One of the basic truths of life is this – things don’t always go according to plan. For this reason, the old axiom “hope for the best, plan for the worst” is truly sage wisdom. When it comes to the field of medicine, we can plan and hope for conservative care to be the answer to your medical issue, but there are times when surgery is a necessary tool for relieving pain and restoring normal foot function. Depending on various factors, Dr. Jan Tepper may recommend foot or ankle surgery—even though his approach is always to start with nonsurgical treatment whenever possible—to resolve a problem caused by physical trauma, an inherited structural issue, or arthritic condition. With his almost 40 years of podiatric experience, Dr. Tepper can quickly identify issues that will best be addressed through surgical intervention. If this is his assessment, Dr. Tepper will take the time to discuss your options with you and answer any questions you might have – so you are able to make an informed decision.
Physical Trauma and Foot Surgery
The typical association for the word “trauma” (when used in a physical context) tends to be “blunt force,” but trauma can actually refer to almost any kind of body tissue injury that requires immediate medical attention and has a sudden onset. Accordingly, cuts and burns meet the definition. As a note, surgery itself can actually be considered physical trauma. Of course, this is a planned, controlled trauma being performed by skilled, trained professionals, but trauma nonetheless. For unexpected trauma, there are often a host of serious medical concerns – with potential problems that include severe pain and/or blood loss. The injuries resulting from physical trauma are usually referred to as being “acute.” This differs from chronic conditions and injuries, which usually (but not always) develop after performing physical activities—like running, sports, and exercises—for lengthy periods and are considered to be “overuse” injuries. Examples of these include plantar fasciitis and Achilles tendinitis. Probably unsurprisingly, one particular kind of injury that often results from blunt force is a bone fracture. There are different kinds of breaks, including:
- The fractured bone only features a single break and has not pierced through the skin.
- The broken ends of the bone are lined up in a normal manner and will likely heal correctly (if the fracture is stabilized).
- The fracture line of the bone is at an angle.
- The fracture line is perpendicular to the bone.
- The bone has broken or shattered in two or more parts.
- Skin has been punctured – either by the broken bone itself or the traumatic incident responsible for the break. This is an emergency situation and immediate medical attention is needed. It is imperative to take proper precautions to reduce the risk of serious infection.
With regards to treatment for this traumatic injury, the body actually does most of the heavy lifting itself. That said, our job is to make sure the bone(s) stays stable during the healing process, which happens in three stages:
- Immediately following the injury, your body begins this particular stage wherein blood is flooded to the area and begins to clot. This provides a certain degree of stability, along with framework, as the body starts the process of generating new tissue.
- Bone production. During this stage, the clotted blood is gradually replaced by cartilage and fibrous tissues. In turn, they will eventually be replaced by solid bone.
- Bone remodeling. The final stage of healing, this is where bone tissue increases in density and become compact. Additionally, circulation to the area will return to pre-injury levels.
In addition to providing external stability, we may need to perform surgery to realign broken parts and then secure them into place using screws, pins and plates.
Conditions That May Require Surgery
There are a variety of conditions that are more likely to necessitate surgery than others. This is not a comprehensive list, but examples of issues that can benefit from surgery include: arthritis, bunions, hammertoes, cartilage damage, bones spurs, posterior ankle pain, and, as noted, compound fractures. When a patient’s arthritis does not respond to nonsurgical procedures, especially in severe cases, the bones of painful joints can be fused together. This type of surgery has a high success rate and only a small percentage of patients develop complications. Some conditions such as bunions and hammertoe are progressive. This means they worsen over time (when left untreated), but it also means they cannot be reversed without surgical intervention. Dr. Tepper can create a treatment plan based on conservative care—and this might relieve symptoms and halt progression of the condition—but severe cases may need surgery. In fact, surgical intervention is the only way to restore wayward and bent toes back to their normal positioning and function.
Identifying if Surgery is Necessary
When deciding whether or not to recommend surgery, Dr. Tepper will likely use certain diagnostic tools and tests, including x-rays and MRI (magnetic resonance imaging) scans. Beyond diagnostic tests, he will take into consideration factors such as the level of pain the condition is causing, how it affects your foot’s functionality, and your overall health. In the instance of a compound fracture in a foot or ankle, surgery becomes an obvious necessity. In part, there are high odds of infection—caused by breakage in the skin—and immediate operation is needed in order to prevent contamination. But there is also an urgent need to stabilize the fracture as quickly as possible (for optimal healing). With regards to ankle surgery, an important factor in our decision whether or not to recommend operating is the stability of your ankle joint. If you have an existing condition that is causing instability in the joint, then surgery will likely be recommended. In a situation involving this valuable joint, your mobility is a primary concern – and trying to save or re-establish it is paramount.
Types of Surgical Procedures
There are an array of surgical procedures Dr. Tepper is trained and experienced in using to fix a variety of lower limb problems. Depending on the nature of your specific circumstances, you may benefit from bone fusion, joint replacement, tendon repair or transfer, nerve decompression, tumor removal, osteotomy (cutting bone tissue in a precise manner), or bone spur excision. Arthroscopy is a minimally-invasive surgery that utilizes a fiber optic camera that allows Dr. Tepper to see what is happening inside the body on an external monitor. The advantage with this kind of procedure is that only small incisions are required. This decreases or even eliminates most of the difficulties (potential infection and patient pain) encountered with large cuts. Additionally, minimally-invasive procedures like this also typically have shorter recovery times, require less anesthesia, and leave less scar tissue. ORIF (open reduction and internal fixation) is more invasive than arthroscopy, but can be required to set broken bones back into place. This is done in a traditional procedure, where an incision is made to see the entire fractured bone. The fragments are placed back into position and held there with metal plates, pins, and/or screws.
Recovering from Foot or Ankle Surgery
The general recovery process begins with an immobilization of the operated area. Once the body has repaired the soft tissue, a cast or removable boot will be used to help stabilize the region. Gradually, bodyweight can be placed upon the repaired foot and ankle. Normal activities can resume anywhere from within a couple of months up until one year removed from the operation. Naturally, you can expect to receive specific post-operative instructions following your procedure. For optimal healing, it is essential these instructions are followed. Many complications and issues following surgery are the result of instructions not being heeded. For more information on surgeries performed by Dr. Tepper, or to request an appointment with our Upland, CA office, either fill out the online form found on our website or give us a call at (909) 920-0884.