What Are Foot Deformities?
The disparity in the structure and anatomy of the human foot is collectively referred to as foot deformities. The human foot is designed to be in a specific shape and form that facilitates the foot’s functioning and enables mobility. All the structures in the foot, including muscles, tendons, bones, ligaments, and joint structures, give a specific structural form to the feet. There are a wide range of conditions that bring in foot deformities. The deformed foot can precipitate troubled walking, painful walking, and even complete functional impairments.
Foot deformities can arise from diverse causes. Some forms of foot deformities are the result of developmental errors that occur within the womb stage (intrauterine life), while some others develop as a consequence of injury or trauma. Foot deformities precipitated by birth are generally categorized as congenital or inborn foot deformities. Certain disease conditions also contribute to foot deformities, like osteoarthritis (a degenerative condition that deteriorates the joint structure).
Foot deformities can be further graded based on the severity of the malformation. Minor foot deformities are frequently encountered and generally do not need therapeutic interventions. Deformities that severely disrupt the functional status of the leg and distort the structural form warrant medical attention. Foot deformities make the individual vulnerable to developing heel pain and leg pain and even influence the way of walking. Abnormal alignment of any of the bones in the foot can also lead to stress buildup in associated structures, eventually resulting in gross leg deformities.
What Are the Surgery Options for Foot Deformities?
There are a range of foot deformity conditions, and none of them demand surgical intervention. Some foot deformities do not bring about appreciable functional impairment. In such cases, there is no need for an extensive surgical approach. Surgical options are considered the last resort for foot deformities, where conservative therapies encompassing physical therapy and orthopedic devices fail to produce fruitful results. In addition, the surgical options are chosen considering the type, severity, and etiology behind the foot deformities. Some of the frequently advised surgical options for foot deformities include the following:
1. Bunionectomy: A peculiar surgical procedure advised for foot deformity caused by bunions. Bunions are abnormal hard (bony) projections or protuberances that develop when the big toe merges with the foot. As a result, the big toe tends to lean over the rest of the toes, creating an unpleasant look. The more the inclination of the big toe, the more severe the condition. The pronounced inclination of the big toe precipitates soreness and puffiness over the bony bump. Bunionectomy refers to the surgical elimination of the bony bump, relieving pressure and stress over the big toe.
2. Tendon Reconstruction Surgery: Here, the tendons concerned with the foot deformity are modified and reconstructed to tackle the foot deformities. Tendon reconstructions are typically advised for flat feet, where the individuals lack the normal arching of the foot’s undersurface. In a flat foot, the foot makes flat contact with the undersurface while upright. The tendons that traverse across the lateral and under surfaces of the foot are reconstructed in such a way as to accommodate the normal foot arching.
3. Tendon Release Surgery: In this surgical approach, abnormally constricted or tightened tendons will be protracted and stretched. It is generally advised to correct a hammertoe, which arises due to exaggerated tendon pull in the toe, particularly seen in the second or third toe. The involved toe always rests in a bent position, with the middle portion of the toe pointing upward, producing a hammer-like appearance. Claw toe deformities, where the toes arch downwards, giving rise to pressure points in the toe, can also be rectified with tendon-release surgery.
4. Ostectomy: In an osteotomy, a tiny bony segment will be eliminated to compromise foot deformity. It is recommended for severe bunions and hammertoe foot deformities. Once a tiny fragment is eliminated, it creates room for the remaining bones to align properly. For certain foot deformities, instead of osteotomy, an osteotomy is performed, where the bone is surgically cut, which enables realignment of the bone fragments in the correct position.
5. Foot Fusion Surgery: These are surgical approaches where the foot’s individual bony components are made to fuse. It has wide applications ranging from arthritis (joint inflammation) to fractures and flat feet. Surgical technique varies in accordance with the deformities. Ankle and hindfoot fusion are variants of foot fusion surgery where the ankle and hindfoot bones are made to fuse, respectively. Bony fusion is assisted by tiny metal-based screws and plates, which keep the bone segments in close proximity and facilitate fusion.
6. Plantar Fascia Release: It is a specific surgical approach primarily performed to mitigate the tension and pull in the plantar fascia (tissue strip that bridges the toe to the heel). The fascia is partly released from the attachments, which aids in fascia lengthening. It is indicated for plantar fasciitis, where the patient experiences tightness and soreness across the undersurface of the foot. Plantar fascia release is preferred only when other nonsurgical and conservative approaches seem ineffective and fail to provide appreciable relief for the patients. In plantar fascia release, the access is made through a heel incision.
7. Tendon Transfer Surgery: This surgical approach is employed for various intricate foot deformities. In tendon transfer surgery, a functional tendon is transferred to an adjacent area where the corresponding tendon is nonfunctional. The transferred functional tendon brings about necessary actions in that particular area, thus compromising the impairment precipitated by the foot deformities. Tendon transfer surgery aids in re-establishing the soft tissue balance in a deformed foot. At the same time, if needed, the bony correction can be incorporated to bring in structural correction. Foot drop (experiences challenges in elevating the front foot), flat foot, and ankle deformity are the conditions for which tendon transfer surgeries are preferred.
Conclusion
There are a wide range of surgical approaches for foot deformities. However, surgical approaches are considered only for indicated cases in which other non-surgical techniques fail. The surgical choice is evaluated by the health care professional considering certain patient factors and their associated success rates. The surgical options offer promising outcomes and enhance the functional status of the legs, enhancing their quality of life. The surgical approach must be determined promptly to bring out the best result for that patient. Diagnostic procedures like X-ray and magnetic resonance imaging techniques often aid in determining the choice of surgical approach.
