What is forefoot surgery?
To understand what Forefoot surgery is, we should probably start by knowing what part of the foot this refers to. The foot can be split into three regions based on the groups of bones that make it up. The hindfoot refers to the back of the foot housing the calcaneus and talus. The midfoot (middle region) contains the navicular, cuneiform and cuboid. Finally, the forefoot is made up of the metatarsals and phalanges. This can be seen as your toes and the area before them, part way up your foot.
Forefoot surgery is performed on this front part of your foot, often to treat pain or deformity and to restore function.
What conditions can benefit from surgery?
Surgery of the forefoot is performed for:
- Bunions – a common deformity where the bone and tissue around your big toe joint becomes enlarged, often red, swollen, and inflamed, and makes wearing shoes and walking difficult. Bunions are often heredity.
- Lesser toe deformities – including hammer, mallet and claw toes, caused by tendon or joint imbalances. They can be painful, unsightly due to buckling of your toes, and corns and calluses may form making it difficult to wear shoes.
- Neuroma – an enlargement of a nerve section, often between your third and fourth toes, caused by trauma, arthritis, high-heeled shoes, or an abnormal bone structure. The nerve irritation can cause burning or tingling in the ball of your foot or adjacent toes, numbness and swelling, and may feel like you’ve got a stone in your shoe.
- Bunionette (Tailor’s bunion) – in your facet joint (spine) and sacroiliac joint. This affects the little toe causing a bump similar to a bunion.
- Stiff big toe – a form of osteoarthritis that causes stiffness and pain in your big toe joint. You may have difficulty lifting your big toe upwards or an inability to lie it flat in your shoe, and this often results in difficulty walking. Often people have a foot deformity or family history, although it can happen spontaneously or be triggered by injury, inflammation and infection.
- Bone spurs – where an overgrowth of bone occurs on your foot due to pressure, trauma, or reactive stress of a ligament or tendon. A bone spur can cause pain, joint restriction, and nail deformity if under nail plate.
When is surgical intervention recommended?
Typically, more conservative treatments may initially be advised to relieve your symptoms including: shoe modifications and shoe inserts (orthotics).
If these do not work then forefoot surgery may be recommended. Your foot surgeon may request further tests such as x-rays and a biomechanical examination. They will discuss the best treatment options with you based on your individual diagnosis and needs.
What happens during forefoot surgery?
Usually, surgery of the forefoot is performed under general anaesthetic. The exact procedure will depend on the condition you are suffering from.
Typically, the main joint of your big toe will be fused to make it stronger, straighter and more able to take on weight as you walk.
Options may also involve straightening of your small toes, sometimes removing a small piece of bone from the base of your toe, repairing any ligaments or tendons, and sometimes pinning your toe into position.
Following surgery your foot is wrapped in a protective dressing and you will be given pain relief.
As with any surgery there could be general complications including: pain, bleeding, swelling, infection and blood clots.
Complications specific to forefoot procedures include:
- Nerve injury
- Toe fusion failure
- Toe does not heal in its correct position
- Deformity reoccurs
So, what are the benefits of having a surgical procedure?
Forefoot surgery aims to relieve your pain, treat deformity and restore normal function of your foot so that you can walk and wear shoes again.
Ultimately, comfort and a better quality of life are the main benefits of having this procedure.
The type of forefoot surgery performed will determine your speed of recovery and the aftercare required. You will need to rest and elevate your foot following surgery. Bandages, splints, surgical shoes, casts, crutches, or canes may be required to aid your recovery.
It’s important you discuss with your surgeon, and follow, the appropriate aftercare advice specific to your forefoot surgery.