Orthopaedic Surgery & Physio / Metatarsalgia

Orthopaedic surgery is any surgery performed primarily on the musculoskeletal system of the body. Common orthopaedic surgeries you may have heard of are joint replacements and reconstructions.

Physiotherapists have a large role to play in the recovery of these kinds of surgeries especially in the more extensive operations, such as a total hip or knee replacement.

It is not unusual to wake up in the hospital a few hours post-op knee replacement, hip replacement or shoulder reconstruction, to have your hospital-based physio asking you to get out of bed for the first time. This may seem daunting and entirely too early, however there is very well researched evidence for why getting out of bed early is so important: your speedy return to normal health and wellbeing!

Hospital-based physiotherapy typically includes re-learning how to walk and making initial improvements on your range of movement and function of the affected joint. The physio will also help you maintain healthy respiratory function by checking your lungs regularly. Drugs administered during surgery change your breathing pattern, which can lead to complications in the days after surgery, and hence the need for physiotherapy management.

Following your in-patient stay, it is highly likely your surgeon will request for you to continue with outpatient physiotherapy either in an outpatient hospital-based setting or in a private-practice setting.

With your outpatient physio, your recovery will be measured and monitored, goals will be discussed and set, and you will be given an exercise program created to achieve those goals.
Physiotherapists use a variety of treatment methods to assist a post-operative orthopaedic surgery patients achieve their goals. These include soft tissue work, stretching, hydrotherapy, manual therapy and gym or home based exercise.

Recovery from orthopaedic surgery can take up to 12 months to occur. During this time, it is not unusual to experience bouts of pain and swelling; however these episodes should reduce the further into rehabilitation you progress.

Many post-operative orthopaedic surgery patients can expect to return to a normal life following a period of rehabilitation guided by a physiotherapist. This includes return to some sport and regular exercise!

Note: Please seek professional advice prior to beginning a post-operative exercise program.

Metatarsalgia

What is Metatarsalgia?

Metatarsalgia is a medical term used to describe pain that occurs in the ball of the foot. This occurs due to rubbing of the long bones of the foot, called metatarsals, causing inflammation. Build-up of inflammation in the ball of the foot compresses the small nerves that run between the toes and along the foot. Inflammation and compression of these small nerves is painful.
The pain can involve one or more joints of the foot including the big toe, second toe and third toe. It is unlikely to include the fourth or fifth joints. On occasion, the pain may involve the entire foot, or larger parts of the foot.
The pain or symptoms may be made worse when bearing weight through the foot, such as walking or running. In severe cases, just standing or even wearing tight footwear can affect the foot.

How does it happen?

Metatarsalgia can be caused by a number of things. An abrupt change in posturing of the lower back or pelvis may alter the way the foot is loaded, and cause rubbing of the long bones. Altered loading of the foot may also be caused by arthritic conditions that affect the knees, hips or pelvis and carrying extra weight.

Unavoidable factors, which may lead to the development of metatarsalgia, include increased age, and the physical shape of the foot and toe. As your body ages, the ligaments of the foot may loosen or weaken. Therefore, the bones of the foot move differently leading to altered positioning and loading of the foot.

Avoidable factors, which may lead to the development of metatarsalgia, include wearing inappropriately fitting footwear, and the type of exercise performed. Metatarsalgia is more highly associated with high impact-type exercise such as running or gymnastics.

What are the signs and symptoms of Metatarsalgia?

The signs and symptoms of metatarsalgia may vary from person to person. Generally, a complaint of pain is common. This may range from mild to severe, or may be described as burning or shooting pain in the foot or toes. Another common description is a tingling sensation in the foot or toes.

Typically, symptoms worsen when weight bearing and improve once weight is removed from the foot.

How can Physio help?

Your physiotherapist will determine the cause of the metatarsalgia pain and assist you with adapting your posture, or improving the loading pattern of your foot. You may be advised to unload the foot by reducing or stopping exercise, changing the shoe you wear, or strengthening certain muscles in your legs.

Electrotherapeutic modalities such as icing, ultrasound or interferential therapy may be of assistance to reduce pain and inflammation in the beginning stages of treatment as well.

The information in this newsletter is not a replacement for proper medical advice. Always see a professional for assessment of your individual condition.

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