General Complications following Foot Surgery
Complications can occur following any foot operation. The common
complications to all foot operations have been outlined below.
However, there are specific complications to each individual
procedure and anyone considering foot surgery should ensure they
are aware of these before undergoing surgery.
The complication rate is generally low and most are easily
treated. A thorough pre-operative history and assessment helps to
identify potential complications and therefore minimise the
risk.
However, due to these risks surgery should only considered if
conservative treatment (non-operative treatment) has failed and
there is regular discomfort.
All surgery results in a degree of pain and swelling, generally
dependent upon the type of operation. Swelling causes discomfort
and , following foot surgery, this can be reduced by keeping the
foot and leg elevated level with your heart. Increased / too much
activity in the early post operative period can increase the amount
of swelling. Following the post operative instructions specific for
the operation will help to minimise this complication.
There is a small risk of infection which is generally
superficial, around the wound. If this occurs, this is usually
managed successfully with antibiotics.
However, it can be deeper and involve the bone (osteomyelitis).
This is infrequent with foot surgery but is a serious complication
if it occurs. It often requires treatment with intravenous
antibiotics, requiring a stay in hospital, followed by a long
period of oral (tablets) antibiotics. In some cases, surgical
removal of the bone is required and this can leave the foot less
functional.
Although very uncommon, foot infections can be fatal as can any
infection. Early recognition and treatment is essential to reduce
the risk of serious complication.
Due to the relative immobility following foot surgery, there is
a risk of DVT much like there is a risk when flying. Fortunately,
this is infrequent and appropriate exercises during the post
operative period can reduce the risk. Certain operations, requiring
plaster cast immobilisation can increase this risk. Preventative
treatments are available if a patient has a known risk.
Although information is provided regarding the likely healing
time following surgery, this does vary between individuals. There
is always a risk that it may take longer. This could either be the
skin (soft tissue) or bone.
Delayed bone healing can take several months to settle and in
some cases, it does not heal properly. This is termed a non union
and can occur with any bone operation but is more common in some
than others. Cessation of smoking reduces the risk. If non union
occurs, it is not always painful. However, if it is causing a
problem, further surgery may be required. This usually involves
removing the area of non healing bone and replacing it with healthy
bone from another site (bone grafting). This obviously prolongs the
healing time considerably.
All operations result in a scar. Whilst the vast majority
settle, some can take longer to heal. It is possible that it will
be painful, have some nerve entrapment, be discoloured and may
become thickened. Whilst every care is taken during the operation,
problems can occur. Fortunately, they are usually short term but
can be long term. Certain skin types (e.g. Afro-Caribbean) are more
predisposed to thickened scars known as keloid scars.
Previously called reflex sympathetic dystrophy, this is an
extremely uncommon condition that can occur following injury
(including surgery). The exact process is not fully understood but,
essentially, the body over reacts to the injury and becomes
extremely sensitive and painful. Even the lightest touch or
movement can be unbearable and this can be disabling. Treatment is
required by a specialist pain clinic and successful treatment is
significantly improved by an early diagnosis (within 6 months).
Despite the best planning and surgery, studies evaluating the
outcomes of foot surgery all indicate that problems can re-occur.
Whilst every effort is taken to ensure a successful long term
outcome this cannot be guaranteed.
The nature of foot surgery is such that, even if the underlying
problem is resolved / corrected, there may still be residual
discomfort or prolonged swelling. As a result, there could be
continued difficulty with shoes. Women often wish to return to
fashionable court shoes and this can by no means be guaranteed.