Ankle Surgery

Conditions that May Require Surgery

 

 

Arthritis

Arthritis (inflammation to a joint) can affect any joint of the foot or ankle. This typically produces pain, swelling and warmth. It eventually can lead to destruction of the joint resulting in deformity, stiffness, decreased range of motion, and the inability to ambulate normally.

There are numerous forms of arthritis. The most common type in the foot is called osteoarthritis.

Other forms include:

• Rheumatoid arthritis
• Psoriatic arthritis
• Reactive arthritis
• Septic arthritis
• Gout

Osteoarthritis is characterized by a destruction of cartilage within a joint. This typically stems from repetitive stress on a joint that is breaking down. It is a degenerative process and typically advances with age. Joint cartilage is the smooth, hard tissue that covers the end of the bones at the joint.

This is essential for the normal function of a joint as it helps protect the bones during movement. When the cartilage is broken down, it can cause joint space narrowing, extra bone formation and cystic formation (pockets of fluid within the bone). When the bones are no longer covered by this smooth surface, mechanical rubbing will continue to precipitate inflammation and pain.

Common reasons for development of osteoarthritis are trauma or underlying biomechanical abnormalities that precipitate increased strain on a joint.

Diagnosis typically starts with obtaining X-rays to evaluate the bony architecture of your feet. Advanced imaging studies such as CT or MRI are sometimes recommended after a thorough clinical evaluation is performed.

Nonsurgical treatment is typically the first approach and can be effective to help relieve symptoms. As the arthritis continues to progress, surgery may become the recommended course of treatment.

 

Equinus

Equinus is a condition characterized by limited upward motion at the ankle joint. You may notice this when you try to bring your toes up to your shins on one or both of your legs.

You also may be wondering what is causing this condition. The usual culprit is a tight Achilles Tendon, which is formed by the combination of the two calf muscles: the gastrocnemius and the soleus.

There are a multitude of conditions that can cause a tight Achilles Tendon and accompanying equinus including:

• Persistent inactivity
• Staying in a fixed position for a long period of time (for example when in a split or cast)
• Congenital predisposition
• Other medical conditions such as diabetes mellitus
• Less often, equinus can occur due to an osseous (bony) problem such as arthritis or loose bony fragments

The consequences of equinus can be significant if left untreated. Correlated pathologies include:

• Plantar fasciitis
• Flat feet
• Tendonitis
• Arthritis in the forefoot, midfoot and rearfoot
• Fatigue in your lower extremity
• Bunions, hammertoes
• Pain in the forefoot, midfoot, hindfoot and ankle

The Achilles Tendon is the largest and strongest tendon in your body. You can imagine when this is abnormally tight that it could have some very grave consequences on the foot and ankle. You may be experiencing some of the symptoms of this condition without even knowing it!

As your body tries to compensate, you may experience some of the above-mentioned issues. It is important to visit with a specialist who can help evaluate the totality of your condition.

 

Osteochondritis Dissecans (OCD Lesions)

Osteochondritis Dissecans, also commonly referred to as an osteochondral lesion (OCL) or osteochondral defect (OCD), is a condition in which there is a cartilaginous defect within one of the joints in your foot or ankle.

A joint, also called an articulation, is comprised by the ends of two bones that are covered by a smooth, spongy surface called cartilage. The purpose of joints is to withstand large compressive and loading forces while allowing fluid movement between the two bones.

When there is damage to the cartilage within the joint, a defect is sometimes created. The most common place for these lesions to occur is on the cartilaginous surface of the talus (one of the bones comprising the ankle joint).

Some injuries that could lead to an osteochondral defect are:

• Ankle sprains
• Sports injuries
• Lower extremity trauma

Symptoms typically include:

• A dull, aching
• Deep pain in the ankle

Some patients may feel:

• A clicking sensation
• Decreased mobility of the joint
• Increased swelling
• General instability

Diagnosis typically begins with X-rays and a thorough clinical evaluation. While this can sometimes confirm an OCD lesion, often times advanced imaging studies such as CT or MRI are required. Treatment depends on the location and severity.

 

Haglund’s Deformity (Retrocalcaneal Exostosis)

A Haglund’s Deformity is a bony prominence that develops on the back of your heel bone where the Achilles Tendon inserts.

