Painless foot surgery: myth or reality?
Introduction
“Foot surgery is not very successful. »
“Foot surgery hurts a lot. »
These two ideas are quite widespread in the population. Indeed, everyone has an acquaintance, a relative, a friend who has undergone an operation in the region of the foot, with often mixed results, and sometimes painful memories. What about now?
Diseases and problems of the foot and ankle
Foot problems can be very varied. The majority of cases are treated without surgery, but a number of situations require one, especially after other treatments have failed.
Here is a brief overview of the main conditions:
chronic tendinitis of the heel (plantar fasciitis, heel spur)
flat foot
ankle sprains
inflammations and ruptures of the Achilles tendon
the “bunion” of the big toe (hallux valgus)
Morton's neuroma
corns on the feet (claw or hammer toes)
ankle osteoarthritis
a special case: rheumatoid arthritis
Corrective foot and ankle surgery: what, when, how, where?
minimally invasive Achilles tendon suture
Morton's neuroma surgery
the correction of the bunion of the big toe by the method of "scarf"
big toe bunion correction by fusion
claw toe correction
treatment of ankle osteoarthritis by prosthesis
treatment of ankle osteoarthritis by arthrodesis
Foot surgery without pain: which anesthesia?
The severity of post-operative pain after foot surgery depends a lot on the extent of the operation: thus, a claw toe correction limited to a single toe generally only requires a little rest with constant elevation of the foot and simple painkillers, such as ponstan or dafalgan. As surgical procedures are added to a foot, post-operative pain and swelling will become more severe, as for example in cases where a bone has to be cut and fixed in a position. corrected (Ex. the "scarf" operation).
Thus, for the operation itself, the technique is chosen by the patient and the anesthesiologist by mutual agreement: either general anesthesia (complete narcosis), or loco-regional anesthesia (spinal anesthesia, epidural anesthesia).
The first 24 hours are the most painful period after foot surgery; it is therefore essential to have techniques that allow the operated limb to be left "asleep", or in any case less sensitive during this period of time.
Several possibilities are available to us:
regional foot block: a series of injections around the ankle is performed at the end of the operation, when the patient is still under the effect of the main anesthesia; this blockage of the sensory nerves ensures a comfortable level of pain for 12 to 24 hours. This technique is mainly used for small operations, or for outpatient procedures.
the popliteal block: a catheter is placed in the hollow of the knee, generally before the operation; anesthetic products are then injected into it which thus “sleeps” the nerves which go to the foot. This catheter can be maintained for 2 to 3 days. This technique is used for heavier operations.
the epidural continues: as for any epidural, a catheter is placed between two lumbar vertebrae, and an anesthetic is injected into it which first produces complete insensitivity of the 2 legs, for the time of the operation. For the postoperative period, we switch to a less powerful product, which leaves mobility more or less intact, but eliminates pain; thus the patient can quickly begin walking rehabilitation while having bearable pain. This technique is mainly used when operating on both feet in the same session.