It is said of her that she is “open to the sky”. Traditional foot surgery is so named because it requires a large incision, providing a 5 star view of the part of the foot to be repaired. The oldest surgeries are still performed in theaters today. But it is no longer the only option for surgeons. “For the past 10-15 years, operations have become less and less aggressive”, rejoices Professor Didier Mainard, orthopedic surgeon. The big difference? Minimal openings. “With minimally invasive surgery, where the scar was before 4 to 5 cm, today it is 2 to 3 cm, or even less. With percutaneous surgery, the incision is only a few millimeters”.
More and more miniaturized instruments
“These less invasive surgeries have also been made possible thanks to the miniaturization of instruments. Today we have very fine scalpels, tiny burs, and even very small screws.”
Operations are now often performed under locoregional anesthesia (only the leg and foot are put to sleep). This allows, more than before, “outpatient practice: the patient enters the block in the morning and returns home in the evening.” A smaller scar is prettier. But this type of operation also allows for a simpler return home: less swelling and pain, faster recovery.
Excellent results for hallux valgus
The most operated pathology concerns the hallux valgus. Surgery is indicated when the pain makes it difficult to put on shoes and daily activities or in the case of hallux valgus in adolescents, for psychological reasons. But never for a simple isolated aesthetic discomfort. The goal is to realign the big toe in order to eliminate the bony protrusion: “The surgeon cuts certain bones (first phalanx or metatarsal), releases the retracted tissues, then realigns the bones before fixing them together”, explains Professor Mainard .
Less and less invasive surgery
Surgery can relieve a variety of other forefoot disorders, such as toe deformities, big toe osteoarthritis, or Morton’s neuroma. “Often, these interventions are even less cumbersome than that of hallux valgus, and are done percutaneously or minimally invasive,” emphasizes Professor Mainard. Thus, the operation of Morton’s neuroma, which most often consists in removing the nerve causing the pain, takes 15 minutes and makes it possible to walk in the evening even without slippers. Claw toes are operated by cutting in the bone, then by lengthening the tendons and articular envelopes which were retracted.
“But the ease of the gestures and the good results obtained should not hide the possible complications, sometimes disabling, such as a reduction in the mobility of the foot or even the appearance of osteoarthritis, warns Dr Tulio Sarron, a doctor specializing in foot pathologies. feet and ankle in Paris. You should therefore discuss the risks with your surgeon before the operation.”
Finally, with regard to disorders of the hindfoot (Achilles tendinitis, ankle sprains, etc.), except for the calcaneal spur, they still require open surgery. But even here, specifies Dr. Christophe Piat, “some practitioners are already trying to develop less invasive interventions”.
Beneficial techniques for patients… Provided they are carried out according to the rules of the art. “The gestures require a real technicality”, insists Professor Mainard. Because, if with a classic surgery, the specialist sees what he is doing “live”, percutaneously, it is not possible, because the incisions are too small. “To be guided, the surgeon does not take his eyes off the foot x-rays during the operation, taken live by low-irradiation intraoperative radiography, or fluoroscopy. This allows him to check, at all times, that he is at the good place to make the gesture.” This requires real expertise and does not tolerate any approximations.
When to operate?
Even if it is “very ugly”, the aesthetic criterion is not a sufficient argument on its own to have the operation. What must be taken into account is the handicap in one’s daily life, the pain, the difficulty, even the impossibility, of putting on shoes “Before turning to surgery, it is often preferable, depending on the pathology, to try medical means such as physiotherapy, infiltrations, shock waves…”, advises Prof. Mainard
Read also :
- How to take care of your soles
- Heel pain: what is plantar fasciitis?
- How to find (the right) shoe for you
- 9 tips to prevent foot pain