This deformity can arise from various factors, including:

• Genetics
• Foot structure
• Tight calf muscles
• Ill-fitting shoes

It is more commonly observed in women, often due to wearing high-heeled shoes. Individuals with Haglund’s Deformity may experience swelling, redness, and tenderness at the bony prominence. Additionally, it can cause friction and skin irritation, leading to the formation of blisters or calluses.

The treatment for Haglund’s Deformity varies based on the severity of symptoms. For mild cases, home remedies such as wearing open-backed shoes and using heel pads can alleviate discomfort by reducing pressure on the bony prominence.

In more severe instances, your doctor might suggest physical therapy to stretch tight calf muscles and strengthen the surrounding muscles, thereby alleviating symptoms.

Orthotic inserts could also be prescribed to help redistribute weight and reduce heel pressure. For extreme cases where conservative treatments prove ineffective, surgery may be necessary.

 

 

Tarsal Tunnel Syndrome 

The tarsal tunnel is an region on the inside of your ankle that is defined by a small, narrow space. Several important structures through area such as tendons (posterior tibialis, flexor digitorum longus, flexor hallucis longus), arteries, veins, and nerves.

A thick ligament is overlying it to protect the underlying structures. When this area becomes compressed, tarsal tunnel syndrome can present significant dysfunction and pain throughout the foot and ankle.

You may experience:

• Burning
• Tingling
• Numbness
• Electrical shocks
• Pain and dysfunction

You may notice this is intermittent and gets triggered by certain movements or activities. There are several causes of tarsal tunnel syndrome, all of which must be carefully considered during diagnosis.

Some common reasons include:

• Varicose veins
• Soft tissue masses
• Ankle injuries
• Structural deformities (i.e. flat feet)
• Anatomic abnormalities
• Systemic conditions such as diabetes mellitus

Proper diagnosis starts with a thorough clinical examination. Many times, additional diagnostic studies such as MRI and Nerve Conduction Velocity (NCV) will be ordered.

 

 

Types of Ankle Surgery

 

 

Arthroscopy

Arthroscopy is a surgical procedure in which your specialist will insert a very small camera into a joint in your foot or ankle. The most common place for this to take place is within your ankle joint.

The purpose of this procedure is to help diagnose and treat joint problems. A joint, also called an articulation, is comprised of the ends of two bones that are covered by a smooth, spongy surface called cartilage. The purpose of a joint is to withstand large compressive and loading forces while allowing fluid movement between the two bones.

Utilizing this minimally invasive procedure allows your surgeon to skillfully evaluate the pathology that may be present. Additionally, depending on the severity and type of damage to the joint, you surgeon may be able to perform intervention at the same time as this procedure occurs.

Common conditions that can be diagnosed with arthroscopy include:

• Damaged cartilage Synovitis (inflammation to the tissue surrounding the joint)
• Scar tissue build up
• Loose bone fragments
• Partially or completely torn ligaments
• Osteochondritis Dissecans

There are many benefits to undergoing a joint arthroscopy. In addition to being minimally invasive, patients are typically able to bear weight in a fracture boot right after the procedure is completed unless additional procedures were performed.

The procedure itself usually completed in an hour and patients are often able to go through the post-operative recovery using our unique post-operative pain protocol without any narcotics. Patient satisfaction is generally very high with this procedure.

Often times, your specialist will administer an injection to your joint before the arthroscopy procedure is performed to evaluate how much pain relief is obtained. We typically tell patients that if they experience significant pain relief, we are in the right spot!

Our hope is that this procedure provides long lasting relief but sometimes it is only temporary. The benefit of joint arthroscopy is that it allows us to evaluate your condition, potentially clean up any pathology, and hopefully provide long lasting relief.

 

External Fixation

An external fixator (external fixation) is a device that is applied on the outside of the foot or ankle that provides stability and/or correction. Although the devices have changed over time, the principles and applications have been around for hundreds to thousands of years. There are numerous types and applications for external fixation.

Candidates for external fixation may include:

• Open or severe fractures
• Dislocations
• Limb deformity
• Bone infection (osteomyelitis)
• Joint fusion (arthrodesis)
• Non-unions
• Mal-unions
• Charcot neuroarthopathy
• Brachymetarsal correction

It is vital to have a specialist that has the ability to understand and recommend when external fixation may be necessary. If external fixation has been discussed with your or you think you are a candidate for this procedure, don’t hesitate to contact us today to learn more.

