Complications

Complications of any surgery occur despite the best efforts of surgeons and medical staff to prevent them. The surgery that we perform is inherently safer than traditional forms of foot surgery as the surgery itself will be undertaken under local anaesthetic, as a day case patient with the earliest possible mobilisation.

Other factors that help us reduce complications are appropriate choice of procedures and undertaking the surgery carefully as well as mobilising patients with a sensible post-operative regime. All steps are taken at the hospital to ensure that modern practices are followed to help minimise risks.

We have a leaflet explaining the general risks that are faced with foot surgery and in part will apply to all types of foot operations and, indeed, all types of operations. Please check that you have been given the leaflet if you are going to have an operation.

NORMAL SYMPTOMS

Post-operative pain and swelling

Both of these are inter-connected and by carefully following the advice of the podiatry team should be minimised with the use of painkillers and resting techniques.

Bleeding

To some extent the wound will bleed after surgery. Rarely this will bleed through the large dressing that has been placed on the foot and this would be the only time that the dressing would need to be changed. Usually this is done via the practice nurse at your surgery to make your foot comfortable. However, if you have any specific concerns please feel free to contact us.

POSSIBLE COMPLICATIONS

Infection

The measured infection rate for patients undergoing foot surgery is 0.8% (less than one in 100 patients). We have no record of MRSA or other hospital “super bugs.” Basically infections can present in one of three ways.

• The commonest are skin and soft tissue infections, which are treated relatively quickly with antibiotics. Usually these will clear within a week.
• Bone infections can occur but fortunately this is very rare. These often need prolonged courses of antibiotics to provide a cure.
• Exceptionally rarely infections can be catastrophic to patients and result in permanent disability or even death. Fortunately this is an extremely rare complication, particularly with local anaesthetic surgery as a day case.

The most reliable symptom of infection is worsening pain that is not relieved by rest and elevation with painkillers.

Deep Vein Thrombosis (DVT)

A deep vein thrombosis (DVT) is where a clot develops within a vein of the lower limb in particular. It is a recognised risk of all forms of surgery and indeed is very relevant for world travel these days with long-haul flights. Overall I would expect one in 450 patients to develop a DVT that requires treatment. A complication of a DVT is the development of a pulmonary embolus where the clot shifts from the leg into the lung. This is a serious complication that would require in-patient hospital admission for its care.

The symptoms of a DVT are pain and swelling of the lower limb, particularly swelling that does not disappear with resting or elevation of the leg.

N.B. You should NOT undertake a long flight (greater than 6 hours) two weeks before or one month after your surgery.

Failure of the Procedure

Occasionally with healing following surgery problems occur in one of several ways. At times the healing rate is very slow and patients can experience delayed healing where the bones in particular take much longer to fully heal than expected. This can, in some cases, result in non-healing of bone, which may be associated with infection or failure of internal fixation.

Recurrence of deformity or failure to achieve the aims of surgery can happen. Approximately two patients in 100 would probably require further surgery to their foot, as the aim of the surgery has not been met.

Occasionally surgery is performed which completely solves the original problem although the patient can be left with secondary problems. These mainly fall into two categories:

• Mechanical changes within the foot that displace pressure from one area to a second, which then fails to cope with this increased workload. This is often termed metatarsalgia if it occurs in the fore foot.
• The healing process itself may be faulty and occasionally operation sites can remain stiff or swollen and indeed the wound line itself could remain numb or hypersensitive. A very rare complication of surgery is chronic regional pain syndrome where the foot or limb remains hypersensitive following complete healing of the site.

The important thing to remember about your foot surgery is that the vast majority of people do well, however all patients should be aware of complications. If at any time you are concerned about your foot or leg then you must seek appropriate treatment either on the advice of Mr Jones or via your GP. Should you be in a position where neither are available then please make contact with your local accident and emergency department.