For most foot ankle conditions, surgery is considered a last resort. In this case conservative measures have been tried and failed to provide sufficient pain relief or correction of the problem. That’s when surgery is approached as an option.
In some cases, like ruptured connective tissues or displaced broken bones, surgical intervention is actually the best way to avoid chronic pain, weakness, or even deformities. Serious arthritis, joint disease, tumors, and birth deformities may need more invasive remedies as well.
There are many different kinds of foot and ankle surgeries, but you can take comfort knowing that Dr. Gerald Mauriello and the staff has extensive experience and provides compassionate care for you and your loved ones.
Reconstructive Foot Surgery
Our goal is always to resolve your foot conditions and injuries with nonsurgical care as often as possible. Unfortunately, surgery is sometimes the best course of treatment. There is good news in the fact our medical team has the proven ability to perform successful procedures for conditions like:
- Bone fractures. There are different types and severity of broken bones, including ones where there are multiple pieces or the broken ends do not line up correctly for proper healing. In these cases, reconstructive surgery can be used to place everything back where it belongs.
- Bunions. The most common of the potential toe deformities a patient might develop, this is a progressive condition. That means we might be able to use conservative care to treat the symptoms and slow its development, but surgery is the only way to truly correct it.
- Charcot foot. This deformity is one of the major lower limb concerns that can result from a diabetic condition. Impaired blood flow and damaged nerves can weaken bones, make them more susceptible to fractures, and leave you unaware problems have developed. Normal usage leads to further deformity and the need for reconstructive surgery.
- Flatfoot. If you have flexible flatfoot, or a child has pediatric flatfoot, there is not likely need for surgical reconstruction, but a rigid condition causing difficulty and pain with your daily activities may need surgery.
- Hammertoes. This particular deformity, along with the related mallet and claw toe conditions, develops when an imbalance in strength between the muscles and tendons located on the bottoms and tops of toes leads to abnormal bending of the toe(s). Much like with bunions, these are progressive conditions, and they are best resolved at early stages, so do not wait to seek treatment.
Some of the types of reconstructive surgical procedures we may use include:
- Bone fusion. Separate foot or toe bones can be fused together to restrict movement by a procedure sometimes used to treat severe arthritic conditions.
- Bone grafting. Bone grafts are taking a graft of bone from a different location to help repair bone tissue damaged in physical trauma.
- Joint implantation. This procedure essentially entails replacing a damaged or dysfunctional joint with an artificial joint or an orthopedic prosthesis.
- Osteotomy. Depending on your condition, we need to make cuts in bones, reposition them, and then hold the bones in place with the use of screws, pins, or plates.
- Tendon repair/transfer. In some reconstructive surgeries, we either repair a damaged tendon by making cuts and sewing the ends together or transferring a tendon from one location to another.
Ankle Surgery and Reconstruction
The ankle joints are instrumental for your ability to stay mobile and independent. When medical conditions like bone fractures or arthritis cause pain in an ankle and/or impairs its functionality, the affected ankle will need to be treated.
Arthroscopy is a minimally-invasive procedure. An advantage of using this surgery is that only a small incision needs to be made. This eliminates most of the difficulties (including patient pain and potential infection risk) that can accompany larger surgical cuts.
Of course, sometimes we need to use a more traditional procedure known as open reduction and internal fixation (ORIF) – which is more invasive than arthroscopy, but necessary for setting fractured bones back into place. The larger incision provides a better view of the entire broken bone. It also allows fractured pieces to be placed into the proper position and secured with the use of metal screws and/or plates.
For arthritic conditions, some of the surgical procedures we may recommend include joint fusion and joint replacement. In ankle fusion, we can use plates, screws, pins, and bone grafts to permanently connect the bones that make up the ankle joint. This type of procedure does eliminate pain from bone-on-bone grinding in a joint, but it takes away a certain degree of joint mobility.
