Foot Conditions
Rearfoot Surgery
Description
Many Conditions Affect the
Rearfoot
Many conditions can affect the back portion of the
foot and ankle. Fortunately, many of these problems can be resolved
through conservative treatments. However when pain persists or deformity
occurs, surgical intervention can often help alleviate pain, reduce
deformity, and/or restore the function of your foot or ankle.
Heel Surgery
Two common conditions that can cause pain to the bottom
of the heel are plantar fasciitis and heel spur(s). Although there
are many causes of heel pain in both children and adults, most can
be effectively treated without surgery. When chronic heel pain fails
to respond to conservative treatment, surgical care may be warranted.
Plantar fasciitis is an inflammation of a fibrous
band of tissue in the bottom of the foot that extends from the heel
bone to the toes. This tissue can become inflamed for many reasons,
most commonly from irritation by placing too much stress (such as
excess running and jumping) on the bottom of the foot.
Heel Spur(s) or heel spur syndrome are most
often the result of stress on the muscles and fascia of the foot.
This stress may form a spur on the bottom of the heel. While many
spurs are painless others may produce chronic pain.
Based on the condition and the chronic nature of the
disease, heel surgery can provide relief of pain and restore mobility
in many cases. The type of procedure is based on examination and usually
consists of plantar fascia release, with or without heel spur excision.
There have been various modifications and surgical enhancements regarding
surgery of the heel. Your podiatric physician will determine which
method is best suited for you.
There are many other causes of heel pain, which has
become one of the most common foot problems reported by patients of
podiatric physicians. Many of them have a basis in heredity, as do
a lot of other foot conditions. Among the causes are stress fractures
and stress-fracture syndrome, entrapped nerves, bruises, bursitis,
arthritis (including gout), deterioration of the fat pad on the heel,
improper shoes, and obesity, just to name some. Most of these conditions
will be treated nonsurgically, though surgery may be recommended in
some instances.
Haglund's Deformity
(pump bump)
This deformity is characterized by a bony enlargement
on the back of the heel. Although not always painful, it may become
so if bursitis develops near the Achilles tendon secondary to footwear
irritation. If attempts at shoe modification and other medical treatments
fail to improve this condition, surgical correction may be beneficial.
Based on X-ray evaluation and other tests or examinations your podiatric
surgeon will select an operative treatment to alleviate the condition.
Insertional Achilles Clarification/Spur
This deformity differs from Haglund's deformity, in
that spur formation or calcification at the insertion of the Achilles
tendon is the cause of pain. Often associated with Achilles tendinitis,
this deformity can often be difficult to treat medically and therefore
surgical treatment may be necessary in chronic cases. There are many
causes of this condition, including arthritis, but the most common
appears to be overuse syndrome, where trauma occurs where the Achilles
tendon attaches to the heel bone. Surgical treatment includes removal
of the bone spur and/or calcification, along with repair of the Achilles
tendon.
Reconstructive Surgery
Reconstructive surgery of the foot and ankle consists
of complex surgical repair(s) that may be necessary to regain function
or stability, reduce pain, and/or prevent further deformity or disease.
Unfortunately, there are many conditions or diseases that range from
trauma to congenital defects that necessitate surgery of the foot
and/or ankle. Reconstructive surgery in many of these cases may require
any of the following: tendon repair/transfer, fusion of bone, joint
implantation, bone grafting, skin or soft tissue repair, tumor excision,
amputation and/or the osteotomy of bone (cutting of bones in a precise
fashion). Bone screws, pins, wires, staples, and other fixation devices
(both internal and external), and casts may be utilized to stabilize
and repair bone in reconstructive procedures.
Preoperative Testing
And Care
As with anyone facing any surgical procedure, those
undergoing foot and ankle surgery require specific tests or examinations
before surgery to obtain a successful surgical outcome. Prior to surgery,
the podiatric surgeon will review your medical history and medical
conditions. Specific diseases, illnesses, allergies, and current medications
need to be evaluated. Other tests that help evaluate your health status
that may be ordered by the podiatric physician include blood studies,
urinalysis, EKG, X-rays, blood flow studies (to better evaluate the
circulatory status of the foot/legs), and biomechanical examination.
A consultation with another medical specialist is sometimes
advised by a podiatric physician, depending on your test results or
a specific medical condition.
Postoperative Care
Surgery of the rearfoot requires close care following
surgery. To assure a rapid and uneventful recovery, it is important
to follow your podiatric surgeon's advice and postoperative instructions
carefully. Rest, ice, compression and elevation of your foot/ankle
postoperatively is often advised. The usage of bandages, splints,
casts, surgical shoes, crutches, or canes may be necessary after surgery.
Your podiatric surgeon will also determine if and when you can bear
weight on an operated foot.
Information provided by the American Podiatric Medical Association
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