Harris Foot and Ankle Institute - Optional Surgery - Lewisville, TX
Harris Foot and Ankle Institute - "Where our bedside manner is innate, and not mocked".
Optional Surgery:
Surgery options offered at HFAI range from simple bunion surgery to extensive ankle surgery. See information about the most common surgery offered below: Bunion, heel pain, hammer toes, ankle and foot pain in Flower Mound
Bunion Surgery:
The postoperative course and rehabilitation following bunion surgery depends on the procedure and the podiatrist. It can vary amongst podiatrist that provide surgery. Patients have varying levels of postoperative pain but quite often the pain is significantly less than what the patient anticipates. At HFAI, Dr Harris' patients have very minimal pain. Postoperatively, the patient is allowed to bear full weight in a postoperative surgical shoe. In all cases patients are instructed to limit their activities and to elevate their feet above their heart during the first 3 to 5 days. After this, a resumption of gradual weight bearing with a special surgical shoe is begun. Walking without the postoperative shoe is strictly prohibited. Screws provide increased stability when used to fixate bone cuts and most patients can return to full weight bearing and regular shoes in 3-4 weeks following the surgery. The postoperative and rehabilitative course is improved by the use of ice and elevation of the extremity as much as possible. One of the most important aspects of the postoperative treatment is early motion of the joint to prevent joint stiffness. In most cases, range of motion exercises are begun almost immediately following surgery. No matter what the form of bone fixation is used, pins or screws; bone healing will take 6 to 8 weeks or longer. During this period of time it is important that the patient not walk without shoes or in thin-soled shoes or sandals. Should the patient risk walking without an adequately supportive shoe, they risk re-fracturing the bone and increase the duration of healing.
Curative treatment of hammertoes varies depending upon the severity of the deformity. When the hammertoe is flexible, a simple tendon release in the toe works well. The recovery is rapid often requiring nothing more that a single stitch and a Band-Aid. Of course if several toes are done at the same time, the recovery make take a bit longer. For the surgical correction of a rigid hammertoe, the surgical procedure consists of removing the damaged skin where the corn is located. Then a small section of bone is removed at the level of the rigid joint. The sutures remain in place for approximately ten days. During this period of time it is important to keep the area dry. Most podiatrist perfer to leave the bandage in place until the patient's follow-up visit, so there is no need for the patient to change the bandages at home. The patient is returned to a stiff-soled walking shoe in about two weeks. It is important to try and stay off the foot as much as possible during this time. Excessive swelling of the toe is the most common patient complaint. In severe cases of hammertoe deformity a pin may be required to hold the toe in place and the surgeon may elect to fuse the bones in the toe. This requires several weeks of recovery.
Complications associated with the surgery are infection, excessive swelling leading to delays in healing and potential deviation of the toe. If excessive bone is removed during the surgery, the toe may be a bit floppy. The toe always has a floppy feeling for several weeks following the surgery. This is normal and generally not permanent.
If pinning the toe is not required during the procedure, then the surgery could be performed in the doctor's office under a local anesthesia. Some patients perfer the comfort of sedation during the surgery and if this is the case or if a pin must be placed, then the surgery could be performed in an outpatient surgery center.
Heel Spur/Plantar Fascia Release:
Most surgical procedures are aimed at detaching the plantar fascial ligament from its attachment into the heel bone. This may be accomplished with a small incision on the bottom of the heel or on the side of the heel. The procedure is performed by "feel". The surgeon inserted the scalpel blade and felt for the plantar fascia. Once they were confident that they had identified the plantar fascia they would cut the ligament free from the heel bone.
Adult Flatfoot:
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity.
Stage one deformities usually respond to conservative or non-surgical therapy such as anti-inflammatory medication, casting, functional orthotics or a foot ankle orthosis called a Richie Brace. If these modalities are unsuccessful surgery is warranted. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss.
Stage two deformities are less responsive to conservative therapies that can be effective in mild deformities. Therefore, these patients may be candidates for a 15 minute outpatient procedure to correct the flexible flatfoot deformity which is referred to as hyperpronation. The procedure is called a Subtalar Arthroereisis. It involves the placement of an implant in the space under the ankle joint (sinus tarsi) to prevent only the abnormal motion, but still allowing normal motion. This brief procedure only requires very little recovery time, and is completely reversible, if necessary. Your surgeon can consult you about this exciting, life-changing procedure.
Stage three deformities are better treated with surgical correction by our podiatrist, in healthy patients. Patients that are unable to tolerate surgery or the prolonged healing period are better served with either arch supports known as orthotics or bracing such as the Richie Brace. Surgical correction at this stage usually requires fusion procedures such as a triple or double arthrodesis. This involves fusing the two or three major bones in the back of the foot together with screws or pins. The most common joints fused together are the subtalar joint, talonavicular joint, and the calcaneocuboid joint. By fusing the bones together the surgeon is able to correct structural deformity and alleviate arthritic pain. Tendon transfer procedures are usually not beneficial at this stage.
