Foot surgery

What is meant by foot surgery?

Foot surgery covers all orthopedic foot conditions that remain debilitating despite well-conducted medical treatment, including compartment syndrome. Traumatology is a part of foot surgery.

Foot surgery is very broad, as it may concern:

• the forefoot,
• the midfoot,
• and the hindfoot.

The forefoot corresponds to the toes and metatarsals. Surgery addresses conditions such as hallux valgus, hallux rigidus, metatarsalgia, and Morton's neuroma.

The midfoot corresponds to the Lisfranc joints, as well as the talonavicular and calcaneocuboid joints.

Surgery involves correction of flat-valgus feet, high-arched feet, and Lisfranc arthropathies.

The hindfoot is composed of the calcaneus, the heel bone, and the subtalar joint, which provides adaptability of the foot and ankle on uneven and unstable ground.

Surgery addresses calcaneal fractures and their aftereffects, subtalar arthropathies, as well as Achilles tendinopathies and their insertion, which may fall within the scope of Haglund's disease.

The different foot surgeries

There are different types of surgical foot operations:

• Minimally invasive surgery,
• Percutaneous surgery,
• and arthroscopic surgery.

Minimally invasive surgery

Minimally invasive surgery consists of performing a surgical procedure through a limited-sized incision, but large enough to see through.

We operate on hallux valgus using the minimally invasive technique to allow for the most precise possible adjustment of the bone correction made in the metatarsal. The adjustment of the final position of the metatarsal head is performed in several planes:

• Height
• Translation
• Length
• Rotation

In congenital or juvenile hallux valgus, there are often abnormalities in the orientation of the articular surfaces.

Percutaneous surgery

Percutaneous surgery involves working through one or more tiny skin punctures using instruments such as rasps or powered burrs.

We mainly use percutaneous surgery for the lateral metatarsals. For damaged or fragile skin, we use the percutaneous approach at the midfoot or hindfoot in certain cases.

Arthroscopic surgery

Arthroscopic foot surgery allows for intra-articular or extra-articular exploration; we mainly reserve it for pathologies of the sesamoids.

Common reasons for consultation

Corns on the feet

A corn is a painful area of thickened skin. The thickening of the skin is a mechanism of adaptation of the skin to friction or pressure.

Corns can be found between the toes, they are also called "soft corns". They initially require treatment by a podiatrist. If pain and the corn persist, a consultation with an orthopaedic specialist may help to find a cause for the persistence of the corn. Phalangeal fractures can heal with a residual deformity called a malunion, which can be responsible for the presence of the corn.

Corns can be found under the plantar pads and can be part of the clinical presentation of metatarsalgia.

Hallux valgus is an instability of the metatarsophalangeal joint of the big toe. This instability leads to a weakness of the big toe's support strength and therefore a lack of propulsive force while walking. Support is then increased on the lateral toes, thickened skin may appear, this is an initial hyperkeratosis that is barely or not painful, or a corn. With worsening hallux valgus, weight bearing on the 2nd metatarsal can become painful, this is called second ray syndrome. If pain spreads under the other metatarsals, it is called metatarsalgia.

The synovial cyst

A synovial cyst usually appears as a subcutaneous swelling, whose size may vary over a few days, either increasing or decreasing. It may also regress spontaneously and completely.

When it tends to increase in size, it may compress a small neighbouring nerve, for example, and cause pain.

It may also be located in a pressure area inside the shoe, causing pain.

A synovial cyst comes from a joint or the sheath of a tendon. When a joint or tendon is overused, there is a reactive increase in the secretion of synovial fluid, which can cause a localized deformation of the joint capsule or tendon sheath responsible for the cyst.

In cases of pain or shoe-wearing problems, surgery may be proposed to remove the cyst entirely, this is called an excisional biopsy. Any removed cyst is systematically sent for anatomical pathology analysis to confirm the diagnosis of a synovial cyst.

Hallux valgus or bunion

Hallux valgus is a very common reason for consultation. It is an unsightly deformity of the big toe, commonly called a bunion.

The bunion can appear at any age.

• Some patients are born with hallux valgus, which is the congenital form.
• Other patients develop a bunion around puberty, which is the juvenile form.
• If it appears progressively later, this is called the acquired form.

Pain and functional problems are an indication for surgical correction. We never advise having this surgery purely for aesthetic reasons, as studies show that in the vast majority of cases the results are disappointing.

We recommend the use of an orthosis or splint only in the case of disabling pain for patients who do not wish to have surgery.

Splints or orthoses cannot correct a deformity or prevent the worsening of a hallux valgus deformity. They have a pain-relieving effect.

Hallux rigidus

Hallux rigidus can mistakenly be considered as hallux valgus. In fact, the joint is deformed by osteoarthritis, but mainly on the dorsal side, and there is no lateral deviation of the big toe.

Hallux rigidus is common; there are factors that promote its onset:

• A traumatic factor is found in 80% of cases
• Micro-traumatic factor with repeated joint injuries
• An anatomical factor: hallux enlargement (hallomegaly)

Request for prosthesis as an alternative to arthrodesis

Arthrodesis is most often proposed to relieve pain due to hallux rigidus when the joint cannot be preserved.

We are in favour of preserving even minimal joint mobility at the level of the hallux.

To maintain adaptive mobility, we propose the placement of a spherical pyrocarbon implant as an alternative to arthrodesis in certain cases.

Foot surgery in Nice

Consultations take place in Nice, at the Clinique du Pied located at 30 rue Gioffredo. We ask that you have your imaging tests done before coming.

Surgical procedures are performed at the Saint George clinic in Nice.