Healthy, beautiful feet by specialist foot surgery

Complex Fore Foot Deformity (CFFD) is the most common pathology of the foot, which only can be treated successfully by surgery. Over years the disease progression leads to dramatic changes in the structure of the foot. The most visible is the bunion. The metatarsal head becomes prominent because of an abnormal tension of two groups of muscles and tendons building the square and longitudinal arch and drawing the toe-part to the lateral side of the foot. As the large toe bends to the lateral side in an extreme way, the neighbouring toes are deformed by lack of space. The pressure between the toes rises. The consequences will be calluses, under crossing or crossover of the toes, and finally claw and hammer toes.These are the full symptoms of CFFD. The affected foot does not fit into normal shoes and each step causes pain. This pain will only become worse. In order to restore comfortable walking and the functional aesthetics of the foot, the physician, specialised in these pathologies, will advise surgical correction.

Most patients present themselves too late to the specialised physician, usually when the pain becomes intolerable and the wearing of normal, pretty shoes is impossible. However, the pain is the last signal and occurs at the end of the deformity of the foot, which has been taking place over 10 to 15 years. With new techniques, specialists can make gentle corrections to the CFFD at an early stage. Regretfully the longer people wait, the more difficult the correctional operation will be.

If the early indications of CFFD are recognised, the foot and ankle specialist can perform a micro-invasive operation right after diagnosing the closure of the epiphyses. Females start this physiological process at the age of 14 and men at the age of 18. Thus the new, careful operative techniques can be performed very early in life. As well as improving the condition of the foot, the surgery also helps to improve quality of life – a most important benefit.

The first target is the preservation of a functioning toe joint. These operations, involving the shifting and repositioning of the metatarsal head part, are named after their inventing surgeon in most cases. At present there are 138 different techniques of which 25 procedures have become the gold standard in modern foot and ankle surgery. Nowadays the most successful and most preserving operation technique is the 3D bone shift and conversion operation of the first metatarsal bone – the BOESCH technique –  performed as a micro-invasive procedure, i.e. the necessary incision is about 5 to 7 millimetres. Alongside that procedure, the square and longitudinal arch can be corrected to an anatomically correct position, a very important step to optimise the function of the foot.

The operation requires a very careful bone conversion and repositioning in a step-by-step procedure. After making an incision in the skin right under the prominent bunion the procedure is performed by 4 steps.

  • Step 1: Separating the first metatarsal bone by a fast drilling mill.
  • Step 2: By shifting the distal part of the separated bone to the lateral side the valgus (X) angle of the big toe is corrected to a normal upright position and new functional aesthetic form
  • Step 3: The rotated toe can be normalized by counter rotation to the normal dorsal looking position.
  • Step 4: At the same time the square and longitudinal arches are pulled up by a vertical repositioning and downshifting of the distal bone portion. This will reconstitute the lost shock-absorbing function of the foot.

All of these steps are performed by the specialist, like a sculptor remodeling the foot. The final step is to fix the rebuilt foot by an inner titanium K-wire so the new foot form cannot be disturbed by slipping.

The small incision, the covered, not open procedure and the temporary, fixating titanium K-wires are great advantages for the patient. In over 90 per cent of the cases both feet can be done at the same time, because both feet can be loaded immediately after the operation due to the inner wire-fixation. The patient is able to take care of him/herself, from walking out of the clinic until the day the wire is taken out in a simple pain free process. The demands of daily life can be managed as normal albeit not as nimble as before. Most of the patients do not require external care and will be able to manage independently. A medication regime helps patients to stay pain-free during the recovery.