What Is Reconstructive Foot Surgery? Purposes

Foot reconstruction is a surgery performed to correct the anatomy of the foot and restore function.

Foot reconstruction is a surgery performed to correct the anatomy of the foot and restore function lost due to trauma, birth defects, infection and other illnesses.

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:

• Ankle
• Sole
• Upper surface (dorsum)
• Toes

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.

Foot defects typically occur in six key conditions:

Major injuries

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.

Metabolic diseases: Metabolic diseases like diabetes, gout and alcoholism induce alteration of blood and nerve supply to the whole body causing painless, crater-like ulcers on the foot

Tumors including: 

• Melanomas
• Epitheliomas
• Sarcomas of the bone or of soft tissues

Infection: Infected ulcers often are from trauma, vascular disease, or diabetes due to low tissue oxygenation of tissues

Malformation: Birth defects such as the clubfoot or spina bifida.

• 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.

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

The risks, complications and side effects of foot reconstruction surgery include:

• Reaction to anesthesia
• Hematoma (blood clot)
• Infection
• Partial or complete loss of the flap or graft
• Pressure sores
• Clots in the arteries and veins

• 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