Surgeries – Foot & Ankle

FOOT & ANKLE

Ankle arthrodesis (Ankle fusion)

The ankle joint connects the lower end of the leg bones, the fibula and tibia, with the talus bone of the foot. Articular cartilage covers the ends of bones where they come together to form a joint. Ankle arthritis is a joint condition which results from damage and loss of the articular cartilage. It can cause pain, stiffness, deformity, and limited mobility of the joint.

What is an ankle fusion?

Ankle fusion surgery involves the fusion of ankle joint bones to form a single structure. This procedure may be recommended in certain cases of end-stage arthritis where non-surgical treatments have not been successful. The main goals of the surgery are to reduce pain and improve the joint’s functionality. However, it is essential to remember that after the procedure, the joint will be fixed in place, resulting in an inability to bend.

 

How is surgery done?

Your surgeon will make an incision in your ankle to access the joint and remove the damaged bone and cartilage. Bones are carefully positioned and secured with screws, plates, or other metal implants to promote fusion into a single, combined bone. In selected cases, ankle fusion can be performed using a minimally invasive technique called Arthroscopy (see Ankle arthroscopy).  At the end of the procedure, the wound is closed with sutures(stitches) and a splint/boot is applied.

What’s the recovery time for ankle fusion surgery?

Ankle arthrodesis is one of the foot and ankle surgeries with the longest recovery time. It is extremely important that you rest and keep your foot elevated for a couple of weeks. You will be non-weight bearing for the first 6-8 weeks, and after this period you will be weight-bearing with a walker/fracture boot unless instructed otherwise by your doctor.                        Patients usually return to their usual activities around 4-6 months after surgery. However, it might take up to 12-18 months for maximum benefits to be achieved.

Ankle arthroscopy

What is ankle arthroscopy?

Ankle arthroscopy is a minimally invasive surgery that uses a tiny camera and pencil-sized instruments to examine or repair the tissues inside your ankle.

 

How is ankle arthroscopy done?

Instruments are inserted through small incisions (portals) which causes less trauma to the skin and soft tissues. Your surgeon uses a special tool called an arthroscope that comes equipped with a camera and sends the image to an external monitor. This allows the surgeon to view the inside of your ankle and make any necessary repairs with the help of other tiny surgical instruments.

Why Is the procedure performed?

Ankle arthroscopy might be recommended for patients experiencing the following ankle problems:

  • Cartilage injuries – if you’ve suffered cartilage injuries, a surgeon can diagnose and treat your condition.
  • Impingement – tissues in your ankle can become inflamed and painful from overuse. Surgeon can remove the damaged tissue.
  • Synovitis – when the lining of the joint becomes inflamed. The damaged tissue can be removed arthroscopically.
  • Arthritis – patients with end-stage arthritis may need an ankle fusion. In some cases, ankle fusion can be done by arthroscopy.
  • Loose bodies – “loose bodies” refer to fragments of detached cartilage or bone that may be present inside the joint. These fragments can be effectively removed through arthroscopy.
  • Unexplained ankle symptoms – during arthroscopy, surgeon may diagnose conditions that were not detected by imaging tests.
  • Infection – in certain situations, septic arthritis or joint space infection can be addressed using arthroscopy as a treatment option.

How is the recovery after an arthroscopy?

It depends on the type of surgery and your condition. But compared to open surgery, you will experience less pain and faster wound healing. Patients can expect pain and swelling following surgery which can be managed with the elevation of the leg, oral pain medication and cold therapy (ice therapy). Your surgeon will guide you through this process.

Hallux valgus (Bunion)

The hallux is the scientific name for the big toe. Hallux valgus is a condition in which the big toe migrates laterally toward the lesser toes. A bunion is a painful bump that develops on the inside of the foot at the big toe joint. Patients may also have limited joint mobility and swelling.

What is bunion surgery?

Bunion surgery, sometimes called a bunionectomy, is a surgical treatment to correct bunions. The goals are to relieve pain and improve function. Several different techniques can be performed. It may be needed an osteotomy (bone cut) and/or an arthrodesis (joint fusion) to promote realignment of the big toe and implant materials like metal plates, screws and wires can be used.

What is the recovery process after bunion surgery?

Weight-bearing will depend on what type of procedure is being done to correct your bunion. Usually, right after the surgical procedure, you will be heel weight-bearing as tolerated. You will wear a splint/boot and may use a walking device for your comfort. You should not drive for about 2 months if your right foot was operated on. If it was your left foot, you can drive as soon as you are comfortable and out of the boot. After 6 to 12 weeks, you will start to regain foot function. Patients usually return to their usual activities around 3 months after surgery.

Hallux rigidus (Stiff big toe)

The hallux is the scientific name for the big toe. The big toe joint that connects the head of the first foot bone (metatarsal) with the base of the first toe bone (proximal phalanx) is called the first metatarsophalangeal (MTP) joint. In the MTP joint, as in any joint, the ends of the bones are covered by articular cartilage.

