Dr Kudchadkar is a Foot and AnkleFellowship trained Surgeon and presently the President of Indian Foot & Ankle Society and is a National Faculty for training surgeons all over India with 25 years of clinical and surgical experience
Foot and Ankle pain cannot be neglected as it can be a indicator of problem in spine, hip and knee joints and can be rectified by simple measures like exercise ,weight loss and orthotics(modification in shoewear) if detected early.
Neglected and Advanced injuries can also be treated by various surgical procedures like transferring strong tendons to weaker areas , correct fixed deformities by bone realigning cuts to allow the foot to distribute normal pressures on the sole , and in very advanced damage resort to joint fusion to create a stable painless foot.
90% surgeries in Foot & Ankle can be done under local/regional anaesthesia and can be done as day care surgeries and discharged home on same day.
Recovery period can range from 2 weeks to 12 weeks depending on type of surgery.
Lets visit some Common Foot and Ankle Issues:
Ingrown toe nails with recurrent pain and infections can be treated by partial nail bed ablation to give permanent relief and is a day care surgery
Bunions, Claw toes, Hammer toes, Cross over deformities can be painful and can lead to formation of calluses which prevent normal walking ,use of normal shoewear and interfere with maintaining good foot hygiene. This deformities can be completely corrected using various realignment procedures involving the bone and joints and give a normal looking and painless foot. You may be prescribed special shoes during recovery period for 4-12 weeks depending on the degree of correction and complexity.Generally takes maximum of 3 to 4 months for independent walking in complex surgeries.
Flat foot deformities can be corrected permanently in young patients by inserting a special metallic stent in the foot and can be removed once growth is complete and is a day care surgery. In older patients with severe deformities we can use combination of tendon transfers, bone realignment and joint fusion in various combination based on degree of the flatfoot deformity. Painful inside of the ankle and recurrent swelling can be an early sign of acquired flatfoot I overweight women in 40-50s.
Heel pain and heel spurs are usually due to combination of weight gain ,long standing hours, and sudden increase of physical activity. Overloading of hindfoot can lead to tendon getting overstretched and sometimes torn and this can lead to transfer of abnormal forces on the insertion of ligaments and tendon and also on the nerves and lead to various heel pain issues. Weight loss, Stretching of muscle and ligaments by structured exercises and use of different offloading shoe inserts we can rectify the problems in majority of patients. Nerve release, excising bony overgrowth and tendon transfers can help to restore normal biomechanics and allow healing.
Achillis tendon rupture can occur in healthy young people during sports activities as well as abnormal tendons damaged by smoking, Diabetes, certain medications. Acute tears can be treated by functional bracing in low demand individuals, while open surgical repair is reserved for extensive damage and high demand younger population with excellent results.
Diabetic foot issues can range from burning feet, to painless ulcers and corns and to advanced Charcot Arthropathy. Detailed counseling on tight control of sugar, prophylactic foot care by maintaining moist callus free foot can prevent ulcers and amputation. Offloading braces can allow early healing of diabetic foot ulcers without need of prolonged dressing changes and reduced chances of bone infection and gangrene.
Nerve Compression in the ankle and feet are usually secondary to a deformity, loss of muscle tone or growth of tumor mass which create pressure on the nerves and result in burning pain, tingling numbness which is more at rest and night time. If splints and rest don’t help then the nerve has to be released from the trapped tissue by surgery to achieve complete relief. Mortons neuroma, Tarsal tunnel syndrome, Baxter nerve compression are some of the common types.
Arthritis of the foot and ankle generally present with gradual onset of pain and stiffness after rest. Base of big toe,midfoot and hindfoot are prone for arthritis and are usually treated successfully by fusion surgery where the affected joint is welded together with screws and plates.Ankle joint arthritis can be treated with joint replacement.
Club foot deformities at birth can be corrected by serial plaster moulding and stretching and rarely need surgery in neglected and resistant cases.
Foot and Ankle fractures can occur due to fall from heights or due to Road Traffic Accidents. Calcaneus fractures if extending into the joint,Talus fracture and midfoot Lisfranc injuries generally show good outcome after surgery. Ankle fractures have to be treated very precisely as they can cause long term pain and deformities if treated inadequately.
Ankle sprains and Sports injuries in and around foot and ankle need prompt treatment with ICE & Rest, followed by splinting and good physical rehabilitation.More severe injuries may need surgical repair for best outcome.