 

Fusion (Arthrodesis)

A fusion (also called arthrodesis) is a surgical procedure that is sometimes performed when conservative treatment measures do not relieve the pain associated with your condition. When the structure of your foot or the cartilage at your joint is damaged, it can lead to severe pain and dysfunction.

A joint, also called an articulation, is comprised by the ends of two bones that are covered by a smooth, spongy surface called cartilage. The purpose of your joints is to withstand large compressive and loading forces while allowing fluid movement between the two bones.

A fusion procedure consists of removing the cartilage from the joint and fixating the two ends of bone together, typically with plates and screws. This, in essence, fuses the two bones together to make “one” bone. The main benefit of this procedure is a very high success rate of alleviating arthritis and pain.

Additionally, fusions are extremely durable and require fewer restrictions. With any surgery, there are potential risks and complications to weigh. Our priority is your health and to spend the time with you to educate you on all the pros and cons.

The most common reason that a fusion procedure is performed is due to arthritis. Arthritis (inflammation to a joint) can affect any joint of the foot for ankle. This typically produces pain, swelling and warmth.

Arthritis can eventually lead to destruction of the joint resulting in:

• Deformity
• Stiffness
• Decreased range of motion
• Inability to ambulate normally

 

There are numerous forms of arthritis. The most common type in the foot is called osteoarthritis.

Other forms of arthritis include:

• Rheumatoid arthritis
• Psoriatic arthritis
• Reactive arthritis
• Septic arthritis Gout

Common reasons for development of osteoarthritis are trauma or underlying biomechanical abnormalities that precipitate increased strain on a joint.

If you are experiencing significant pain or dysfunction, it’s important to visit with our specialists to properly evaluate the severity of your condition. If left untreated, arthritis typically worsens with time.

Diagnosis starts with obtaining X-rays to evaluate the bony architecture of your feet. Advanced imaging studies such as CT or MRI are sometimes recommended after a thorough clinical evaluation is performed.

 

 

There are numerous ankle joint replacement options on the market right now. Our specialists have been trained on many of these systems, which should be a crucial factor when considering a specialist.

We like to tell patients that one shoe size doesn’t fit all, so why should only one ankle replacement system? Each system has their pros and cons and our specialists can discuss which system may be best for your condition.

In addition, not every patient is a candidate for a total ankle surgery replacement, which may be the most important distinction of all. Be sure to talk to with our specialist about our unique post-operative pain protocol.

Incorporating the latest recommendations from surgical and medical literature, our regimen aims to not only reduce post-operative pain but also supports the reduction of swelling while expediting patient’s recovery.

Although not the case for every patient, we have had patients not need narcotics post operatively. Our specialists will also discuss your recovery period and help you understand what expectations should be set.

Our priority is your health and to spend the time with you to educate you on all the pros and cons. We understand that this is a difficult decision, and we are here to help.  Come see our specialists today so we can help take that pain away!

We invite you to click on some of the links and videos below to learn more about some of the total ankle replacement systems on the market.

Trauma and Fractures

Injuries to the foot and ankle can be serious, life-altering events. We understand that this is a challenging time in you and your family’s life and we are here to help. Whether it be a fall, trip, car accident or sports injury, our specialists can expertly diagnose your injury and recommend a proper treatment regimen.

If you have had an injury or suspect you have had an injury, you may be experiencing severe pain, swelling, bruising, tenderness to the touch, difficulty walking or performing activity, throbbing, increased warmth and possible deformity.

Treatment of your condition depends on the location, severity, and timing of the injury. Some trauma and fractures that our specialists commonly see include: ankle fractures (fibular, bimalleolar, trimalleolar, pilon), calcaneal fractures, cuboid fractures, lisfranc fracture/dislocations, Jones fractures, metatarsal fractures, navicular fractures, stress fractures, talus fractures, and toe fracture/dislocations to name a few.

It is important to come see a specialist as soon as possible to get the proper evaluation and treatment. If left untreated, it could lead to significant debilitation and dysfunction! Contact Florida Foot and Ankle Specialists for an evaluation on foot and ankle surgery.