What is a ‘stiff big toe’?

Hallux rigidus is arthritis of the first MTP joint. There is damage and loss of articular cartilage. It is the most common arthritic condition in the foot and can make walking painful and difficult.

Will I need surgery for a ‘stiff big toe’?

If you still have pain, stiffness or walking is painful after non-operative measures, you are a candidate for surgery.

What is done in ‘stiff big toe’ surgery?

Several different techniques can be performed, and the surgeon will decide the type of operation based on your case. It may be needed an osteotomy (bone cut), a cheilectomy (bone spurs removal), and/or an arthrodesis (joint fusion). Implant materials like metal plates, screws and wires can be used. It usually takes 1 to 2 hours.                                                  Most of the surgeries are outpatient procedures, meaning you can go home the same day as the surgery.

Total ankle replacement

The ankle joint connects the lower end of the leg bones, the fibula and tibia, with the talus bone of the foot. In the ankle joint, as in any joint, the ends of the bones are covered by articular cartilage. Ankle arthritis is a joint condition which results from damage and loss of the articular cartilage. It can cause pain, stiffness, deformity, and limited mobility of the joint.

What is Total ankle replacement surgery?

Total ankle replacement is a type of joint replacement surgery. It is usually performed as a treatment for end-stage ankle arthritis. Also called Total ankle arthroplasty, may be indicated in selected cases, especially when the non-operative treatment has failed. The main goals of ankle replacement surgery are to relieve pain and improve ankle function.

How is surgery done?

Your surgeon will make an incision in the front of your ankle to access the joint and remove the damaged bone and cartilage. The next step is to replace the damaged parts of your tibia and talus bones with artificial components (prosthetic components) made of metal and plastic. At the end of the procedure, the wound is closed with sutures(stitches) and a splint/boot is applied.

How long is recovery after Total ankle replacement?

You will be non-weight bearing for the first 2 to 4 weeks, and after this period you will be full or partial weight-bearing, depending on the surgeon’s preference, with a boot unless instructed otherwise by your doctor.                                                  Patients usually return to their usual activities around 3-4 months after surgery. However, it might take up to 12-18 months before engaging in low-impact activities such as swimming, dancing and cycling.

Foot & ankle – Trauma surgeries

Achilles tendon rupture (tear)

The Achilles tendon is the strongest and largest tendon in the body. It is located at the back of the ankle and connects the calf muscles with the heel bone. A rupture of the tendon is a tearing and separation of the tendon fibers so that the tendon can no longer perform its normal function. The injury has long-lasting consequences and may affect your ability to walk, jump and run.

How is a ruptured Achilles tendon treated surgically?

The type of surgery will depend on the location, the amount of damage to the tendon and whether it is an acute or chronic injury.  The surgeon stitches the two ends of the torn tendon back together which can be done with one large incision (open surgery) or a few smaller incisions (percutaneous surgery). If the tendon is badly torn, a tendon transfer may be necessary.                                                                                                                                                                                            Talk to your doctor to determine the best surgical technique for your case.

What happens after Achilles tendon surgery?

Immediately after surgery, you will be wearing a cast or splint to keep your foot and ankle immobilized as you heal. After your first postoperative visit, it may be switched to a boot. You will need a walking device (crutches, walker, knee walker, wheelchair, etc) to help you avoid putting weight on your foot. It’s a long rehabilitation process. A physiotherapist can help you strengthen your leg muscles and regain mobility in your ankle. The Physio team will also help you with balance exercises. Daily activities are usually resumed after 4-5 months. Patients usually can return to full activity in 8-12 months.

Ankle fracture (Broken ankle)

The ankle joint is composed of the end of the tibia and fibula, and talus bone: the tibia (shinbone) which forms the inside, or medial portion of the ankle; the fibula (smaller, thinner bone in your lower leg) which forms the outside, or lateral portion of the ankle; and the talus underneath. 

Why do I need surgery for an ankle fracture?

A broken ankle may require surgery if the ankle is unstable and the broken bone is displaced, or not well aligned.

What happens during surgery?

Your surgeon makes one or two incisions to access your broken bones and put them back in place, that’s called reduction. The broken bones are kept in the right position using specialized metal hardware such as plates, screws, or nails. An X-ray is done to ensure the bones are in the correct position as well as the hardware.  At the end of the surgery, the wound is closed with sutures (stitches) and a cast/splint is applied.

Will I need a walking device?

Yes, you will. In the postoperative period, a walking device (crutches, walker, wheelchair, knee scooter) is needed because you will be non-weight-bearing for a few weeks.

What is the recovery process after ankle fracture surgery?

Sutures are removed on the first postoperative visit, and you may be placed into a removable boot. It usually takes about six weeks for bones to heal; only after that period will you be allowed to start bearing weight. Physiotherapy will help you strengthen your leg muscles and regain mobility in your ankle.                                                                                                              Patients feel comfortable performing daily activities usually after 4-6 months. However, full recovery can take more than a year after the procedure.