Foot Health

Foot Surgery and Other Procedures
by Food and Drug Administration (FDA)

(Page 4 of 5)

Common types of foot surgery include surgery to correct bunions, surgery for fungal nails when medications don't work, and surgery to reduce arthritis pain. For people who have chronic ingrown toenails, a procedure called matrixectomy may be used to prevent recurring problems. Andersen says, "We numb the toe and remove the smallest amount of the nail on the side, usually about one-eighth of an inch, and then use a chemical to kill the root or remove the root of the nail surgically."

Sometimes, bunions can be treated without surgery, but when bunions limit or affect one's daily activities, bunion surgery may be appropriate. Pain is the big factor here. Kaye says, "Bunion surgery may also be warranted if there is chronic inflammation and the person gets no relief from nonsteroidal anti-inflammatory drugs and other conservative treatments."

Kaye says there are two main components to bunion problems. "One problem is the pain associated with shoe pressure against the bony enlargement," he says. "The second condition is a stiff toe joint that causes internal joint pain during movement of the big toe. Both or either of these problems can occur."

Advanced surgical techniques have improved outcomes for bunion surgery. The type of surgery needed depends on the patient's age, activity level, and degree of deformity. Kaye says he doesn't only remove the "bump of bone," which won't usually produce lasting results. "We realign the bone and use a surgical screw for stable bone alignment," he says. Recovery time usually takes about four weeks.

"The precision in which the bone is cut, shaped, and realigned is critical," Kaye says. Though consumers may see lasers publicized to treat bunions, lasers can't cut bone or correct bunions, he says. Lasers are not cleared by the FDA for these indications.

According to the American College of Foot and Ankle Surgeons, there have also been advances in less invasive foot and ankle surgery. Newer surgical plates and screws let surgeons repair fractures with less trauma. Smaller incisions mean less bleeding and tissue damage.

In ankle arthroscopy, surgeons look at the ankle joint with a fiber optic camera system. This technique has been applied to knee surgery for several years, but now it's being used for bones and joints in the foot and ankle. This type of surgery can relieve inflammation from arthritis and ligament damage, with reduced recovery time as compared to open surgical procedures.

Before considering any surgery, people should always explore and discuss the nonsurgical options with their doctor, and the benefits and risks of surgery. It is also important to consider the doctor's experience and results with the procedure.

The American Orthopaedic Foot & Ankle Society has released statements warning about trends in cosmetic surgery to improve the appearance of the foot. "Some women are getting surgeries to shorten toes and narrow their feet so they can fit into fashionable shoes," says Sharon Dreeben, M.D., chairwoman of the AOFAS Public Education Committee and an orthopedic surgeon in La Jolla, Calif.

"A woman recently called asking if I would inject collagen into her heel, and she will probably go doctor shopping to find someone who will do it," Dreeben says. "Some people want more padding to have cushion for high heels. But cosmetic foot surgery can result in chronic pain, infection, and nerve injury."

Dreeben has had to fix problems from cosmetic foot surgery that went wrong. "One woman had bunion surgery even though she hadn't been experiencing pain," she says. "She ended up with more problems, including nerve pain and difficulty walking."

The AOFAS defines cosmetic foot surgery as surgery that is aimed at only improving appearance. Dreeben says, "Foot surgery should only be used if the goal is to provide pain relief, improve function, or enhance quality of life during normal activities of daily living."

"I tell people: One difference between cosmetic surgery on the face and cosmetic surgery on the feet is that you don't walk around on your face. When you readjust one piece in the foot, it can affect everything."

Shock Wave Therapy

The most common cause of heel and arch pain is painful stretching or tearing of the plantar fascia, which runs along the bottom of the foot and supports the arch of the foot. Extracorporeal shock wave treatment is an outpatient procedure in which a medical device uses shock waves to relieve chronic heel pain. A dome filled with water is placed against the heel so shock waves pass through. The shock waves increase blood flow to trigger the healing process so that inflammation and pain subside.

FDA-approved devices for this procedure are the Ossatron, made by SanuWave Inc. of Marietta, Ga.; The Epos Ultra, made by Dornier MedTech, Kennesaw, Ga.; and the Orsabone Pain Relief System, made by Orthometrix Inc., White Plains, N.Y. People who have bleeding disorders, who are taking blood-thinning medication, or who are pregnant, should not undergo shock wave therapy. Complications can include mild neurological symptoms and tears in the tissue in the bottom of the foot.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.