Procedures

Skin is a natural barrier to infection so anything that breaks this, from a graze in the garden to major surgery, puts you at some risk of infection. The level of risk depends on a wide range of factors relating to both the surgery and your health. Whilst we cannot entirely prevent infection during surgery we do take steps to reduce this risk as much as possible, such as prescribing antibiotics at the time of surgery and sometimes afterwards. If you are unfortunate enough to suffer an infection, the vast majority are thankfully minor and just treatment with antibiotic tablets to clear everything up. Rarely, infection can be more serious and may require an admission to hospital or further surgery.

Whenever we cut skin, the body heals the wound by forming scar tissue. Scars around the foot and ankle tend to heal nicely, but occasionally you may be left with noticeable scars. This tends to happen if something interferes with the skin healing, such as infection or excessive swelling. Moisturising and massaging healed scars, as well as avoid sun burn on them, will help soften any scar. There is also deep scar in the wound that can make a joint stiff. Where possible, “Minimally Invasive Techniques” can be used, which creates the smallest possible scar. But this is not possible for all operation.

Around the foot and ankle there are many large and small nerves that supply feeling to the skin. Whilst Mr Talia is an expert in the anatomy of the foot, occasionally nerves do get damaged during surgery. Damage to a nerve can cause an area of numbness which most patients are not too troubled by. Occasionally nerve damage can also lead to troublesome pain or a tender scar. Most nerve symptoms improve over time but some can be permanent.

Rarely the nerve damage can be bizarre and complex, with pain, stiffness, abnormal sweating and over sensitivity on a small area or region. This is called complex regional pain syndrome and can be difficult to manage. Thankfully, this is very rare.

Any surgery that slows down your walking probably carries a risk of the development of a blood clot in your leg, known as deep vein thrombosis or DVT. In exceptionally rare situations a blood clot can spread to the lungs and be fatal.

Thankfully the risk of blood clots in your leg following most foot surgery is very low. To reduce this chance, we recommend measures such as a stocking on your other leg and getting you up and moving straight after surgery. However, in certain larger procedures, especially those requiring a plaster cast afterwards, or if you have had a clot before, the risk is enough to warrant using a medication to reduce that risk (VTE chemoprophylaxis). This mostly takes the form of a daily injection (Clexane) that you will be taught to give yourself, for either 2 weeks or 6 weeks after surgery. You will be shown how to use this by the nursing staff on the ward following surgery.

To achieve the best possible outcome a further operation may be required, especially if you have had a complication. Once an operation has successfully relieved the problem that you first came to see us about, unfortunately a new problem can arise in one of the many structures nearby in the foot, which may need further treatment. The commonest second operation we do is to remove a screw or a plate, which has become noticeable under the skin after the swelling has gone down. The screw was needed to help the bone heal correctly, it can be removed in a small operation down the track (usually many months) as a day case.

In some situations further surgery is mandatory, such a removing a screw or plate that is crossing a joint. If this is the case Mr. Talia will discuss this with you when booking the first operation and this will be done in a planned fashion.