Why do you have foot reconstruction surgery?
Foot diseases may make parts of daily life difficult and frustrating. Severe foot conditions often require long-term care and rehabilitation. They may affect one’s mental health, personal and social life, making them dependent on others for physical and emotional support.
The foot is divided into four regions:
- Upper surface (dorsum)
Foot reconstruction considers the tissue reconstruction, function restoration, cosmetic rehabilitation and whether the foot can or should be saved by reconstructing.
The final choice of different reconstructive options relies on the extent of the disease and the surgeon’s preference.
What are the causes of foot defects?
Foot defects typically occur in six key conditions:
Many foot injuries result from motor vehicle or work-related accidents. The severity of such cases depends on how much of the tissue is damaged and whether the bones in the foot have been affected. Foot trauma is classified by severity as follows:
Type I: soft tissue loss less than three square centimeters
Type II: soft tissue loss greater than three square centimeters without bone involvement
Type III: significant tissue loss with bone involvement
Diseases of the foot
Vascular diseases (blood vessel related): Destruction to the blood vessels; artery or vein leading to ulcers or tissue death and infection.
- Sarcomas of the bone or of soft tissues
Malformation: Birth defects such as the clubfoot or spina bifida.
What are the methods of foot reconstruction?
- Small wounds with living soft tissue can be treated medically.
- Open wounds with dead soft tissue and/or bone often require surgical debridement (removal of foreign bodies/ damaged/ infected/ dead tissue and bone from wounds).
- Once all dead tissue is removed, skin grafts or flaps may aid in wound healing.
- Depending on the depth of the defect and extent, the flap type is decided.
- Three kinds of flaps could be considered based on the use of skin, muscle and bone during reconstruction:
- Fasciocutaneous flap: tissue flaps that include skin and the underlying tissues
- Musculocutaneous flap: includes skin, underlying tissue, fat, and muscle along with rich blood supply
- Osteocutaneous flap: bone-containing flap with elements of skin, underlying tissue and with blood supply
- Tendon transfers, tendon release and tendon lengthening procedures are also performed to restore anatomy and function.
- Amputation may be required if reconstruction is not recommended or when function can be improved by use of prosthetics.
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When should foot reconstruction surgery be avoided?
People who have the following are not good candidates for foot reconstruction surgery:
- Bacterial or fungal contamination and necrosis (tissue death)
- Large tumors
- Severe trauma or degeneration
- Severe vascular or metabolic disease
- Poor general health
- A severe tobacco smoking habit
What are the complications of foot reconstruction surgery?
The risks, complications and side effects of foot reconstruction surgery include:
How long does it take to recover from foot reconstruction surgery?
- Recovery time depends on the extent and type of reconstructive surgery.
- The patient may require complete bed rest for two to three weeks, after which they can start walking slowly with or without support.
- The leg should stay elevated the first two weeks and may be in a cast.
- Stitches may be removed after 10 to 14 days.
- It is not advised to apply weight on the operated foot for six to eight weeks.
- Around 12 weeks after surgery, patients may be able to wear normal shoes with or without a foot or ankle brace.
- Complete recovery can take up to a year depending on the surgery performed.
- Regular follow-up and physical therapy may be necessary
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