Forefoot Reconstruction

Many or all the toes have buckled and become deformed making the joints in the forefoot prominent. Rubbing on the joints makes them red and painful and hard skin or ulcers often develop at these pressure sites. If the toes have been in this position for a long time, then arthritis will almost certainly develop.

Performed under general anaesthetic, your surgeon will fuse the big toe joint and either remove a section or fuse one of the joints of the remaining toes. The procedure also involves removing sections of bone from the ball of the foot. The corrected position of all the toes is maintained with wires, which are left in for six weeks.

The foot will be heavily bandaged, and you will be given a special shoe to wear over your bandage which must be worn whenever you walk about. The shoe can also be worn in bed to keep the weight of the sheet off your toes.

For the first 48 hours you should rest with your legs elevated above hip level in bed or a chair. It is important to perform anti-DVT (deep vein thrombosis) exercises 15 times every 30 minutes, whilst resting in bed or a chair. * See DVT symptoms in general post operative information. You will be given two compression stockings (so you can alternate them daily) to wear on your other leg. These need to be worn until normal mobility is resumed. One should be kept on during the day and removed at night; use the spare the next day after your bath or shower.

Pain control

Most people will experience some discomfort as the local anaesthetic wears off. It is recommended that the pain-relieving medication given to you is taken before the local anaesthetic wears off and then regularly at the maximum recommended dose sage for the first two to three days.

Ice packs (a proper ice pack or frozen peas wrapped in a tea towel) will also help with discomfort. These can be applied for 10 minutes every two hours, but not directly onto the skin or on top of the dressing but on your shin above the bandage.

Mobilisation

When you start walking around after your operation you should always wear your special shoe and use crutches if they have been issued.

Bleeding

Bleeding is more likely to happen in the first few days after your operation, especially if you are walking on it too much. If you notice any blood seeping through your dressing, wrap a clean towel on top of the dressing and put your foot higher than heart level and call your GP or 111 for advice.

Wound care

After an operation you will have a surgical wound where the surgeon made a cut into your skin and tissue. It is important you take good care of your wound to lower your risk of infection and ensure it heals. You will be given advice about this on the day of surgery. Keep your dressing dry (do not remove or adjust it) and do not get your feet wet. You can buy waterproof protection sleeves which will enable you to bathe or shower as normal. You will be given a clinic appointment to have the dressing changed after two to three weeks. If wires are used these will be removed after six weeks. The foot will be bandaged until the wires are removed. The black Darco shoe should be worn this whole time, and you may need crutches to get around.

Infection

Most surgical wounds will heal without causing you any problems. A wound infection can develop at any time from two to three days after surgery until it heals. Very occasionally, an infection can develop several months after an operation.

Look out for these signs and symptoms of infection:

• Heat around wound.
• Increased pain.
• Wound discharge.
• High temperature.
• Generally feeling unwell.

If you have any of the above symptoms, please contact your GP or dial 111.

You will be able to return to work from eight to twelve weeks after the operation, depending on whether you need to stand or walk a lot in your job. We can give you a Statement for fitness form if your employer requests one.

Please remember it is an offence to drive a vehicle while restricted by a post-operative boot or shoe.