Inflammatory arthritis of the forefoot can cause painful bunion deformities and dislocated claw toes. Patients report drawn-out pain on the ball of their foot, and degenerative arthritis can set if left unmodified.
If shoe wear modification cannot improve your symptoms, the best option is to have a forefoot reconstruction. This surgery involves a fusion of the big toe and correction of all of the lesser toes. Pain relief is excellent and function improves because pain is relieved.
Are you experiencing pain in your forefoot? Have you been diagnosed with arthritic degeneration in your foot?
If so, let Dr. Silverman help. For more information about forefoot reconstruction, keep reading.
What Happens Before Forefoot Reconstruction Surgery?
The surgical center will inform you how to prepare for surgery. The day of surgery you will receive regional anesthesia known as a popliteal nerve block. This is a procedure performed by the anesthesiologist prior to surgery. You will be placed on your stomach and a small needle is used to inject Novocain-like medication around the nerve in your leg. It gives complete pain relief that lasts for 12 to 36 hours. Patients report extraordinary satisfaction with this type of anesthesia. You will be given sedatives during the surgery. Rarely, patients require general anesthesia. You will also receive antibiotics just before surgery to help prevent infection.
What Happens During Forefoot Reconstruction Surgery?
During the surgery you will be kept in “twilight sleep”, unaware of time or sound by the medication delivered through the I.V. A tourniquet will be placed around your calf, and an incision will be made on the top of the big toe joint. The spurs are then removed, and the bones of the big toe joint are roughened to simulate a fracture. Wires, screws or plates may be used to stabilize the toe while it mends. The metatarsal heads on the smaller toes are excised and the hammer toes are corrected. X-Rays are taken to confirm that the bones are in the correct position. A sterile dressing will be applied to the wounds after they are closed.
What Happens After Forefoot Reconstruction Surgery?
You will be permitted to leave the surgical center once your anesthesiologist is satisfied that you have recovered. During this recovery time your family member may take your prescription to the nearest pharmacy. You will be given crutches and a walking boot to ease the process of moving around. Take your narcotic pain control medications before falling asleep or as you feel the “numbing” effect wearing off. Remember, postoperative pain is much easier to control with prevention as opposed to treatment. Call to schedule your post-operative visit for 2-5 days after surgery when you feel able.
Forefoot Reconstruction General Recovery Timeline
This timeline is a general guideline. Your post-operative course may vary.
| Elevation | 23 hours / day for 3 days; then keep elevated as needed. Swelling may last over 4 months. |
| Motion | Move your ankle when the block resolves. This will decrease pain and swelling, and it will improve healing. |
| Walking | Heel weight bearing only as tolerated in the fracture brace or post-op sandal. When the great toe fusion heals, around 6 weeks, you may wean out of the brace. |
| Bathing | Keep dressing dry. You may shower but do not bathe. |
| Dressing | After three days begin twice-daily dressing changes. Gently tighten the Ace wrap each time for better swelling control. |
| Pain Control | Expect to use strong narcotics for the first 3-5 days. Wean off as soon as you are comfortable using Tylenol or Ultram (Rx only). |
| Work | Return depends on specific demands. It is safe to return to sedentary work at 10 days post-op. Return to heavy labor will take at least 3 months. |
| Driving | Patients with left foot surgery may drive an automatic transmission. Patients with right foot surgery must wait until healing is adequate and they feel safe. |
Routine Clinic Visits
| 2-5 days | Dressing change and X-Ray. |
| 4 weeks | Pin removal and X-Ray. |
| 6 weeks | X-Ray, earliest time of bone healing to permit time out of boot. The time to return for your next visit varies significantly. |
| 3-4 months | Return for recheck; Strength improves over then next year. Minimal feelings of discomfort may linger, your overall comfort level improves over a year. |
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If at any time during your post-operative period you notice any drainage or foul odor from your incision, a temperature of more than 100.4 degrees and/or increased swelling or tenderness, you should contact our office. |