115 - Surgery of the foot and ankle

Summary

The foot is a highly specialized organ that connects us to the ground, providing support and balance, shock absorption, and finally, push-off power and direction. Through its complex bony, ligamentous, and musculo-tendinous units, the foot is able to adapt from a flexible structure that conforms to uneven surfaces to a fairly rigid and solid platform that can provide push-off and spring during various activities. Throughout ambulation, the foot may have to support repetitive loads equal to eight times body weight. In order to resume normal function after foot surgery, it is important to allow enough time for bony and soft tissue healing.

The following is a discussion of common foot surgical procedures:

Surgery of the diabetic foot

Diabetic foot ulcers and infection are a common cause of hospital admissions. Patients usually present with non-healing ulcers and superficial or deep infections and will require immediate antibiotic treatment. Management and prognosis depends on the extent of the infection, vascular and sensory status of the extremity, and foot deformity. Interdisciplinary collaboration between medical subspecialists, nurses, physical therapists, and social workers is needed to provide effective treatment.

Surgical debridement is indicated for patients with bony infection such as osteomyelitis. Amputations may be necessary if the infection cannot be controlled with conservative treatment or if the foot remaining after adequate debridment is judged to be inadequate for ambulation.

Hospital course and postoperative rehabilitation

The duration of hospital stay is dictated by the severity of the infection and the associated medical problems.