Foot and ankle surgery at Haywards Heath Hospital

What is foot and ankle surgery?

This is an umbrella term for operations that address problems with the bones, joints, connective tissue and muscles making up your feet and ankles. It's done to ease pain, correct a deformity or restore function, never simply for cosmetic reasons.

What conditions does foot and ankle surgery treat?

Foot and ankle surgery can be used for:

• arthritis affecting the foot or ankle joints
• fractures (broken bones) in the foot or ankle
• deformities, such as flat feet, bunions or hammer toes
• torn or damaged tendons, including the Achilles tendon
• torn or weakened ligaments, leading to chronic instability
• bone spurs or tissue trapped inside a joint, known as impingement.

Doctors tend to reserve surgery to the point when conservative treatments, pain relief, physiotherapy or supportive footwear among them, haven’t managed to control symptoms on their own.

What are the benefits of foot and ankle surgery?

Foot and ankle surgery aims to relieve pain and restore the ability to use your foot or ankle, particularly where problems have made it very difficult to get around or where your condition is expected to get worse without treatment.

Recovery takes time: things are generally described as fair by 3 months, good by 6 months, and most people feel back to their usual selves by around the 12-month mark.

Are there different types of foot and ankle surgery?

The right procedure depends on your specific condition. Common types include:

• Fracture repair, using metal plates, screws or wires to hold broken bones in place while they heal.
• Fusion surgery, removing damaged cartilage and bone before fixing the joint in position with plates or screws, so the bones grow together.
• Ligament reconstruction, tightening or replacing damaged ligaments to treat chronic instability.
• Tendon repair, which may involve removing damaged tissue, tightening the tendon, or transferring a healthy tendon from another part of the body to replace one that’s badly damaged.
• Osteotomy, where a bone is precisely cut and repositioned.
• Joint replacement, where damaged parts of a joint are replaced with an artificial implant.

Many of these procedures can be carried out using minimally invasive techniques, making small incisions and using a camera (arthroscopy), which can shorten recovery time, though this isn't suitable for every case.

What happens before foot and ankle surgery?

Before you're admitted, it helps to think through the practical side of things: whether someone can help with everyday tasks such as shopping, how you'll manage stairs, whether you have sturdy handrails, and whether it would help to move your bed downstairs temporarily if your toilet isn't upstairs.

• Bring or wear a flat, sturdy shoe for your un-operated foot.
• Remove nail polish and clean and trim your toenails the day before surgery.
• Tell your surgical team about all medication you take, including over-the-counter drugs, herbal remedies, blood thinners, HRT and the contraceptive pill.
• If you have asthma, remember to pack your inhalers.

Most foot surgery is carried out under general anaesthetic, though a local anaesthetic combined with sedation is sometimes used instead. A local anaesthetic block for pain relief can leave the area feeling numb for 12 to 24 hours afterwards, which is normal.

What happens during foot and ankle surgery?

What happens during surgery depends on the specific procedure. Many operations are now carried out using minimally invasive techniques, with small cuts and a thin camera (arthroscope) used to see and work inside the joint, though open surgery through a larger incision is sometimes more suitable.

In fusion surgery, damaged cartilage and bone are removed from the joint, and the remaining bone ends are held together with plates or screws until they join. Ligament reconstruction generally tightens damaged ligaments with stitches or replaces them where the damage is more severe. Tendon repair may involve removing damaged tissue, tightening the tendon, stitching a tear closed, or borrowing a tendon from another part of the body where the damage is extensive. Fracture surgery uses plates, screws or wires to hold broken bones in the correct position while they heal.

What does recovery look like?

When you come round from surgery, your foot will usually be in a padded bandage or a plaster cast, with your leg propped up on pillows or a frame, which helps keep bleeding, swelling and discomfort down. Your bandage or cast, along with any stitches, is usually removed after around 14 days.

• Protect the area, using crutches correctly if you need them, and gently working your toes and the rest of your foot if you're not in a cast, to help your circulation
• Make sure you rest properly and keep your foot up, arranging time away from work, which could be a few days for something minor or up to 6 weeks for a bigger operation. If you have a more manual job, you may need more time off work.
• Elevate your foot above hip level for much of the day, particularly for the first 2 days, gradually reducing this as swelling settles.

How much weight you can put on your foot depends on your procedure, ranging from full weight-bearing to none at all, and your physiotherapist will explain which applies to you and how to manage stairs and crutches safely. Your wound dressing usually needs to stay dry and intact until your outpatient appointment, around 2 weeks after surgery, and you'll be told when it's safe to drive or return to sport.

What are the risks and complications?

Possible risks of foot and ankle surgery include:

• infection, which is more likely if you smoke, or have diabetes or a rheumatoid condition
• scarring, which is occasionally painful or inflamed
• nerve damage, causing numbness or tingling, which usually improves over time
• blood clots
• the bone failing to fuse properly after fusion surgery, more likely in people who smoke
• reactions to the anaesthetic, problems with wound healing, or accidental injury to a nerve or blood vessel nearby during the operation.