A joint replacement, on the other hand, uses metal and plastic components that recreate the functionality of the natural ankle joint. Depending on the patient, we may need to lengthen a tight Achilles tendon to improve range of motion.
When we use arthroscopy to address foot or ankle injuries, the equipment used is a narrow tube attached to a fiber optic video camera, which avoids the need to make a large incision (as would be used in traditional surgery). Instead, we will make only a small incision, insert the tube, and then use a high-definition video monitor to see what is happening inside your body during the surgery.
Minimally-invasive procedures have an array of benefits over other surgical options, including quicker recovery times, lower infection risk, and less scarring than traditional surgeries. Additionally, they can be performed on an outpatient basis and the risk of complications is low.
We may recommend arthroscopy for issues like:
- Damaged or torn cartilage
- Inflamed joint linings
- Joint pain or infections
- Loose bone fragments
- Scarring within joints
- Torn ligaments
Accordingly, arthroscopy can be a great treatment option for patients who have developed an arthritic condition in their feet or ankles.
[Bunion Surgery] As we look at surgical procedures for bunions, it is important to note that likely candidates are patients who suffer from intense pain and/or have restricted mobility as a result of the condition. If a bunion is mild and not causing a great issue, we will prescribe conservative methods.
Patients who do experience sever pain and restricted mobility will often benefit from bunion surgery, including procedures like:
- Osteotomy – This surgery entails small cuts being made into bones to help realign the joint into its natural position. Plates, pins, or screws may be used to fix the cut bone and keep everything in place.
- Exostectomy – This procedure is rarely used alone, but it is centered on removing the bump from the big toe’s MTP joint. Most often, it exostectomy is performed in conjunction with osteotomy.
- Arthrodesis – For patients who have severe arthritis, we may use this procedure to remove arthritic joint surfaces. As with osteotomy, plates, pins, and screws can help to hold surfaces together while the affected bones mend. We also sometimes use arthrodesis in cases where previous bunion surgery has been unsuccessful.
Other procedures include repairing the ligaments and tendons that surround the big toe (to correct any imbalances in the affected joint) and resection arthroplasty (removal of the damage part of the joint).
It is worth noting at this point that, much like with a bunion, conservative care can address the symptoms, but is not able to reverse the condition. To actually correct a toe that is abnormally bent, surgery needs to be used. That being said, the best chance for nonsurgical treatment to be effective is when the condition is in its earliest stages.
If the deformity is severe and prevents you from performing normal activity and causes pain, we may need to discuss a surgical procedure.
The root cause of a hammertoe and related conditions is an imbalance in strength between the muscles and tendons on the top of your toes versus the ones found in the bottom. Now, when opposing sets work together in the intended manner, everything runs smoothly. With an imbalance, though, that simply doesn’t happen. In this case, we can correct the problem by either cutting supporting tissue or even moving tendons.
Other potential surgical options for hammertoe correction include arthroplasty and arthrodesis. Arthroplasty is a matter of removing part of the affected toe bone; whereas arthrodesis is removal of part of the affected joint(s) (and then allowing the toe bones to fuse together). In some cases, we may even need to straighten the toe or replace a bent joint with an implant. This is extremely rare, but there are some severe cases where amputation needs to be considered. (If that sounds concerning, we’d like to emphasize the “extremely rare” part!)
Surgery for Arthritic Conditions
Before we recommend arthritis surgery, we may attempt to help you find relief from symptoms using treatment options that include medication, physical therapy, and orthotic devices. Depending on the nature of your case, treatments like these might be able to relieve your symptoms.
If nonsurgical care isn’t effective or your pain is causing severe disability, it’s probably time to look at surgery as a solution. The surgical procedure(s) we recommend for you will depend on the location and type of arthritis, and the impact it has on your joints. In some cases, you may benefit from having more than one procedure performed.
Types of arthritis surgery we may recommend include:
- Arthroscopic debridement.This surgery is often helpful in early stages of arthritis. Debridement (cleansing) is a procedure we use to remove loose cartilage, inflamed synovial tissue, and bone spurs from around the arthritic joint.
