Bony spurs (exosectomy)

What is an Exosectomy?

An Exosectomy is the removal of an exostosis (a bony lump or spur). Exostoses can be of varying size and shape and can cause chronic pain, which ranges from mild to severe. Exostoses are nearly always benign and can occur as a result of trauma to an area, chronic irritation, a bone infection and arthritis. Some exostoses are hereditary.

Sometimes exostoses grow around a joint margin and cause locking or stiffening of the joint, resulting in pain and immobility. Some exostoses grow under the toenail (subungual exostosis) and can deform the nail plate and cause localised infection.

Why is an Exosectomy performed?

The aim of surgery is to improve comfort. Exostoses can grow upwards and outwards from a bone, making it painful and difficult to wear enclosed shoes. Sometimes the overlying skin can become red, sore and broken – increasing the risk of infection.

Nerves that overlie an exostosis can become irritated, leading to altered / painful sensations in the foot or ankle. A subungual exostosis can be exquisitely painful and can lead to infections around the nail plate and give the appearance of an ingrowing toenail.

Exostoses rarely resolve of their own accord and can increase in size, over time. Not all exostoses require surgery though, and you should weigh up how is makes you feel and how it affects your quality of life, before deciding to have surgery.

What are the risks of surgery?

Surgery carries general risks such as:

• infection
• blood clots
• chronic pain
• painful/ thickened scaring
• numbness
• bleeding
• swelling
• Exostoses can recur.
• Subungual exosectomy may cause permanent loss or deformity of the nail plate.
• Exostoses can cause nerve irritation resulting in burning, pins and needles, shooting pains and/or numb sensations in the foot. This is not always resolved with surgery.

What does the operation involve?

This procedure can be performed as a day case operation, using either general or local anaesthetic. If done using local anaesthetic, you can eat and drink as normal. You will have a small skin incision followed by some stitches and a dressing to cover the wound. You do not usually need to have a plaster cast.

You will have a post-operative shoe and crutches. You must have a responsible adult at home to support you afterwards.

What will happen after the surgery?

1-3 days after surgery

The first 1-3 days are the most uncomfortable. You will receive advice on how to manage pain and will be told how to take painkillers.

You should spend a restful few days with your foot elevated as much as possible. You should drink plenty of fluid and move around the home only to use the toilet and fetch refreshments.

You will usually be able to weight bear on the foot, using your post-operative shoe and crutches, unless you have been advised otherwise. If you do too much at this stage, your foot will swell and the wound will become more painful than expected and may bleed and increase the risk of infection.

1-2 weeks after surgery

Between 1-2 weeks following surgery, you will have your dressing changed and stitches removed. You can usually bathe again once stitches are removed and start to gradually increase your activities, depending on how comfortable you are.

3-4 weeks after surgery

Time from work varies depending on occupation, but an average recovery time is 3-4 weeks, providing you have no complications.

You may be able to fit into a normal shoe and be able to drive again by this point. Recovery may be longer if your surgery was more extensive. You may have some swelling in the foot and ankle for 3-6 months after surgery. This is normal and can be affected by the amount of activity you do.

12 months after surgery

By 12 months, you should have made a full recovery.