma – Tibialis posterior dysfunction – Plantar fasciitis Page 3 of 28 Foot and ankle surgery information booklet At a glance Foot and Many types of foot ankle surgery surgery can be performed as day cases or only need a short stay Do I need surgery? in hospital. Most people with arthritis-related problems in their feet or ankles don’t need surgery. The decision to operate will be based on: • how bad your symptoms are (pain or loss of function) • your needs What are the possible • your response to other treatments. advantages? The benefits of having surgery What are the common types can include: of foot and ankle surgery? • pain relief Conditions that may need surgery • improved function in your feet include: • feet looking more ‘normal’ • bunions (this isn’t always the case depending on the procedure). • hammer toes • damaged metatarsal bones What are the possible • arthritis disadvantages? • Achilles tendon disorders The disadvantages of having surgery • Morton’s neuroma can include: • tibialis posterior dysfunction • reduced joint movement, depending • plantar fasciitis (although this on the operation is very rare). • replacement joints wearing down quicker than natural joints • possible complications. Page 4 of 28 Foot and ankle surgery information booklet What are the possible complications? Every possible care is taken to prevent complications, but in a few cases these do happen. They may include: • increased pain • infections • stiffness • haematoma (bleeding) • reduced function • altered or loss of feeling. Page 5 of 28 Foot and ankle surgery information booklet How do the feet and The middle of the foot (midfoot) is made up of five tarsal bones. These form ankles work? the arch of your foot. The tarsals are Our feet are made up of 26 bones and connected to the front and back of your more than 33 joints arranged in columns foot by muscles and the arch ligament and arches that vary in stiffness and (the plantar fascia). They act as shock flexibility. Many common problems can absorbers when we’re walking or running occur in this complicated structure. (see Figure 2). The foot is usually separated into three The front of the foot (forefoot) is different parts (see Figure 1): made up of your toe bones (phalanges), The back of the foot (hindfoot) is made which are connected to five long bones up of your heel bone (calcaneus) and your (metatarsals) by joints (see Figure 2). ankle (talus). They’re joined together by The joints in your toes don’t move very the subtalar joint, which allows your foot much. The forefoot takes half of your to move from side to side. Your ankle body’s weight. bone is joined to your leg bones (tibia and The muscles in your lower leg are attached fibula) at your ankle joint, which acts like to bones in your feet by tendons, and they a hinge. This allows your foot to bend up control movement that allows us to stand, and down (see Figure 2). walk, go on tiptoes and jump. Forefoot Figure 1 Parts of the foot Hindfoot Midfoot Page 6 of 28 Foot and ankle surgery information booklet Figure 2 The bones and tendons in the foot and ankle Plantar fascia Tibia Fibula Achilles tendon Talus Phalanges Metatarsals Tarsals Calcaneus Page 7 of 28 Foot and ankle surgery information booklet These muscles move the toes and control Discuss these with your healthcare the position of your foot as it hits the professionals, who’ll be able to advise ground, allowing it to become flexible you on whether they think surgery and cushioning the impact. They also would be a suitable option. The decision make the arches of your feet more rigid to whether to have foot and ankle surgery push your body forward when you move. is usually based on lifestyle choices and Your heel bone is connected to the calf the information given by surgeons rather muscles in your lower leg by the Achilles than being essential in terms of life and tendon, which is the most important death. But if your skin is affected or your tendon for movement. The tibialis feet are quickly becoming deformed, it’s posterior tendon, which attaches the important to get an assessment for urgent underside of your foot to your lower leg, surgery to avoid infection and alert your helps supports the arch of your foot and healthcare professionals to possible allows you to turn it inward (see Figure 2). stress fractures. You’ll always have the final decision on whether to have the The main nerve of your foot controls the operation. muscles in your sole and gives feeling here and to your toes. Other nerves give You may feel nervous, stressed or feeling to the top and outside edge of scared if you’ve been offered surgery. your foot. Finding out as much as you can about the operation and understanding the See Arthritis Research UK booklet process will help you feel calmer and Feet, footwear and arthritis. more in control. What are the possible Do I need surgery? Most people with problems in their advantages of foot and feet or ankles won’t need surgery. ankle surgery? The decision whether to operate The main advantages of foot and ankle depends on a number of factors: surgery can be: • how bad your symptoms are (pain • long-lasting pain relief and the effect this has on your life) • better function and mobility • your needs • a greater choice of comfortable • your response to other treatments, footwear, depending on the procedure including drugs, orthoses and special • feet looking more ‘normal’, depending footwear. on the procedure. Page 9 of 28 Foot and ankle surgery information booklet Understanding what’s involved in your operation will help you feel • In some cases where bones are joined more relaxed and (fused) together, the bones can take longer to fuse together than expected in control of your and you won’t be able to use your foot treatments. properly during this time. Occasionally a non-union occurs and you may need further surgery. What are the alternatives What are the possible to surgery? Most people with foot and ankle disadvantages of foot problems will receive other treatments and ankle surgery? from their family doctor (GP), There are some disadvantages to foot and rheumatologist or podiatrist before they ankle surgery: see a surgeon for an operation. These may • Replacement joints aren’t as hard- include: wearing or long-lasting as natural joints. • exercise • Some operations restrict joint • footcare movement (although this doesn’t • drug treatments, usually painkillers mean that it’ll reduce your mobility). (for example paracetamol) and non- • You may not be able to use your steroidal anti-inflammatory drugs, or foot properly for some time after the NSAIDs (for example ibuprofen) operation (for example, you may need • disease-modifying anti-rheumatic to keep weight off your foot for three drugs (DMARDs) if you have rheumatoid months after an ankle fusion). This arthritis can be a particular problem if you’re likely to have problems getting around • steroid injections using crutches. • advice on footwear style • Occasionally small nerves around • insoles/orthoses and specially the cut in your skin (the incision) can altered shoes. be damaged, leading to patches of If these treatments don’t ease the pain numbness on your skin. then your healthcare professional may • There can be complications during suggest you have surgery. surgery, for example swelling, stiffness For more information on other treatments or infection. that you may wish to discuss with your healthcare professional before surgery, Page 10 of 28 Foot and ankle surgery information booklet see Arthritis Research UK booklet Feet, on the affected area of the foot. This footwear and arthritis. will mean you’ll be awake during the procedure but you won’t be able to feel See Arthritis Research UK booklet anything. You can take a book or some and drug leaflets Rheumatoid music along to relax you if you like. arthritis; Drugs and arthritis; Local Your anaesthetist will discuss the best steroid injections; Non-steroidal anti- choice of anaesthetic with you before inflammatory drugs; Painkillers.

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