- Arthrodesis (fusion).Arthrodesis is a procedure wherein we fuse the bones of the joint completely together, thereby making one continuous bone out of two or more bones. The goal of this particular procedure is to reduce pain by eliminating any possible motion in the arthritic joint.
- Total ankle replacement (arthroplasty).In a total ankle replacement, we remove the damaged bone and cartilage, and then position new plastic or metal joint surfaces to restore the function of the affected joint.
There are pros and cons of each respective type of surgical procedure we use to treat arthritis, and we will carefully review these with you beforehand.
Tenex for Heel Pain
Tenex is an advanced technology we use in some cases as an alternative to more traditional surgical procedures. This treatment starts with ultrasound diagnostics used to locate problems within the affected tendon or fascia. After we have found where the problems actually exist, we numb the area and insert a TX MicroTip directly into the spot. The TX MicroTip only requires a tiny incision and basically looks like a hollow needle.
Once inserted into place, we agitate the TX MicroTip with an ultrasound frequency – which causes it to vibrate at an incredibly fast rate in the designated area. This fast vibration gently breaks down and removes the damaged part of the tendon or fascia, but without affecting the healthy tissue surrounding it. In addition to directly addressing the damaged area, this procedure also speeds up your body’s natural healing processes.
[Heel Pain] One of the benefits of this approach over traditional forms of surgery is the fact stitches aren’t needed. Additionally, no is sedation used, so you will be able to drive yourself home afterward (no need to arrange for a friend or loved one to give you a ride).
Additional benefits to using Tenex treatment for Achilles tendon or plantar fascia injuries include almost immediate pain relief and faster recovery time. There are several factors that can play a role in this, but most patients are able to return to their normal activity levels in about six weeks after the procedure.
Surgeries for Diabetic Feet
Diabetic wound care and limb salvage is intended to stabilize and save feet damaged by diabetes. High blood sugar levels in the body weaken all the tissues in your lower limbs, as well as restrict your immune system. This combination of spiked glucose levels and impaired immune function leaves your feet vulnerable to ulcers and tissue breakdown that could lead to a foot collapse. If not caught early enough, the complications could require amputation. Salvaging the limb, however, can help you keep your foot.
Diabetic limb salvage involves cleaning out and packing an open wound so that it doesn’t become infected. Better blood flow may need to be restored or promoted in the feet. Diabetic foot collapse may involve reconstructing the bones and holding them in place with metal plates, too.
Charcot foot causes a deterioration of the joints and bones, and can lead to fractures. Because neuropathy causes loss of sensation, you may keep walking on your damaged feet, making the problem worse. Starting treatment immediately is your best chance of stalling the breakdown and preventing serious deformity or even amputation.
We treat Charcot foot in two phases. The acute phase may or may not involve surgery to remove bony growths or repair fractures and reconstruct the arch, but it will mean many weeks in a cast or brace to keep the joints in your feet from moving. During this time, it is crucial to stay off your feet. Using a wheelchair or crutches to avoid all weight-bearing is best. Any weight put on your feet will increase the time needed for healing.
The post-acute phase of healing will last the rest of your life. You need to understand how to protect your feet with braces or restraints as it heals, and continue with special shoes that may help keep your foot structure from breaking down. Total healing time may take a year or more. Of course, managing your diabetes will be a huge part of the equation as well.
Expert Surgical Care at Functional Foot and Ankle Restoration
If you’re struggling with pain in your feet or ankles, don’t let fear of surgery keep you from seeking the help you need. Conservative remedies are our preferred method of treatment, saving invasive procedures for feet and ankles that really need them to restore full health and functionality.
If you need surgery, don’t avoid the issue and allow the condition to get worse; you may experience a longer recovery time with higher risks as a result. Instead, contact Dr. Gerald Mauriello for an appointment or more information. Visit the website contact page or call our Belvidere or Hackettstown office at (908) 475-8750 to reach us.