Stage four deformities are treated similarly but with the addition of fusing the ankle joint.
Recovery Time
Time off work depends on the type of work, as well as the surgical procedures performed.
Pediatric Flatfoot:
If the child has a mild flatfoot deformity and no symptoms, then generally no treatment is recommended other than possibly yearly check-ups by the podiatrist. If, however, the child has a moderate to severe flatfoot deformity of has significant symptoms in the foot or lower extremity, then treatment is indicated.
Treatment generally starts with both supportive shoes, such as high tops, and some form of in-shoe insert such as arch padding for the milder cases of flatfoot deformity. More significant cases of flatfoot deformity may require more exacting control of the abnormal motion of the foot such as that offered by functional foot orthotics. Functional foot orthotics limit the abnormal flat arch shape and rolling in of the heel bone during standing, walking and running activities which helps not only improve the appearance and function of the foot, but also greatly reduces the symptoms in the foot or lower extremities. Calf muscle stretching exercises are also commonly prescribed for children with tight calf muscles since the tight calf muscles can worsen the flatfoot deformity with time and make the child's symptoms worse. Our podiatrist are well trained in the assessment of pediatric flatfoot and the steps needed to correct any pathology diagnosed by our podiatrist.
If the child has a severe flatfoot deformity and disabling symptoms which does not respond to foot orthotics, shoes and/or stretching, then surgery to correct the flatfoot deformity may be indicated by our podiatrist.
These children may be candidates for a 15 minute outpatient procedure to correct the flexible flatfoot deformity which is referred to as hyperpronation. The procedure is called a Subtalar Arthroereisis performed by the podiatrist. It involves the placement of an implant in the space under the ankle joint (sinus tarsi) to prevent only the abnormal motion, but still allowing normal motion. This brief procedure only requires very little recovery time, and is completely reversible, if necessary. Your surgeon can consult you about this exciting, life-changing procedure.
Chronic Ankle Sprain or Instability:
Surgery may be indicated for those cases of chronic ankle sprains failing to respond to conservative treatment. There are various surgical options available. These surgical procedures can be divided into two types. The first type involves the use of local tissue to reconstruct the lateral collateral ligament complex. The second type of surgery involves the use of a tendon graft or some other type of graft material to reconstruct the lateral collateral ligament complex. See ankle surgery.
Ankle Arthritis/Ankle arthroscopy:
Arthroscopy is a surgical technique that involves the introduction of a small circular lens (2.0 to 6.0 mm in diameter) into a joint for the purpose of inspection and possible treatment. The arthroscope is an elongated tube possessing a series of lenses that allow for the magnification of structures within the joint. A camera is affixed to end of the arthroscope so that joint images can be projected onto a television monitor. Small incisions (one-quarter inch or less) are placed strategically around the joint to allow for the introduction of the arthroscope, as well as other pieces of equipment needed for the precise correction of joint injury. See ankle surgery; Our podiatrist well trained in ankle surgery!!
Achilles Tendon Rupture Repair:
Early treatment is imperative for the best long-term outcome. Surgical repair is the most common treatment producing the greatest return to function and activity level. The goal of surgery is to realign the two ends of the ruptured tendon to allow healing. There are multiple techniques to accomplish this goal that will vary from surgeon to surgeon. Recovery from this injury is usually very successful with return to full function in approximately 6 months. Post operatively casting is required with the use of crutches or other means to remain non-weightbearing for 4-8 weeks. This is followed by a course of physical therapy. Partial rupture may or may not require surgical intervention depending on the extent of injury but cast immobilization is a common requirement. Most tendonitis of the achilles can by diagnosed and treated conservatively by our podiatrist.
Use of screws: Why?:
In a great number of bone procedures of the foot and ankle, your podiatrist or foot and ankle specialist may tell you that they are going to fix the bone with screws to hold them in place. Screws are used to secure two bones or bone fragments together to allow for compression of the bone to promote healing. This is not much different than when you screw two pieces of wood together to hold them in place. This compression of bone helps to secure the bone together to produce what is known as primary bone healing. This type of healing is different from secondary bone healing, in that secondary bone healing producers a bone callus while primary bone healing does not. Complete bone healing typically takes 6 to 8 weeks, but may take longer in some cases. Screws also allow for immediate weight bearing in some procedures after surgery or for movement of your foot and ankle to regain strength in your muscles, particularly after a fracture.
These screws are made out of either a high-grade surgical stainless steel or titanium. Screws used in the foot range in sizes from 1.5 mm to 7.3 mm in size and have many different applications from fixation of fractures to arthrodesis procedures.
Fractures of Foot and Ankle:
Here at HFAI, our podiatrist offers extensive treatment for trauma induced fractures of the foot and ankle ranging from closed reduction,casting/spinting to ORIF.