Osteoarthritis surgery of the foot
Osteoarthritis of the foot is performed by Doctor Julien Lopez, a specialist in foot and ankle surgery in Nice.
Osteoarthritis of the foot is a deterioration (wear) of the cartilage of a joint. It can manifest on different joints of the foot and ankle and affect daily life. Most often, the patient has osteoarthritis on the top of the foot, osteoarthritis of the back foot or osteoarthritis of the ankle. When osteoarthritis reaches the big toe, it is called hallux rigidus.
Doctor Julien Lopez performs osteoarthritis foot surgery in Nice, Cap d'Ail and Mandelieu-la-Napoule.
How to recognize osteoarthritis of the foot? The most common symptoms are:
- Stiffness and swelling in the joint, making walking more painful
- Mechanical pain located under or above the foot.
- Deformation of the bone and second toe, in the form of a claw in the case of a hallux valgus.
- Presence of osteophytes (bone growth), located on the dorsal part of the joint.
- Frequent cracking of the foot during ankle movement.
The factors of osteoarthritis of the foot are multiple and vary from one patient to another. Most often, these factors can be related to age, genetics, injuries and sports-related injuries. Other common risk factors include physical inactivity and work activities involving significant physical exertion.
First-line treatment is always medical. Some methods such as infiltration or wearing orthopedic soles and shoes may be prescribed to slow down osteoarthritis of the foot and pain, but this is not a long-term treatment. In case of failure of a well-conducted medical treatment, to treat osteoarthritis of the foot, surgical treatment is considered. Indeed, there are currently no natural or drug treatments to effectively treat it. If the pain is too intense and disturbs daily activities such as walking or sports, surgical treatment will be offered. The operation is performed under general anesthesia, loco-regional (leg and foot) or spinal anesthesia (two lower limbs).
The treatment of osteoarthritis of the foot by the most classic surgery is osteoarthritis, especially for the subtalar osteoarthritis. Arthrodesis is a surgical fusion of the joint concerned. It can eliminate joint pain at the cost of a loss of mobility. This involves shaving areas of cartilage that are in poor condition. Then, the doctor fixes the contact bone surfaces with material to block the joint. It takes at least 45 days for it to fuse together. In case of non fusion after 6 months (pseudarthrodesis), a surgical recovery is necessary. If there is bone loss, bone grafting may be necessary.
Osteoarthritis of the toe (large toe) is more commonly known as hallux rigidus or hallux limitus. This pathology is manifested by a weakening of the cartilage in the area between the first metatarsal and phalanx. Osteoarthritis of the toe is usually caused by repetitive microtrauma, idiopathic juvenile arthritis, but also an elevation of the metatarsus (metatarsus elevatus).
If osteoarthritis is not treated quickly, it can cause significant deformities and pain.
Among the most representative symptoms of osteoarthritis of the foot/toe are:
- Stiffness and difficulty in mobilizing the toe joint.
- Pain during back flexion movements, caused by friction of the bones.
- Osteophytes: appearance of bony growths most often at the dorsal part
Doctor Julien Lopez practices the treatment of osteoarthritis of the big toe through surgery. Such an intervention becomes necessary if medical treatment has not been sufficient, as in the case of an operation for the front of the foot, the top of the foot or the back foot.
Depending on the stage of osteoarthritis, the patient and its requirements, various surgical techniques are proposed by Dr. Lopez:
- Resection of the top 1/3 of the 1st metatarsal and 1st phalanx:
Resection of the upper part of the metatarsal head and phalanx is proposed when the dorsal conflict is in the foreground with mild osteoarthritis.
- By osteotomy, if sufficient healthy cartilage remains:
Osteotomy is performed if the toe is not “too” damaged. To do this, the practitioner performs fractures in the area of the phalanx or metatarsus, in order to reduce the constraints of cartilage. This treatment is preferred when the first metatarsus is too long. The foot will be shortened by half size.
- By pyrocarbon ball placement or coarse toe arthroplasty
A fairly recent technique, this type of intervention involves placing a pyrocarbon ball at the joint to restore mobility. Overall, this technique gives good results.
- By arthrodesis, when osteoarthritis is severe or in case of weak functional demand
Arthrodesis refers to the fusion of the joint obtained by removing the damaged cartilage using surgical action. Once the damaged cartilage is removed, the practitioner secures the assembly in the correct position with equipment for bone consolidation.
- By implant prosthesis, replacing the two sides of the damaged joint. Currently, this type of technique is not widespread because the results are bad.
Most often, Lopez prefers the treatment of osteoarthritis of the big toe by percutaneous surgery. The operation acts on the same principle as arthrodesis, but is carried out by mini-incisions on the side of the toe, about 1 to 2 millimeters. The gesture is made with small instruments, so as not to open the joint.
The advantage of percutaneous surgery is that it leaves almost no scar and thus limits the aggression of the tissues. Healing is less painful and the recovery is faster.
The next steps after surgery for osteoarthritis of the foot are variable, depending on the patient but also and especially on the surgical gesture and the technique used.
Following osteoarthritis surgery of the foot, the patient’s foot and ankle will be placed with a “shock” hard-soled shoe. Footwear must be worn within 15 to 45 days of the operation.
The support on the foot depends on the type of intervention carried out. It can be immediate as in the case of a pyrocarbon ball or unauthorized for up to 6 weeks. Recovery includes rehabilitation sessions with a physiotherapist.
Sick leave from work of 30 to 60 days is usually prescribed. From the 2nd or 3rd month, the patient can resume physical activity at a moderate pace.