How is the Surgery Performed?

How much surgery your foot requires depends on the deformities present and the symptoms. Some rheumatoid patients have dislocated toes and a severe bunion. They cannot put weight on their big toes and they feel like they are walking on marbles. They require a fusion of the great toe joint to give them a solid base, and removal of the prominence of the bones in the sole of the foot that causes a lot of pain. Wires are inserted into the toes to hold the foot in a reasonable position while the tissues heal. These remain in place for six weeks.

Some rheumatoid patients do not have such aggressive disease. They can be treated as any other patient with a bunion.

The risks of surgery are greater in rheumatoid patients compared to others because of increased wound breakdown and infection. There is also a greater risk of fusion operations failing. Anti-TNF drugs should be stopped at least 2 weeks prior to surgery and not recommenced until 4 weeks after surgery to decrease the risk of wounds not healing. Methotrexate can be continued.

The toes can end up flail and sitting off the ground as they have been shortened and there is no bony continuity in the lesser rays. This is cosmetic, but should still allow painfree walking.

Surgery is carried out under general anaesthetic, but can be carried out with local anaesthetic injections behind the knee or around the ankle. The injections are normally given while you are asleep for your comfort. They can give good pain relief for the first day after the operation. You can go home the same day in the evening.

Risks of Surgery

Bleeding, infection, poor bone healing, poor skin healing, injury to tendons, injury to nerves, recurrence, and a need for further surgery.

There is a small risk of blood clots in the legs or lungs (DVT and PE), and there are also risks from anaesthesia - the process of being put to sleep for your operation.

Risks of Anaesthesia

The injection behind your knee is given using an ultrasound machine to guide the needle. There is a less than 1% chance of injury to the nerve. General anaesthetic also carries risks. These risks are proportional to your general health. You will need to be assessed for your fitness for surgery and an Anaesthetist will be able to advise you on your individual risk.

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