As podiatrists we get asked this question or variations on a daily basis. People just all too often are in no big hurry to get their painful foot deformities like bunions and hammertoes fixed. This can be because of the perception that the recovery from foot surgery is painful, or fear of the surgery itself, or belief that their life needs to be put on hold during the recovery.
When to proceed with surgery is almost always a decision made by the patient. Ask yourself this simple question, “Has my foot condition affected my quality of life?” Inability to enjoy the things in your life that matter make surgery a must in these cases.
Examples:
- If you are a runner and cannot run the distances you enjoy because of foot pain, it is time.
- If you can’t play with your children or grandchildren because of foot pain, it is time.
- If you suffer from pain from your foot deformity in your work shoes, it is time.
The list of things that foot pain can affect is endless.
Reasons to proceed with foot surgery by diagnosis:
Bunions - enlarged bump on the middle of foot behind great toe. As they get larger pain worsens, and fitting into shoes becomes difficult.
When to proceed with surgery:
- The bump is noticeably getting larger over a short period of time.
- The area of the bump or area between the first and second toes is starting to form a blister or sore from rubbing
- The big joint behind the 2nd toe has become painful. This is called capsulitis, which is an inflammation of the joint. If this joint tissue becomes torn, even with repair, chronic pain can occur.
- Pediatric: a child with a large bunion is not normal, and in most cases will require surgery. Orthotics are required to slow progression until maturity of bones occurs at around age 16, at which time surgery is recommended.
Hammertoes – toes that curl and get painful at the tips or on top of joints from rubbing on shoes.
When to proceed with surgery:
- The toes have developed painful calluses that do not improve with padding or proper shoes
- Sores develop that lead to risk of soft tissue or bone infection
- The large joints behind the toe are becoming painful (capsulitis) see above
Neuroma – painful enlargements of the nerve(s) on bottom of foot that leads to sharp pain or burning/numbness.
When to proceed with surgery:
- Padding, inserts, and injections have not improved pain
Tendonitis/Tendonopathy – pain in one of the tendons of foot
When to proceed with surgery:
- If a complete tear has occurred, surgery is needed ASAP. Conservative care, like casting, has shown to be consistently inferior to surgery, have higher risk of repeat tear in future. Surgery also allows for faster return to normal activity
- If no tear has occurred, the patient must have failed to improve with traditional sports medicine including: rest, ice, anti-inflammatory medication, immobilization, elevation and physical therapy.
Fractures (broken bones):
When to proceed with surgery:
- If the fractured piece of bone has moved from its original location, casting or boot immobilization will not result in normal healing
- The fracture extends into a joint, failure to fix surgically will result in arthritis.
- The fracture has affected a bone with notoriously slow healing due to poor blood flow, in areas like the 5th metatarsal.
We understand that the decision to proceed with surgery is a difficult one, but we can help you answer the questions you have about the process. We want you to have a quick and minimally painful recovery, request an appointment for an evaluation so you can get the quality of life back you deserve!
