The aim of surgery is to reduce pain, improve function and correct any deformity in the foot. Generally surgery is considered if the condition you suffer from fails to get better with the various non operative treatments on offer. So the indication for surgery is the failure to get better by any other means.
There are many potential complications of surgery and the exact incidence of these will depend on the individual operation being carried out. Your surgeon is highly trained and makes every effort to minimise these risks and complications. Any surgeon who however says he has a zero complication rate is either lying or not performing enough surgery.
Infection: Any operation has a risk of infection. If you are a smoker or if you are diabetic the risk increases. If you are having surgery where a metal implant is inserted into your foot such as a screw or joint replacement you will have antibiotics as prophylaxis whilst you are an in patient.
Most infections are superficial and can often be treated by dressing care and the use of antiseptics agents. Occasionally antibiotics are required and very rarely re-admission to hospital is required for more intensive treatment. In the current NHS infections such as MRSA (“The Superbug”) are constantly in the news. The elective surgical centres usually screen patients being admitted for MRSA and if you are positive you will be treated and your surgery may be postponed until you are free of the infection.
Wound problems: Whenever you have surgery you will always be left with a scar. Modern surgical techniques have improved the cosmetic appearance of surgical scars. Minimising swelling in the first few weeks after surgery is essential to prevent delayed wound healing and ways of reducing this are discussed elsewhere. Scars will take time to settle and may be red and raised for up to 18 months following surgery. Once the scar has faded to match the colour of the surrounding skin it has fully matured. At this time the swelling post surgery will be as good as its ever going to get.
Deep venous thrombosis (DVT) or blood clots and pulmonary embolism (PE): These two complications are rare following foot surgery but certain people are at increased risk. These include people with a previous history of a blood clot, smokers, people taking the oral contraceptive pill, and anyone who will be in a plaster cast (POT) or immobilised after the surgery. If anyone has these risk factors you may be started on an injection of heparin (Clexane or Fragmin) and this can either be self administered by the patient or be given by a district nurse as sometimes this will need to be continued for up to six weeks post op. If you are on clexane you will be asked to have a blood test one week after starting the clean / fragmin and this can often be done at the GP surgery. This is to make sure you don’t have a rare complication from the clean / fragmin called heparin induced thrombocytopenia (HIT).
Nerve damage: Nerves can be damaged during surgery or can be stretched or compressed by postoperative swelling. This may result in reduced sensation or absent sensation. Most of the time this will recover but it can take several months. If nerve is cut during an operation the cut end of the nerve may swell and can be very tender. This is known as a neuroma and if symptomatic this may require further surgical treatment.
Failure of the bone to unite (Non-union): This can occur whenever you have an operation to fuse a bone or joint or when we cut a bone and fix it in a different position (osteotomy). The risks increase if you have other medical conditions such as diabetes, or if you have poor circulation in your legs. If you are a smoker your risks of this complication are increased significantly. The reason for this is the nicotine in cigarettes causes the blood vessels in the foot to narrow, thus reducing the blood supply.
The best way to reduce this risk is to stop smoking. If you do stop you must not use nicotine patches to help you, as the nicotine released by these will have the same effect as smoking.