Midfoot Exostectomy - Indications, Procedure, and Complications

Introduction

The midfoot is the central part of the foot, consisting of several small bones that work together to provide stability and support during walking, running, and other activities. When the bones in the midfoot become damaged or diseased, it can lead to inflammation, pain, and difficulty walking or standing. Midfoot exostectomy is a surgical procedure that involves removing bony growths or prominences from the midfoot area. This procedure is often performed to relieve pain and improve mobility in patients with midfoot arthritis, plantar fasciitis, or other conditions that affect the bones and joints in the midfoot region.

What Are the Causes of Midfoot Pain?

One common cause of midfoot pain is arthritis (inflammation and joint damage). Arthritis affects any joint in the body, including those in the midfoot. When arthritis affects the midfoot, it can cause bony growths or spurs to develop, which can rub against other bones or soft tissues in the foot, causing pain and discomfort. Another common cause of midfoot pain is plantar fasciitis, the plantar fascia affects (the thick band of tissue present along the foot bottom).

What Are the Indication of Midfoot Exostectomy?

It is indicated in the following conditions:

• Midfoot Arthritis: Arthritis is a common cause of pain and stiffness in the midfoot area. Midfoot exostectomy may be indicated for patients with midfoot arthritis, particularly if the condition is causing bony growths or spurs to develop.

• Plantar Fasciitis: Plantar fasciitis causes pain and stiffness in the plantar fascia. If conservative treatments such as physical therapy, stretching, or orthotics are ineffective, midfoot exostectomy may be indicated.

• Other Conditions Affecting the Midfoot: Midfoot exostectomy may also be indicated for patients with other conditions that affect the bones and joints in the midfoot, such as tendonitis, stress fractures, or bone spurs.

What Are the Preoperative Preparation Before Midfoot Exostectomy?

Before undergoing a midfoot exostectomy, patients will typically undergo a preoperative evaluation to assess their overall health and determine if they are a good candidate for surgery. This evaluation may include a physical exam, imaging tests (such as X-rays or MRI), and blood tests. In preparation for surgery, patients may be advised to:

• Stop Smoking: Smoking interferes with healing and increases the risk of complications, so patients may be advised to stop smoking several weeks before surgery.

• Stop Taking Certain Medications: Some medications, like blood thinners, may need to be stopped before surgery to reduce the risk of bleeding. Patients should discuss their medications with their healthcare provider before surgery.

• Avoid Eating or Drinking Before Surgery: Patients are advised to ignore eating or drinking for a certain amount of time before surgery, typically after midnight on the day of surgery.

• Arrange for Transportation: Patients will need to arrange transportation to and from the hospital or surgery center on the day of surgery, as they cannot drive themselves home.

• Prepare for Recovery: Patients may need to make arrangements for someone to help them with daily tasks during their recovery period, which may include using support or a wheelchair to get around.

What Is the Procedure of Midfoot Exostectomy?

Midfoot exostectomy is a surgical procedure that is typically performed under general anesthesia. The steps are as follows :

• The surgeon places a small incision on the top of the foot to access the affected bone or joint.

• With the help of some special instruments, the surgeon removes the bony growth or spur.

• The incision used to close using sutures or staples, and a sterile dressing will be applied.

What Is the Postoperative Care After Midfoot Exostectomy?

After a midfoot exostectomy, patients will typically require a period of rest and recovery to allow the surgical site to heal. The specific postoperative instructions will depend on the individual patient's condition and the extent of the surgery but may include the following:

• Patients may need to wear a cast, brace, or splint to immobilize the foot and promote healing. They can also be advised to use crutches or a wheelchair to avoid putting weight on the affected foot.

• Patients experience pain and discomfort after the procedure and may be given prescription pain medication to manage their symptoms. Over-the-counter pain relievers, including Acetaminophen or Ibuprofen, may also be recommended.

• Physical therapy is recommended to regain strength, flexibility, and range of motion in the affected foot. This may include exercises, stretches, and other therapies to promote healing and reduce pain.

• Patients must attend follow-up appointments with their healthcare provider to monitor their recovery and ensure that the surgical site is healing properly. X-rays and other imaging tests are done to assess the progress of the healing process.

• Patients may need to modify their daily activities or lifestyle to avoid placing undue stress on the affected foot during recovery. This may include avoiding certain types of exercise or physical activity, as well as making modifications to their footwear.

What Are the Complications of Midfoot Exostectomy?

As with any surgical procedure, midfoot exostectomy carries a risk of complications. Some potential complications include:

• Infection require antibiotics or other treatments to resolve.

• Excessive bleeding may occur during or after surgery, requiring additional medical intervention.

• Damage to nearby nerves can result in numbness, tingling, or other sensations in the affected foot.

• The incision site may not heal properly, resulting in scarring, delayed healing, or other complications.

• Patients are at risk of formation of the blood clots after surgery, which can be life-threatening if left untreated.

• In some cases, the bony growth or spur may grow back, resulting in a recurrence of symptoms.

• Complications related to the use of anesthesia, such as allergic reactions or breathing problems, can occur.

What Are the Contraindications of Midfoot Exostectomy?

While midfoot exostectomy can be an effective treatment for midfoot pain in many patients, there are some situations where the procedure may be contraindicated. Some possible contraindications include:

• Patients with severe arthritis in the midfoot may need to be better candidates for midfoot exostectomy, as the procedure may not address the underlying condition.

• Patients with severe peripheral arterial disease may be at higher risk of complications and may need to be evaluated by a specialist before undergoing midfoot exostectomy.

• Patients with certain blood clotting disorders may be at higher risk and may need to be evaluated by a specialist before undergoing midfoot exostectomy.

• In some cases, patients may have poor bone quality or insufficient bone mass to support the procedure, making them poor candidates for midfoot exostectomy.

• Pregnant women may need to delay elective surgeries until after giving birth, as the procedure may pose risks to the developing fetus.

Conclusion

Midfoot exostectomy is a surgical procedure to remove bony growths or spurs from the midfoot that can cause pain and other symptoms. While the procedure can effectively reduce pain and improve function in many patients, it carries a risk of complications. Patients should discuss every possible aspect with their healthcare provider and carefully follow all postoperative instructions to ensure the best possible outcome. Contraindications to the procedure may exist, and patients should disclose their medical history and any potential risk factors to their healthcare provider.