The foot plays an extraordinary role in the body. Small bones take the entire body weight plus additional pressure load from walking, running and jumping. Feet and toes are densely connected to nerve endings which help us to stay balanced and navigate the terrain. They are in constant use and contact with the environment. No wonder then that the feet are prone to injuries, deformities and pain over a person's lifetime.
Many disorders of the feet are temporary and self-limiting in nature. Painful conditions such as neuromas and plantar fasciitis (heel spurs) are usually managed non-operatively with a trial of activity modification, weight management, podiatry, physiotherapy, splinting braces, orthotics, injections and shockwave therapy, as the vast majority will recover with time.
Some deformities, such as painless bunions, can be unsightly but do not require surgical treatments. Other patients with chronic foot pain may be able to manage with analgesics. However, when pain is no longer manageable and interfering with sleep or activities of daily living, then surgery may be recommended. By the same token, patients with deformities that are worsening, affecting walking / standing / balancing capacity, or those causing pressure areas with skin breakdowns can be considered for surgery.
Contrary to popular belief, foot surgery is not a simple matter. The foot is more prone to post-operative complications, owing to various factors such as poorer circulation, gravity-dependent swelling and substantial load. These all result in a higher risk of wound breakdowns, infections, nerve and circulation problems, chronic pain and recurring deformities.
Post-operative pain and swelling can also be significant, and can take a long time to improve. Even when an operation proceeds exactly to plan, approximately 10% of patients will still find that the surgery did not deliver the desired outcome.
Therefore, the ultimate decision to operate is a carefully considered process. Dr Won will work through the risks versus benefits and the recovery time involved, taking into account each patientâ€™s circumstances, needs, expectations and health status. Indeed, one size does not fit all.
Dr Won is fellowship-trained in the orthopaedic subspecialty of foot and ankle surgery, and is experienced in performing the following procedures and uses minimally invasive surgical techniques where possible:
Deformities are corrected by a detailed analysis of the mechanics, working out a plan of what soft tissue, bone or joint interventions are needed. Where possible, movement is spared by rebalancing tissues or realigning bones. However, when there is advanced arthritis, some of the joints may have to be fused or locked. The healing phase is therefore very much the same as a "broken" foot.
Dr Won often utilises minimally-invasive techniques, where small incisions are used to perform the operation, to help minimise the soft tissue disruption and hence reduce pain and the risks of complications. Examples include keyhole bunion correction and surgery for toe deformities.
Depending on the level of deformity and location of arthritic changes, often a combination of soft tissue and bone procedures may be needed to restore the foot to a normal alignment and function. This may include tendon releases, transfers, ligament reconstructions, osteotomies and fusions. Where possible, minimally-invasive techniques such as keyhole osteotomy (bone cut) are used together with fluoroscopic (real-time x-ray) guidance to reduce soft tissue disruption.
Fracture management is tailored to the pattern of injury, the intrinsic stability, the fragmentsâ€™ position and the patientâ€™s circumstances. Dr Won is able to offer fixation for acute fractures of the calcaneus and talus, to more complex patterns like Lisfranc injuries. Non-healing (non-union) and mal-positioned (malunion) fractures can also be treated with fixation and bone graft when needed.