Surgical Procedures for Foot Pain
by Ricker Polsdorfer, MD
Surgery is always saved for conditions that haven't responded to medical treatment. This is particularly true with feet. Healing can be a problem, especially if you have diabetes. If you have diabetes and are thinking about surgery, check with the doctor who is handling your diabetes first. Consider the risks and benefits.
Surgical procedures are available for the following foot problems:
In severe cases, treatments that are more intensive are needed. Surgery may involve cutting away the sharp portion of the ingrown nail. It may also involve removing part of the nail bed to stop the nail from growing.
If discomfort persists after treatment, surgery may be necessary. Bunion surgery may include:
Bunionectomy —This procedure involves shaving down the large bone of your big toe joint. In a different method of this procedure, a very small incision is made. The bone-shaving drill is inserted through it. The doctor shaves off the bone, guided by feel or x-ray. Bunionectomy is not a cure.
Bunion surgery —Bunion surgery involves realigning your big toe joint and bone along with tendons and ligaments. For some people, a procedure that corrects the deformity without cutting or fusing the bone may be better. In severe cases, the metatarsal bone must be repositioned. Recovery takes 6-8 weeks. You will need to wear a cast or use crutches.
Surgery may be needed in some severe cases. If your toe is still flexible, only the tendon or soft tissue may be involved. If your toe has become rigid, surgery on the bone may be needed. A procedure called PIP arthroplasty involves releasing the ligaments at the joint and removing a small piece of toe bone. This creates a new joint. It restores your toe to its normal position. Your toe is held in position with a rigid wire for about 3 weeks. Then, the wire is removed.
Neuroma surgery to remove the interdigital (between the toes) neuroma is usually successful. You will be able to walk immediately after the surgery. You may need a cane. Sometimes, the nerve tissue regrows and forms another neuroma.
Heel surgery to relieve pain may be done for heel spurs, plantar fasciitis, and bursitis. Surgery is not advised until nonsurgical methods have failed for 6–12 months. Nonsurgical treatments for heel pain are useful in most people.
Plantar fasciotomy for plantar fasciitis —This procedure releases the plantar fascia from the heel bone. The cause of the pain is the deteriorating fascia where it attaches to the heel bone. The procedure uses an incision. It takes about 2 months to resume normal activity.
Surgery for heel spurs —Surgery for heel spurs involves cutting and releasing the plantar fascia and removing the spurs. The heel spurs are usually caused by plantar fasciitis, and so the 2 problems are associated. This surgery is not always successful. In some cases, it is the only option. Recovery usually requires preventing the foot from moving and using crutches for about 2 weeks. Surgery should be a last resort.
Haglund's Deformity (Pump Bump)
In severe cases, surgery may be necessary to remove or reduce the bony growth. The growth is on the posterior part of the heel bone.
Tarsal Tunnel Syndrome
Surgery is sometimes performed to relieve pressure on the nerve.
If your pain persists after other treatments, surgery is possible. The tendon is explored and the areas of degenerated tendon are removed.
Children with flat feet often outgrow them, particularly tall, slender children with flexible joints. Many children and adults with flat feet have no symptoms at all.
In general, conservative treatment is advised for flat feet that begins in adulthood. Treatment includes pain relief and insoles or orthotics to support the foot and prevent the condition from getting worse. In very severe cases, a surgical procedure called arthrodesis is used to correct misalignment of the joints. Most adults with flat feet can be managed well with shoes and insoles.
Achilles tendinopathy. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated January 22, 2018. Accessed February 7, 2018.
Anterior tarsal tunnel syndrome. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated December 21, 2015. Accessed February 7, 2018.
Hallux valgus and bunion. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated November 22, 2017. Accessed February 7, 2018.
Hammer toe. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114646/Hammer-toe . Updated March 30, 2015. Accessed February 7, 2018.
Morton neuroma. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114041/Morton-neuroma . Updated June 8, 2016. Accessed February 7, 2018.
Pes planus. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114291/Pes-planus . Updated September 26, 2017. Accessed February 7, 2018.
Plantar fasciitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116406/Plantar-fasciitis . Updated July 12, 2017. Accessed February 7, 2018.
Posterior tarsal tunnel syndrome. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated July 21, 2016. Accessed February 7, 2018.
Last reviewed March 2018 by EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
Last Updated: 3/15/2015
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