Foot Surgery without pain: myth or truth?
« bunion surgery hurts like hell !»
This idea is widely spread among the public. Almost everyone has a parent or an accointance who has undergone some type of foot surgery, with burning memories of the immediate postoperative period.
What is the thruth about modern-day postoperative pain after foot surgery?
There is a whole range of foot conditions, which may or may not be treated by surgery.
Bunion, or hallux valgus, is one of the most common pathological conditions of the forefoot, and the only definitive treatment is by surgical correction.
Above: x-ray picture of a right foot with severe bunion
The intensity of postoperative pain varies widely according to the type of surgery performed. For example, a small correction of a hammertoe under local anaesthetic may only need rest, elevation of the foot and regular, over-the-counter pain killers. Full bunion surgery with osteotomy (cutting the metatarsal bone and fixing it with screws), on the contrary, may require a supplementary postoperative anaesthesia or analgesia (pain reduction).
The first 24 hours are the most important; after that time, pain generally becomes managable with regular pain killers.
During that period, several techniques may be used to lessen postoperative pain:
regional foot block: a series of injection is done around the ankle, while the patient is still under the effect of the main anaesthesia (general or epidural); this nerve blockade abolishes, or greatly diminishes, postoperative pain, and may last up to 24 hours. This technique is particularly good for outpatient surgery.
popliteal block: a catheter is placed in the back of the knee, in the vicinity of the tibial nerve, thus producing a blockade of the whole foot; this catheter can be kept running for two to three days with local anaesthetic. This is used for more complicated, inpatient surgery.
continuous epidural: A catheter is placed in the spine, and the pain sensation in both legs is blocked; this continuous anesthesia is kept for 2 to 3 days after surgery; this is mainly used when both feet have surgery at the same time.
In conclusion, it is safe to say that modern-day surgery of the foot can be almost painless in the immediate postoperative period, providing that a well-trained anesthetist ensures one form or another of regional, postoperative pain coverage (analgesia).