Put your best foot forward with forefoot surgery

Written by: Mr Andrew Skyrme
Edited by: Karolyn Judge

Alongside a variety of forefoot surgeries that address different conditions affecting this area, there are numerous reasons why people require it. You may need to relieve your pain, have a deformity treated or require the restoration of normal function in your forefoot.


Here to provide an expert guide to forefoot surgery, taking in its aims, what’s involved and its risks, among other in-depth points, is highly-experienced and respected consultant orthopaedic surgeon Mr Andrew Skyrme.


Woman walking outdoors on a path, using her forefoot


As an orthopaedic surgeon I carry out a significant amount of lower limb surgery including hip replacement surgery, knee replacement surgery, but also foot and ankle surgery.


What are the aims of forefoot surgery?

Within the foot and ankle, forefoot surgery is very common. This essentially involves surgery on the big toe, the lesser toes and the midfoot. The aims of surgery are generally to reduce pain, restore function and restore anatomy. A significant number of forefoot conditions cause deformity, that is to say crossing over of toes, hammer toes, bunions etcetera., all of which become uncomfortable, painful and make footwear very difficult.



What is the most common forefoot condition?

The most common forefoot conditions are bunions, which medically is known as hallux valgus, arthritis of the great toe, which is called hallux rigidus, and then lesser toe deformities. These are generally hammer toes, claw toes and mallet toes. Surgical correction of these conditions is relatively straightforward.



What’s involved in surgery for this condition?

For the great, or big, toe it involves a corrective osteotomy which effectively involves breaking and straightening the great toe, which can be done minimally invasively. Arthritic great toe conditions generally involve clean-up of the great toe which is called a cheilectomy, or a fusion of the great toe.


Fusion of the great toe is an excellent operation in resolving pain completely and despite pre-conceived ideas of reduction in movement, it is amazingly well tolerated with great functional results.


Lesser toe corrections likewise are reasonably straightforward and involve breaking and straightening the toe and fixing it with small wires for a period of weeks.


The recovery from this type of surgery is generally six weeks in a heavy bandage with reduced activity. The patient is able to walk around, but with reduced activity.



What are the risks of forefoot surgery?

After surgery, one needs to elevate the foot to reduce swelling. There are risks associated with forefoot surgery, which include under correction, over correction, infection, thrombosis, mal-union, non-union and nerve injury.


As a rough guide the satisfaction with forefoot surgery is in the order of 85 per cent. To retain a high percentage of satisfaction it involves adherence to instructions, which effectively are after the operation, elevation of the limb to reduce swelling and we often use protected weight-bearing, that is to say crutches, for a few weeks.


As a lower limb surgeon, I carry out hundreds of forefoot operations per year to correct these deformities; the most common being bunions, arthritic great toes and lesser toe deformities.



If you’re looking for relief from forefoot deformity, pain or incorrect functioning, and require expert surgery, arrange an appointment with Mr Skyrme via his Top Doctors profile.

By Mr Andrew Skyrme
Orthopaedic surgery

Mr Andrew Skyrme is a highly-experienced and respected consultant orthopaedic surgeon based in Crowborough, Brighton and Eastbourne as well as Seaford. He specialises in lower limb disorders, taking in hip replacement, knee replacement and foot and ankle surgery alongside knee arthroscopy, bunion surgery and sports injuries, privately practising for Horder Healthcare and Sussex Premier Health at clinics in Crowborough, Eastbourne and Seaford as well as the Michelham Private Patients Unit at Eastbourne District General Hospital (DGH) and Nuffield Health Brighton Hospital. His NHS base is DGH at East Sussex Healthcare NHS Trust.  

After qualifying in medicine with an MBBS from Guy's Hospital in 1993, Mr Skyrme underwent specialist further training at the Royal College of Surgeons, England, in the south east of England and at the renowned Mater Hospital in Sydney, Australia. Here he worked with Dr Bill Walter who is one of the in-demand hip surgeons in the world. 

Following this, Mr Skyrme established himself as one of the busiest joint replacement and foot and ankle surgeons in the south east, regularly carrying out over 650 foot operations per year. Much of the forefoot and hip replacement surgery he performs are carried out as a day-case procedure, using specialist anaesthetic and surgical technique to allow for rapid recovery. 

Mr Skyrme's clinical research has been published in various peer-reviewed journals and subsequently he became the associate editor of the Journal of Bone and Joint Surgery in 2013. Furthermore, he is the joint author for the book 'Common Spinal Disorders Explained'. He is also passionate about training young surgeons during their training and has been the Royal College Tutor for Eastbourne DGH since 2005. 

He is a respected name in delivering quality service and is the south east representative at the National Joint Registry. He is also an active member of various professional organisations, including The British Hip Society (BHS), British Foot and Ankle Society (BOFAS) and the British Orthopaedic Association (BOA). Furthermore he has membership at the Medical Protection Society (MPS), the British Medical Association (BMA) and is a fellow of the Royal College of Surgeons (RCS).

He also undertakes medico-legal work, completing three medical reports a week in the principal areas of lower limb injuries, spinal problems and whiplash. 

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