Rheumatoid Arthritis

What is wrong with my foot?

Many or all of the toes have buckled and deformed making the joints in the forefoot prominent.  Rubbing on the joints making them red and painful. 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 develop.

Why has this happened?

Such pain and deformity within the forefoot is usually caused by either acute trauma or systemic conditions such as Rheumatoid arthritis or Diabetes.

Do I have to have an operation?

Pads, splints, foot orthoses/insoles and special shoes can be used to provide comfort but are unlikely to reduce the deformity. If the foot is still uncomfortable despite these measures then an operation will usually be recommended.

What will the operation involve?

There are several options for surgery and your surgeon will discuss which is the best option for you. Surgery usually involves fusing the big toe joint and either removing a section or fusing one of the joints of the remaining toes. The procedure also involves removing sections of bones from the ball of the foot. The corrected position of all of the toes is maintained with wires, which are left in for 5 weeks. The surgery is usually performed under general anaesthetic. The foot will be heavily bandaged after the operation.

How successful is the operation?

85% of people are very satisfied with the results of the operation, as they have much less pain from the foot.

Are there any risks associated with the operation?

As with all operations there are risks associated with the anaesthetic. Occasionally some patients may have complications such as infection, nerve or vascular damage or some loss of correction. The foot is often swollen for 6 months after surgery and can take a whole year to fully recover.

What will happen after the operation?

You will need to stay at least one night in hospital. The Podiatric surgeon will discuss this with you. For the first 48 hours you will rest in bed with your legs elevated and should take the painkillers prescribed for you. You will be asked to do some foot exercises during this time. You will be given special shoes to wear over your bandages and you must wear these whenever you want to walk. The shoes must be worn for 5 weeks. If used, the wires will be removed at 5 weeks. You may need to use crutches.

What happens when I leave hospital?

You will be given an Orthopaedic and Fracture clinic appointment to have the dressing changed, usually at 2 weeks. The foot will need to be bandaged until the wires are removed and you must keep the foot dry during this time. You will be able to return to work 8-12 weeks after the operation, depending on whether you need to stand or walk around a lot for your job. It is recommended not to drive until you come out of the post-operative shoe.